letters to the editor
New opportunities in health care education evidence synthesis Martina Kelly,1 Tim Dornan2,3 & Sarah Yardley4
Editor– We would like to join the conversation started by Gordon et al.1 about theoretical and conceptual developments in systematic review by drawing readers’ attention to a suite of qualitative evidence synthesis (QES) methodologies. These, we suggest, offer a toolbox which takes medical educationalists into areas of education in which randomised controlled trials, with their methodological restrictions, cannot go. Qualitative evidence synthesis is: ‘any methodology whereby study findings are systematically interpreted through a series of expert judgments to represent the meaning of the collected work. In [QES], the findings of qualitative studies – and sometimes mixedmethods and quantitative research – are pooled.’2 The number of QES methodologies is increasing and now includes thematic analysis, meta-ethnography, realist synthesis, meta-summary, meta-study and critical interpretative synthesis. They have in common the systematic collection, analysis and interpretation of results from diverse studies. Qualitative evidence synthesis addresses the concerns of Gordon et al.1 by including research
1 Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada 2 Department of Educational Development and Research, Maastricht University, Maastricht, MD, USA 3 Centre for Medical Education, Queen’s University Belfast, Belfast Northern Ireland, UK 4 Consultant in Palliative Medicine, Camden, Islington ELiPSe, UCLH & HCA Palliative Care Team, Central and North West London NHS Foundation Trust, Keele University, Keele, UK
Correspondence: Martina Kelly, Department of Family Medicine, University of Calgary, 3330 Hospital Drive, Calgary, Alberta T2N 2N1, Canada. Tel: 00 1 403 210 6318; E-mail: [email protected]
evidence that is typically disqualified from quantitative-only methodologies. Qualitative evidence synthesis explains phenomena of educational interest by contributing to the development of theory. It identifies consensus, generates hypotheses, and investigates contradictions between studies. The results of QES are ‘greater than the sum of [their] parts’.3 The resultant ‘mid-range’4 theories acknowledge the transient nature of knowledge and invite further investigation. Such theories enable researchers to understand how processes operate in relation to their contexts. Relevant aspects of context include the historical, intellectual and political milieu(s) in which research was conducted. Far from treating the effect of context as a confounder, as a traditional systematic review might do, the exploration of such effects is inherent to QES methodology.3 Qualitative evidence synthesis requires reflexivity on the part of researchers; they critically explore their subjectivity and harness it to enrich their findings.5 This is particularly important when distilling studies from different theoretical schools because researchers need to be aware of different readings of the empirical research under examination. Qualitative evidence synthesis thus expects – and accommodates – ambiguity and intricacy; it involves intentional exploration of assumptions, refutational analysis, and the use of creativity and imagination.6 We do not find it helpful to argue that any methodology is inherently superior to any other one.7 Traditional systematic review is assuredly the best way of answering positivist or quantitative questions about educa-
tional effectiveness. However, questions of effectiveness are not the only ones of interest. Qualitative evidence synthesis widens the field by allowing researchers to address questions of a constructivist or exploratory nature.
REFERENCES 1 Gordon M, Vaz Carneiro A, Patricio M, Gibbs T. Missed opportunities in health care education evidence synthesis. Med Educ 2014;48:644–5. 2 Bearman M, Dawson P. Qualitative synthesis and systematic review in health professions education. Med Educ 2013;47:252–60. 3 Thorne S, Jensen L, Kearney MH, Noblit G, Sandelowski M. Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qual Health Res 2004;14 (10):1342–65. 4 Paterson BL, Thorne SE, Canam C, Jillings C. Meta-Study of Qualitative Health Research: A Practical Guide to Meta-Analysis and Meta-Synthesis. Thousand Oaks, CA: Sage Publications 2001. 5 Garside R, Britten N, Stein K. The experience of heavy menstrual bleeding: a systematic review and meta-ethnography of qualitative studies. J Adv Nurs 2008;63 (6): 550–62. 6 Kinn LG, Holgersen H, Ekeland T-J, Davidson L. Metasynthesis and bricolage: an artistic exercise of creating a collage of meaning. Qual Health Res 2013;23 (9):1285–92. 7 Yardley S. Lost in translation: why medical education research must embrace ‘real-world’ complexities. Med Educ 2014;48:225–7.
doi: 10.1111/medu.12566
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 1029
1029
New opportunities in health care education evidence synthesis Martina Kelly,1 Tim Dornan2,3 & Sarah Yardley4
Editor– We would like to join the conversation started by Gordon et al.1 about theoretical and conceptual developments in systematic review by drawing readers’ attention to a suite of qualitative evidence synthesis (QES) methodologies. These, we suggest, offer a toolbox which takes medical educationalists into areas of education in which randomised controlled trials, with their methodological restrictions, cannot go. Qualitative evidence synthesis is: ‘any methodology whereby study findings are systematically interpreted through a series of expert judgments to represent the meaning of the collected work. In [QES], the findings of qualitative studies – and sometimes mixedmethods and quantitative research – are pooled.’2 The number of QES methodologies is increasing and now includes thematic analysis, meta-ethnography, realist synthesis, meta-summary, meta-study and critical interpretative synthesis. They have in common the systematic collection, analysis and interpretation of results from diverse studies. Qualitative evidence synthesis addresses the concerns of Gordon et al.1 by including research
1 Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada 2 Department of Educational Development and Research, Maastricht University, Maastricht, MD, USA 3 Centre for Medical Education, Queen’s University Belfast, Belfast Northern Ireland, UK 4 Consultant in Palliative Medicine, Camden, Islington ELiPSe, UCLH & HCA Palliative Care Team, Central and North West London NHS Foundation Trust, Keele University, Keele, UK
Correspondence: Martina Kelly, Department of Family Medicine, University of Calgary, 3330 Hospital Drive, Calgary, Alberta T2N 2N1, Canada. Tel: 00 1 403 210 6318; E-mail: [email protected]
evidence that is typically disqualified from quantitative-only methodologies. Qualitative evidence synthesis explains phenomena of educational interest by contributing to the development of theory. It identifies consensus, generates hypotheses, and investigates contradictions between studies. The results of QES are ‘greater than the sum of [their] parts’.3 The resultant ‘mid-range’4 theories acknowledge the transient nature of knowledge and invite further investigation. Such theories enable researchers to understand how processes operate in relation to their contexts. Relevant aspects of context include the historical, intellectual and political milieu(s) in which research was conducted. Far from treating the effect of context as a confounder, as a traditional systematic review might do, the exploration of such effects is inherent to QES methodology.3 Qualitative evidence synthesis requires reflexivity on the part of researchers; they critically explore their subjectivity and harness it to enrich their findings.5 This is particularly important when distilling studies from different theoretical schools because researchers need to be aware of different readings of the empirical research under examination. Qualitative evidence synthesis thus expects – and accommodates – ambiguity and intricacy; it involves intentional exploration of assumptions, refutational analysis, and the use of creativity and imagination.6 We do not find it helpful to argue that any methodology is inherently superior to any other one.7 Traditional systematic review is assuredly the best way of answering positivist or quantitative questions about educa-
tional effectiveness. However, questions of effectiveness are not the only ones of interest. Qualitative evidence synthesis widens the field by allowing researchers to address questions of a constructivist or exploratory nature.
REFERENCES 1 Gordon M, Vaz Carneiro A, Patricio M, Gibbs T. Missed opportunities in health care education evidence synthesis. Med Educ 2014;48:644–5. 2 Bearman M, Dawson P. Qualitative synthesis and systematic review in health professions education. Med Educ 2013;47:252–60. 3 Thorne S, Jensen L, Kearney MH, Noblit G, Sandelowski M. Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qual Health Res 2004;14 (10):1342–65. 4 Paterson BL, Thorne SE, Canam C, Jillings C. Meta-Study of Qualitative Health Research: A Practical Guide to Meta-Analysis and Meta-Synthesis. Thousand Oaks, CA: Sage Publications 2001. 5 Garside R, Britten N, Stein K. The experience of heavy menstrual bleeding: a systematic review and meta-ethnography of qualitative studies. J Adv Nurs 2008;63 (6): 550–62. 6 Kinn LG, Holgersen H, Ekeland T-J, Davidson L. Metasynthesis and bricolage: an artistic exercise of creating a collage of meaning. Qual Health Res 2013;23 (9):1285–92. 7 Yardley S. Lost in translation: why medical education research must embrace ‘real-world’ complexities. Med Educ 2014;48:225–7.
doi: 10.1111/medu.12566
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 1029
1029
