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

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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.

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Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was made possible by award of a “Mapping the Landscape, Journeying Together” Grant from the Arnold P. Gold Foundation Research Institute.

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Authors and Affiliations

  1. Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada

    Martina Kelly, Rachel H. Ellaway & Heather Ganshorn

  2. Central and North West London NHS Foundation Trust, London, UK

    Sarah Yardley

  3. University College Cork, Cork, Ireland

    Deirdre Bennett

  4. Queen’s University, Belfast, Northern Ireland, UK

    Helen Reid & Tim Dornan

  5. Engineering and Science, University of Calgary, Calgary, Canada

    Heather Ganshorn

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Appendix A: search syntax medline and CINAHL

Appendix A: search syntax medline and CINAHL

Ovid MEDLINE search strategy

  1. 1.

    exp Meta-Analysis as Topic/

  2. 2.

    exp “Review Literature as Topic”/

  3. 3.

    systematic review*.mp. [mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier]

  4. 4.

    1 or 2 or 3

  5. 5.

    (qualitative or interpretive or ethnograph*).mp.

  6. 6.

    4 and 5

  7. 7.

    (critical interpretative synthes#s or ecological triangulation* or grounded formal theor* or meta-ethnograph* or meta-interpret* or meta-narrative* or meta-stud* or meta-summar* or meta-synthes#s or qualitative meta-analys#s or qualitative synthes#s or textual narrative synthes#s or thematic synthes#s).mp.

  8. 8.

    6 or 7

  9. 9.

    (respect* or trust* or kindness or compassion* or altruis* or empath* or humanis* or humane or presence).mp.

  10. 10.

    exp Humanism/

  11. 11.

    exp Empathy/

  12. 12.

    exp Trust/

  13. 13.

    9 or 10 or 11 or 12

  14. 14.

    8 and 13

CINAHL search history

#

Query

S12

(S1 OR S2 OR S3 OR S4 OR S5) AND (S6 OR S7 OR S8 OR S9 OR S10 OR S11)

S11

critical interpretative synthes?s or ecological triangulation* or grounded formal theor* or meta-ethnograph* s or meta-interpret* or meta-narrative* or metanarrative* or meta-stud* or meta-summar* or meta-synthes?s or qualitative meta-analys?s or qualitative synthes?s or textual narrative synthes?s or thematic synthes?s

S10

S8 OR S9

S9

(MH “Meta Synthesis”) OR (MH “Thematic Analysis”)

S8

(S6 OR S7) AND (qualitative OR interpretive OR ethnograph*)

S7

(MH “Meta Analysis”)

S6

(MH “Systematic Review”)

S5

(MH “Altruism”)

S4

(MH “Respect”)

S3

(MH “Trust”)

S2

(MH “Empathy”) OR (MH “Caring+”)

S1

(MH “Humanism”)

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Kelly, M., Ellaway, R.H., Reid, H. et al. Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education. Adv in Health Sci Educ 23, 833–851 (2018). https://doi.org/10.1007/s10459-018-9829-y

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