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

A Qualitative Review of Patient Feedback for the OPAT (Outpatient Antimicrobial Therapy) Service in Bristol

Outpatient parenteral antimicrobial therapy (OPAT) aims to deliver intravenous antimicrobials to medically stable patients with complex infections outside of a hospital setting. There is good evidence to demonstrate the safety and efficacy of OPAT in the literature. Anecdotally, the feedback from patients has been positive, but only a few studies evaluate this topic in detail. The aim of this qualitative study was to examine patients' experiences with and feedback on the OPAT service in Bristol, United Kingdom, which was established in 2021. A total of 92 patient feedback surveys were reviewed retrospectively, and thematic analysis was undertaken. Feedback from OPAT patients in our centre was overwhelmingly positive. The key themes identified were benefits to the patients, their friends, and family, and positive feedback about OPAT staff. The mean overall satisfaction score for OPAT was 9.6 out of 10. Areas to improve included communication between the OPAT and parent teams, improving OPAT capacity, and expansion of the service.

Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters

BACKGROUND

The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR.

METHODS

We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation.

RESULTS

The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators.

CONCLUSION

Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.

Curated collections for educators: Nine key articles and article series for teaching qualitative research methods

Background

Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level.

Methods

We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research.

Results

We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study.

Conclusions

While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.

Qualitative research in pediatric urology

INTRODUCTION

Qualitative studies have become increasingly common in the pediatric urology literature due to their ability to enhance our understanding of physicians' and patients' preferences, attitudes, and beliefs. The pediatric urology literature currently lacks clear guidelines for reporting qualitative research. In their absence, it is challenging to judge the quality of these studies.

OBJECTIVES

The objectives of this educational article are to define what is involved in rigorous qualitative research studies, help readers recognize high-quality qualitative research, and provide practical skills in designing and implementing qualitative research.

RESULTS

Acknowledging researcher biases, taking steps to reduce bias and increase reflexivity, and clear descriptions of research and data collection methods all contribute increased rigor and trustworthiness of qualitative studies. Proper selection of qualitative methodology, derived from the research question to be answered, establishes a foundation for reliable and meaningful data.

CONCLUSION

As the field continues to grow, the standardization of reporting of these essential parameters becomes paramount so readers can gauge how findings can be appropriately applied to clinical practice.

A practical guide for conducting qualitative research in medical education: Part 2-Coding and thematic analysis

An organized and rigorous approach to analyzing qualitative data can yield important insights into the intricacies of human behavior and can answer "how" and "why" questions. One process of coding interview responses from study subjects using grounded theory with a constructivist approach is outlined and applied to an example study. The emergent themes can provide insight to medical educators to create interventions that optimize the learning environment. For researchers, they may generate hypotheses to study by quantitative analysis.

Leveling the field: Development of reliable scoring rubrics for quantitative and qualitative medical education research abstracts

BACKGROUND

Research abstracts are submitted for presentation at scientific conferences; however, criteria for judging abstracts are variable. We sought to develop two rigorous abstract scoring rubrics for education research submissions reporting (1) quantitative data and (2) qualitative data and then to collect validity evidence to support score interpretation.

METHODS

We used a modified Delphi method to achieve expert consensus for scoring rubric items to optimize content validity. Eight education research experts participated in two separate modified Delphi processes, one to generate quantitative research items and one for qualitative. Modifications were made between rounds based on item scores and expert feedback. Homogeneity of ratings in the Delphi process was calculated using Cronbach's alpha, with increasing homogeneity considered an indication of consensus. Rubrics were piloted by scoring abstracts from 22 quantitative publications from AEM Education and Training "Critical Appraisal of Emergency Medicine Education Research" (11 highlighted for excellent methodology and 11 that were not) and 10 qualitative publications (five highlighted for excellent methodology and five that were not). Intraclass correlation coefficient (ICC) estimates of reliability were calculated.

RESULTS

Each rubric required three rounds of a modified Delphi process. The resulting quantitative rubric contained nine items: quality of objectives, appropriateness of methods, outcomes, data analysis, generalizability, importance to medical education, innovation, quality of writing, and strength of conclusions (Cronbach's α for the third round = 0.922, ICC for total scores during piloting = 0.893). The resulting qualitative rubric contained seven items: quality of study aims, general methods, data collection, sampling, data analysis, writing quality, and strength of conclusions (Cronbach's α for the third round = 0.913, ICC for the total scores during piloting = 0.788).

CONCLUSION

We developed scoring rubrics to assess quality in quantitative and qualitative medical education research abstracts to aid in selection for presentation at scientific meetings. Our tools demonstrated high reliability.

A practical guide for conducting qualitative research in medical education: Part 3-Using software for qualitative analysis

The process of performing qualitative analysis can be a daunting task. Technology can be employed to ease the burden of the work; however, the researcher may not fully appreciate how and when computer software can assist in conducting qualitative analysis. In this, the third installment of our "how-to" series on qualitative research methods, we describe basic concepts and approaches to using both simple word processing programs and specific qualitative research software programs to assist in coding and analysis. We hope that the concepts put forth in this paper will help qualitative researchers become more familiar with available technological approaches and that they will, in turn, enhance the efficiency of the research process as well as the depth, clarity and richness of research findings.

Research Pioneers in Emergency Medicine-Reflections on Their Paths to Success and Advice to Aspiring Researchers: A Qualitative Study

STUDY OBJECTIVE

Research in basic, translational, and clinical emergency medicine has made great strides since the formalization of emergency medicine as a specialty. Our objective is to identify and analyze strategies used by emergency medicine research pioneers to inform further advancement of research in emergency medicine, particularly for aspiring researchers and those in emerging areas, using emergency medicine medical education as one example.

METHODS

This was a prospective, grounded-theory, qualitative study, using a constructivist/interpretivist paradigm. Leading basic science, translational, and clinical emergency medicine researchers who completed residency before 1995 were eligible for structured interviews. Thematic coding followed an iterative process until saturation was reached. A theoretic model was developed and analyzed.

RESULTS

Research pioneers valued advanced methodological training and mentorship. Barriers to funding were lack of recognition of emergency medicine as a specialty, absence of a research history, and lack of training and funding resources. Deliberate interventions to improve emergency medicine research included educational sessions at national meetings, external (to emergency medicine) mentor pairings, targeted funding by emergency medicine organizations, and involvement with funding agencies. Pioneers facilitate research excellence by serving as mentors and allocating funds or protected time to develop researchers. To advance emerging subfields of research in emergency medicine, pioneers recommend advanced methodological training that is specific to the area, deliberate mentorship, and the formation of research consortia to conduct generalizable outcomes-based studies.

CONCLUSION

Research pioneers in emergency medicine cite mentorship, advanced skills obtained through fellowship or graduate degrees, deliberate collaboration with experienced researchers, support from emergency medicine organizations, and forming networks as the cornerstones of success.

A Qualitative Analysis of Patients' Perceptions of Shared Decision Making in the Emergency Department: "Let Me Know I Have a Choice"

BACKGROUND AND OBJECTIVES

Despite increasing attention to the use of shared decision making (SDM) in the emergency department (ED), little is known about ED patients' perspectives regarding this practice. We sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients' desired level of involvement and what barriers and facilitators patients find most relevant to their experience.

METHODS

We conducted semistructured interviews with a purposive sample of ED patients or their proxies at two sites. An interview guide was developed from existing literature and expert consensus and based on a framework underscoring the importance of both knowledge and power. Interviews were recorded, transcribed, and analyzed in an iterative process by a three-person coding team. Emergent themes were identified, discussed, and organized.

RESULTS

Twenty-nine patients and proxies participated. The mean age of participants was 56 years (range, 20 to 89 years), and 13 were female. Participants were diverse in regard to race/ethnicity, education, number of previous ED visits, and presence of chronic conditions. All participants wanted some degree of involvement in decision making. Participants who made statements suggesting high self-efficacy and those who expressed mistrust of the health care system or previous negative experiences wanted a greater degree of involvement. Facilitators to involvement included familiarity with the decision at hand, physicians' good communication skills, and clearly delineated options. Some participants felt that their own relative lack of knowledge, compared to that of the physicians, made their involvement inappropriate or unwanted. Many participants had no expectation for SDM and although they did want involvement when asked explicitly, they were otherwise likely to defer to physicians without discussion. Many did not recognize opportunities for SDM in their clinical care.

CONCLUSIONS

This exploration of ED patients' perceptions of SDM suggests that most patients want some degree of involvement in medical decision making but more proactive engagement of patients by clinicians is often needed. Further research should examine these issues in a larger and more representative population.