Taking Your Qualitative Research to the Next Level: A Guide for the Medical Educator (2024)

PMCID: PMC6001821

Nancy C. Schneider,¹ Wendy C. Coates, MD,^2,3 and Lalena M. Yarris, MD, MCR⁴

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^aReaders may use these suggestions to generate new studies. The authors request that this paper be referenced in the resultant work.

Grounded Theory

The most commonly used paradigm for qualitative research is grounded theory.10 Grounded theory today resides in a gray area between the constructivist and postpositivist epistemologies. The term “grounded theory” comes from the idea that theories arise from data and that it is up to the researcher to recognize the emergent theories and analyze their significance, rather than to test and verify existing theories. If theories are grounded in the data, the researcher cannot lend his or her own prejudices and assumptions to the data gathering process because the theories exist within the data are and just waiting to be uncovered by the researcher; however, it is the researcher's subjective interpretation of the data that allows him or her to determine if and when a new theory has arisen. Researchers must thus be mindful of which epistemology they identify with as well as the impact of their personal backgrounds on their projects. Although grounded theory research can be undertaken by a single researcher, she or he must be especially reflective and creative during the analysis process. It is beneficial to have multiple collaborators (including those from different academic backgrounds) to include a variety of perspectives in the analysis.

The fundamental characteristics of any grounded theory research project are an iterative process of data gathering, a systematic coding scheme applied to the data, and the use of theoretical sampling. The iterative process allows data gathering and analysis to happen simultaneously so researchers can identify avenues that must be explored further and seek explanations for unexpected results. Data are organized into key conceptual areas or themes (coding). Analysis is the creation of conceptual theories from these categories. Researchers can take notes throughout the data collection and analysis stages of a project to recall their initial impressions while writing the manuscript. To demonstrate the rigor of a grounded theory project, researchers must show how the coding process emerges from the data rather than being predetermined and “imposed” on the data. Hypotheses generated from the conceptual theories that emerge from qualitative studies can later be investigated using quantitative (hypothesis testing) methods to determine their practical scope and magnitude.

The true value of a grounded theory study is to contextualize the findings within the big picture. Studies must also contain a “creative element” to truly develop a theory. It is beneficial for researchers to continually ask and confidently answer the question, “Why is this important?” to not lose sight of the big picture. The generation of theory cannot occur in isolation; rather, it requires an open‐mindedness that must coexist with a knowledge of existing theoretical perspectives to consider how new data may complement or offer alternate explanations to related studies.

Ethnography

Ethnographic studies use culture as the lens through which to interpret data. Ethnographers seek to understand a social organization from within,10 generally conducting research by participating by inserting themselves into the subjects’ reality for a period of time.2, 3 While this paradigm has its roots in anthropologic studies of remote cultures, we now employ it to include the social culture of a communal activity.8 For example, an ethnographer may seek to answer a question by examining the culture of a specific, but diverse, group of individuals, such as children in Sacramento, members of the European Parliament, Crossfitters, or classic car enthusiasts. Each of these is called a life world. Obviously, a subject may be a classic car enthusiast and participate in Crossfit classes; however, neither of the first two life worlds are relevant to a researcher seeking to understand how the competitive environment in a Crossfit gym might lead to injuries related to overtraining. Institutional ethnography refers to studying the rules and norms that govern everyday practices and interactions, for example, the effect of a set of teaching guidelines imposed by university administration on the level of engagement between students and professors within a classroom.

Ethnography is a distinctively constructivist endeavor that relies on the social construct that people and their communities have meaning and are constantly evolving.11 Ethnographic studies generally consist of a combination of observation, document analysis, and spontaneous interviews with field contacts. While interviews are not distinctly formal, they rise above the level of a casual conversation. Consent is required and subjects must be informed that the interaction will be included as data. This situation also differs from a formal interview because it is generally the result of ongoing communication and interaction between the researcher and the field contact. Data gathered by ethnographers is unstructured and flexible, which requires researchers to be experts in several methods of data gathering.2, 3 Ethnographers can collect data through observation, casual interviews, and document analysis. Unlike focused observation (discussed below), there is less likelihood that the researcher will affect the subjects. Where formal interviews may be influenced by the Hawthorne effect, subjects in an ethnographic study are under ongoing observation, which makes it easier to discern true habits from showmanship.

Researchers must always be conscious of context when analyzing data; ethnographic studies are culturally relative. Actions and events must be considered in the context of the local culture and researchers must refrain from imposing their own cultural judgments or considering the observations in relation to society at large.11 At the same time, the researcher as an outsider is able to identify the wealth of unique knowledge possessed by the members of a community that was gradually and subconsciously acquired throughout the socialization process of that community. Like other methodologies, saturation is reached when the researcher is “no longer gathering significant new information” about his or her subject. However, ethnographic studies, due to their long‐term nature, rarely reach true saturation before time and budget constraints force an end to the data gathering.11

Phenomenology

Similar to grounded theory, phenomenology is used when researchers are seeking new information rather than testing existing theories. Similar to ethnography, phenomenology is concerned with everyday occurrences. Phenomenologic studies allow researchers to “understand everyday experiences without presupposing knowledge of those experiences” and therefore the phenomena being studied are separate from reality.12 This idea traces back to Plato's cave, where the shadows on the wall are separate from the people casting them, but the reality experienced by those in the cave is confined to the existence and activities of the shadows. The concept of a phenomenon is drawn from Immanuel Kant's idea that what occurs in the human mind is separate from reality and imperceptible by the senses. Essentially, phenomenologic studies seek to understand people's emotional reactions and responses to a particular event or situation.

Phenomenology has two major theoretical approaches that researchers can utilize. Descriptive phenomenology is a postpositivist endeavor, in which human experience and reality are distinct entities and the goal of the researcher is to separate his or her preconceived ideas from the experiences of others to describe the essence of a phenomenon. Interpretive phenomenology is a constructivist endeavor, in which humans exist in the world they interpret and the researcher is concerned with how he or she relates to the phenomenon because it is impossible to separate perception from self.

Phenomenologic studies lend themselves well to gathering data from focus groups because the group interactions allow the researcher to gain insight into how people make meaning from their experiences.13 The interaction between people who have shared a similar experience can give a research team information answers to questions they would not have otherwise thought to ask. However, individual interviews allow a researcher to delve deeper into particular experiences and extract detailed responses that would otherwise be unavailable in a group setting. As this type of study is particularly reflexive, it is imperative for the researcher to thoroughly understand his or her own perceptions of a particular phenomenon, although the greatest challenge to phenomenologic research is that it is impossible for a researcher to fully divorce his or her own perception from either an objective reality or the reality experienced by the subjects.

Interviews

The interview is the most cognate method between qualitative and quantitative studies. Its sibling is the survey, distributed anonymously with fixed answer choices. Both are intended to explore participant perceptions. Interviews are characterized by their open‐ended questions that allow for diversity and elaboration of answers. Construction of interviews should include diverse points of view and they should be read aloud to individuals who are similar to the intended subjects for clarity and process.14 Interviews are classically conducted in person, but this style of data gathering also includes open‐ended surveys. While quantitative surveys and qualitative interviews are capable of asking the same questions, the interview provides deeper, more detailed answers and allows for further development of thoughts and responses. The drawback of conducting interviews is that they are more time consuming and expensive than a fixed survey‐based study.15

An effective interview should seem, to the subject, to be an intimate yet focused conversation. Questions should be broad and a combination of set probes and spontaneous follow‐ups.1, 10 Beyond this, the researcher should allow the conversation to flow naturally rather than simply moving down a list of questions. A conversation allows the subject to feel comfortable expressing an opinion and provides opportunities for the subject to bring up ideas or experiences that may not have been previously considered by the researcher. It is perhaps easiest to determine when saturation has been reached in interview‐based studies because their probing, elaborative nature allows researchers to determine when no new ideas are being gathered.

An interview is perhaps the most direct way for a researcher to understand particular outlier cases. The individual nature of interviews allows researchers to recruit others whose experiences may constitute a pocket of a phenomena that may not have been indicated by an individual outlier that presented with random sampling. Unlike quantitative studies that generally disregard outliers as irrelevant to the data set at large, qualitative researchers are much more interested in the presence of outliers and the series of events that lead to these situations. The interview allows the researcher to ask directly about the subject's thoughts, feelings, and experiences that may have contributed to an atypical outcome.

Observation

Observation seems to be the most passive and intuitive form of data gathering, yet it is complex with a whole range of situations and ethical considerations that a researcher must be mindful of to conduct a meaningful study. Observation allows researchers to analyze a social reality from an external perspective, rather than trusting interviewees to truthfully and accurately describe their experiences. Observation gives the researcher the unique opportunity to utilize all five senses to construct a complete picture of the environment being studied. A special challenge of observation is that people frequently behave differently if they are aware that they are being observed. The researcher must take care to integrate into the environment so as not to influence the actions of the observed. Another challenge of observation is that it can be difficult to gain access to the particular environment you would like to observe, whether because the interactions you hope to observe happen infrequently or because your research team is limited by working hours and funding. For this reason, a thorough understanding of the environment is necessary to successfully conduct an observational study.

Like all qualitative projects, gathering data by observation is an iterative process. This can be broken down into three stages. First, observations should be descriptive, giving researchers a general overview of the surroundings. Next, researchers should focus their observation on the details that are relevant to the research question. Finally, they can purposively select particular phenomena or interactions to observe to expand specific knowledge. Diversity contributes a wealth of knowledge that is inaccessible to any unilateral undertaking. Observational studies especially benefit from a diverse research team because our own personal realities cause us to notice and miss details that might be significant or irrelevant to someone who inhabits a different social reality. At the very least, an observational team should be mixed gendered to capture the two largest subsets of social reality.

A unique challenge for observational studies is determining how to uphold ethical guidelines without compromising a study. In small or intimate settings, it is necessary for an observer to gain consent from all of the subjects; however, this is not necessary in high‐traffic public areas. For example, if you are observing behaviors in a shopping center or park, it is neither possible nor productive to seek consent from every single person who passes through. It is thus imperative that the researcher take care to consider the privacy of the subjects while conducting an inherently intrusive study.2, 3

Focus Groups

One of the most commonly used qualitative methods across many disciplines is the focus group.13 Focus groups are chosen when the researcher believes that the whole of a group's experiences contributes more to understanding a social phenomenon than the experience of a single individual.15 Focus groups combine interview and observation techniques to gain insight on a topic from the interactions of a small group of people. As its own method, a focus group is neither an observation nor an interview. It is best applied for situations in which there are differences of opinion toward a topic or where creation or implementation of a plan or policy requires input from a diverse group or to better understand the experiences of a particular subgroup or culture.1 Unlike an observational exercise, in which particular social structures and choices lead people implicitly or explicitly familiar with one another into a researcher's field of vision, focus group members are deliberately chosen by the research team for their perceived experiential contributions to a topic, as well as their relative anonymity within the group.1

The classic focus group consists of six to 10 people who are unfamiliar to each other. Multiple sources claim that eight people is the optimum number for a focus group—this number allows for diversity of perspectives, but is manageable for one person to moderate.2, 3, 13 A criticism of these small groups is that they are likely not representative of the population at large. However, complex research questions are not answered over the course of one focus group session. Here, the iterative process allows the research team the creativity to decide how to probe for information. One option is to build multiple similar groups to gather information until it is clear saturation has been reached. Another option is to build groups that draw from different microcosms concerned with the particular topic to see how their experiences vary, such as a group of students, a group of lecturers, and a group of administrators. Ideally, projects would use multiple focus groups drawn from the various microcosms; however, a team with limited personnel, budget, and/or access to subjects must decide which is the greater priority for his or her individual study.13

The fundamental difference between a focus group and an interview is in the role of the researcher. In an interview, the subject and the researcher interact with one another as the researcher extracts information from the subject—in this case the researcher takes on the role of investigator. In a focus group, the researcher has a far less personal role as the moderator or facilitator of the group discussion because he or she is interested in the interactions that take place between the subjects in response to the researcher's probe for information.13 For this reason, focus groups should not be employed to answer questions regarding sensitive or personal information. In addition to the moderator leading the focus group session, another member of the research team should be a designated observer to pick up on nonverbal reactions to questions and interactions because these can be equally insightful to verbalized responses and often go unnoticed by a moderator trying to divide his or her attention between multiple people at once.13

Document Tracing

Document tracing is one of the least common methods used in qualitative medical education research. This method is used abundantly in the social sciences to track how particular individuals, groups, and governments have changed their ideas, opinions, and practices over time by analyzing policy publications, literature, and correspondence. While not as interactive as the other methods described above, document tracing gives researchers an intimate look at the information that humans have chosen to record. On an individual level, this represents a person's primary perceptions and reactions to the world around them—their hopes, goals, challenges, and failures. Within groups and institutions, subtle and overt changes in phrasing and policy can indicate changing priorities and agendas that can alert a researcher to how and why these changes occurred over time.