Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education

Abstract

Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity.

Conducting research by mixed methods: an autoethnography account of a PhD research in facilities management from a developing country

“…Second, axiological considerations are important to capture the diverse values of the research participants. This is of importance in hospitals where FM services delivery encompasses multiple players (Kelly et al , 2018). Finally, given the fact that the anticipated framework from the study is useful for health-care policy formulation and implementation, integrating the qualitative and quantitative data was essential to develop a robust knowledge base on health-care performance measurement as suggested by Hargreaves et al (2007) and Buttigieg et al (2017).…”

Meta-Study

“…The first of which is the flip side of the first strength of the meta-study approach outlined above. The more diverse a sample of literature becomes, the more diluted the findings of a meta-study may become (Kelly et al, 2018). For the most part, this issue will depend upon the aims of the meta-study.…”

Attending to the logics of inquiry

“…Combining different logics of what kinds of data are being reviewed and the different logics of how the data might be reviewed can be used to create a contingency table where potentially nine distinct review methodologies might be mapped out (A-J)-abstracted fromKelly et al (2018) …”