Metaphor theory in qualitative inquiry: A research journey Charlotte E. Rees Office of Postgraduate Medical Education, Sydney Medical School

Presentation aims to: Demonstrate how a cognitive linguistics theory of metaphor informed the construction of post-hoc research questions How the theory informed the analysis of focus group data Discuss the strengths and challenges of employing theory-based analysis

The research journey Patient involvement in medical education study (06/04-11/05) A priori RQ: What are the views and experiences of multiple stakeholders about patient involvement in medical education? Conducted 8 focus group discussions with medical students, medical educators (incl. doctors) and patients Conducted framework analysis to consider what participants said and how they said it (1) Important process-related theme identified was participants’ metaphoric talk… so what? Enter theory

Cognitive linguistics theory of metaphor (2) Metaphors are ubiquitous in everyday talk (2) They structure our thinking and behavior (2) Understanding people’s metaphoric talk can reveal how they conceptualize themselves, their relationships with others and educational processes

Conceptual metaphors Metaphor involves understanding an abstract domain (target) in terms of another, more concrete domain (source) e.g. ARGUMENT AS WAR (2) “Your claims are indefensible. He attacked every weak point in my argument… He shot down all my arguments (2, p. 4)

How did the theory help? Theory helped us construct an original research question: What conceptual metaphors underpin stakeholders’ talk about student/doctor-patient relationships? Theory helped us determine how we should re-interogate our data: Systematic metaphor analysis (3)

Systematic metaphor analysis (3) Determine target area for metaphor analysis (student, doctor, patient, S-P relationship, D-P relationship) Unsystematic collection of background metaphors (e.g. paternalism, consumerism etc.) Identify and code all MLEs pertaining to target domain e.g. consumers, real gems Identify metaphorical concepts associated with each MLE e.g. PATIENT AS CONSUMER (n=70) Group majority of conceptual metaphors into six higher-order metaphors relating to relationships

STUDENT/DOCTOR-PATIENT RELATIONSHIP AS: WAR “she is terrified she will be struck off his list” HIERARCHY “As you were saying about doctors being up there and we being down here” DOCTOR-CENTREDNESS “We keep it as a closed shop” MARKET “Well, we’re the customer, aren’t we?” MACHINE “They become like robots” THEATRE “You can actually see the different performances” (4)

A long and difficult journey We were novices, trying to understand new theory and we misinterpreted some of the theory and analysis Social Science & Medicine sent our paper to a number of reviewers including Schmitt Feedback was positive but Schmitt recommended that we re-analyse our data We eventually re-analysed our data, ing Schmitt regularly for his feedback Our resubmission was eventually accepted (4) We have subsequently liaised with Schmitt on another project (5) What we learnt: to contact scholars for advice/feedback if using their theory or methods… they can be the perfect travel guide and prevent you from getting lost

Strengths Theory helped us construct an original research question It lead to us employing a rigorous method of analysis, novel to medical education research It helped us yield results that extended beyond the context of the medical school where we collected data Now we have learnt this theory-based analysis, we have employed it for a subsequent study efficiently (5)

Challenges By employing one theory you invariably preclude another theory By making theory explicit, restrictions can be placed on where you disseminate your research How can we bridge the theory- practice gap? How can we go beyond using theory; instead creating theoretical and methodological innovation?

Acknowledgements The study team included a mixture of theoretical and practically-orientated researchers e.g. Lynn Monrouxe, Clare Wilkinson etc. This patient involvement study was funded by the British Academy (LRG-37523)

References 1.Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: A Bryman, RG Burgess (Eds.) Analyzing Qualitative Data. New York: Routledge; Lakoff G, Johnson M. Metaphors We Live By. London: The University of Chicago Press; Schmitt R. Systematic metaphor analysis as a method of qualitative research. The Qualitative Report 2005;10: Rees CE, Knight LV & Wilkinson CE. “Doctors being up there and we being down here”: a metaphorical analysis of talk about student/doctor-patient relationships. Social Science & Medicine 2007;65: Rees CE, Knight LV, Cleland JA. Medical educators’ metaphoric talk about their assessment relationship with students: “You don’t want to sort of be the one who sticks the knife in them”. Assessment & Evaluation in Higher Education 2008, doi: /