November 30, 2019, by Stevie Agius
The power of stories
Dr Stevie Agius, Assistant Professor of Medical Education at The University of Nottingham
In last month’s blog, Rebecca McConnell wrote about her new role as a Clinical Associate Professor at the University of Nottingham. Her reflections on imposter syndrome struck a chord with me, although for perhaps slightly different reasons. I have worked in medical education for over twenty years, largely as a researcher although latterly, since joining the team at Nottingham, the primary focus has shifted (for a while at least) to teaching and learning.
Although I cannot now imagine a more rewarding career, it is not one which I set out to establish as a young English Literature graduate in the early 1990s when my skill set hinged upon the close reading, analysis and interpretation of literary texts. What on earth was an arts graduate doing meddling in the world of medical education? I asked myself the question time and again when I first started working in the Department of Postgraduate Medicine at The University of Manchester,
Initially doubting my ability to establish any credentials in this area of scholarship, I remember describing myself to colleagues as a non-clinical cuckoo in their nest. Perhaps that isn’t the best analogy, given the rather malevolent intent of that avian species to their adoptive siblings, but hopefully you get my drift…. With very few exceptions, however, the international community of medical educators which has framed my working life, could not have been more welcoming of what ethnographers might call the ‘non-participant observer’ of the professional cultures they inhabit.
My curious career pathway had led from studying the literary canon (Anglo-Saxon poets and 20th Century polemicists aren’t as different as you might perhaps imagine), to spending my days gathering qualitative data from doctors and the policy makers who shaped their training. Not an obvious career trajectory. With the benefit of hindsight, however, I cannot imagine a better training ground for a qualitative researcher in medical education. At its core, qualitative research is concerned with collecting narratives and doing justice to the narrators in bringing their stories, individual or collective, to a wider audience.
As we approach mid-point in the Autumn semester, our MMedSci Medical Education students are busy designing the research projects which will absorb much of their attention over the next year or so. Many are novice researchers, certainly with regard to the social sciences in which our discipline sits, with little prior experience of aligning novel research questions with paradigms, conceptual frameworks, methodologies and methods of data collection and analysis. Without exception, they are approaching the task with a keen appreciation of the responsibility to enhance understanding of the phenomena they are investigating.
Given their biomedical/clinical backgrounds, a surprising number, year on year, elect to conduct qualitative studies. They are perhaps drawn to the opportunity to observe a medical or healthcare professional culture, to gather stories from those who inhabit and co-create those cultures. Unlike me, they may well bring an ‘insider’ perspective, which affords the possibility of greater understanding and illumination but also of the bias that may be borne of familiarity: challenges which all qualitative researchers must be alert to.
At this time of year, perhaps more than any other, as students embark on new projects, I refamiliarize myself with key methodological developments to better support their endeavours. A work I have read with particular interest is Improving reporting of meta-ethnography: the eMERGe reporting guidance, by France et al. This team of academics based largely at The University of Stirling, has conducted a systematic review as part of an extensive mixed methods study to build consensus around what constitutes best practice in conducting and reporting meta-ethnography. They have built on the work of Noblit and Hare who, in their ground-breaking publication Meta Ethnography: Synthesising Qualitative Studies, established a robust methodology in order to produce new interpretations of qualitative research that transcend the findings of individual studies through contextual analytic synthesis. Anyone interested in the application of qualitative research findings to inform policy development, in healthcare or medical education, may well find these texts worth reading. Stories are powerful things, not least the ones we gather for research purposes.
France, E.F., Cunningham, M., Ring, N. et al. Improving reporting of meta-ethnography: the eMERGe reporting guidance. BMC Med Res Methodol 19, 25 (2019)
Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. California: Sage Publications; 1988.