1. Qualitative Research in Medicine Deepak Dath CORE program in Surgery

2. BACKGROUND Used in the Social Sciences for a long time Felt to be “soft science” by those using quantitative methodology Generally was rare in medicine Gained popularity in the nursing literature Now being embraced slowly in medicine as “real” science

3. Why the lag? Push to EBM –Values numerical data –Values typical EBM research designs –Little previous techniques for determining the quality of the qualitative research design Very time (researcher time) intensive Inertia and unfamiliarity Infrastructure for quantitative research

4. Objectives What is Qualitative Research What are the types of Qualitative Research methodologies Do something to wake up and to ‘feel’ the topic How do we use qualitative research in medicine

5. What is it? Helps to answer questions like –What? –Why? –How? –What does that mean ? Can help generate new theories or hypotheses Helps to generate a deeper understanding of an issue or topic

6. What is it? Inductive vs deductive –Deductive:premise 1 and premise 2 and…. therefore ………. All men are mortal. (major premise) Socrates is a man. (minor premise) Socrates is mortal. (conclusion) –Inductive:fact 1 and fact 2 and … therefore new fact is…. after touching much ice, I can say that all ice is cold

7. What is it? Descriptive Analytical Selective Experiential Begins with broad, exploratory aims that provide a focus for study without pre- empting which aspects of the experience may be deemed important or relevant

8. What is it? When there is a gap in knowledge or when little is known about a particular phenomenon, experience, or concept Researchers study people in natural settings Attempts to make sense of, or interpret the meanings people attribute to their experiences

9. Many types of Quantitative Research Participant observation –Intensive, lengthy Direct observation –Trained observers Unstructured Interviewing –Can be very in-depth and focussed Case studies Focus groups

10. Techniques used in Qualitative Research Interviews Focus groups Surveys Observation

11. Data Analysis Data collected is –Variable i.e. not determined apriori –Written (notes/written comments) or spoken, –Large volume Requires consolidation and summarization according to the researchers’ meaningful interpretation Multiple iterations of data consolidiation

12. Data Analysis Data analysis starts the minute you start collecting data, and affects how and what is collected. –As meaning or interest is generated, the data collection is focused to increase the understanding Grounded theory –Previous concepts Thematic analysis –Previous concepts and emergent concepts used to help collate data

13. Data Analysis Software used to streamline analysis –Categorizes –Links –Summarizes –Compares –Functions as a textual database The actual analysis is the meaning that you interpret/generate from the raw data and the discussion that convinces the reader

14. Data Validation Member checks Triangulation Post-analysis observation Repeat study or observational validation in a different setting to determine generalizability

15. Case #1 Dr. Osteo Blast notices that some patients with arthroscopies do well and others do less well – its just an impression, and he wants to know just what that means and what is involved.

16. Case # 2 Dr. Islets Langerhans wants to know whether the patients who come to see him in consultation leave the office satisfied with the consultation. He is a HPB surgeon who spends a great deal of time describing treatment approaches or discussing cases without surgical options.

17. Case # 3 Dr. Ed Ucator is keen to understand what makes a good operative teacher.

18. Dr. Osteone notices that some patients with arthroscopies do well and others do less well – its just an impression, and he wants to know just what that means and what is involved. Dr. Langerhans wants to know whether the patients who come to see him in consultation leave the office satisfied with the consultation. He is a HPB surgeon who spends a great deal of time describing treatment approaches or discussing cases without surgical options. Dr. Ed Ucator is keen to understand what makes a good operative teacher.

19. Questions How do you need to ask? What design would you use? What instruments do you need? How many will need to participate? How can you disseminate the data?

20. In Summary A technique of research that you need to understand to interpret the results Useful as a first step in understanding a question/process A well-validated science Resources on the web: http://www.socialresearchmethods.net/kb/index.php Poor literature on qualitative research methodology in journals Suggest that if you decide on a qualitative project, you include a qualitative expert in your process at the start.