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Twelve tips for using phenomenology as a qualitative research approach in health professions education
Medical Teacher
Abstract
Phenomenology is a qualitative research approach that seeks to understand the individual meanings of lived experience . This 12 Tips article highlights the importance of understanding the philosophical foundations that inform the choice of phenomenological research study, including descriptive and interpretive phenomenology. The article provides a practical guide to the choice of the most appropriate phenomenological research approach and the process of data collection, iterative data analysis and interpretation, with consideration of the essential aspects of bracketing and reflexivity.
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Background: The nursing education sector has felt the impact of the shortage of nursing clinical instructors (CI) or faculty members. This phenomenon became more profound with the pandemic experience along with the global shortage of nurses in the hospitals.
Objective: The study was conducted to explore the lived experiences on learning among undergraduate nursing students in a higher education institution amidst the nursing faculty shortage.
Methods: The study was undertaken using a descriptive phenomenological design with seven informants, using Colaizzi’s approach for data analysis.
Findings: The findings of the study generated three main themes: disruptions in the learning process and platforms, responses to learning disruptions, and learners’ call to action. It uncovered substantial disruptions in scheduled lectures, activities, and clinical rotations due to the nursing faculty shortage.
Conclusion: The findings underscore the critical need for immediate and comprehensive measures to address the nursing faculty shortage. Despite compensatory efforts by the institution, the impact on learning experience remains significant. This study calls for prompt and effective strategies to rectify the nursing faculty shortage, ensuring optimal learning experiences for student nurses.
Aim
To evaluate the characteristics and methodology consistency in nursing research with descriptive phenomenological design.
Design
Scoping review methodology.
Data sources
Three electronic databases (CINAHL, Embase, PubMed) were systematically searched for qualitative studies with a descriptive phenomenological design published in nursing journals between January 2021 and December 2021.
Review methods
Quality appraisal of each study was conducted using the Critical Appraisal Skills Programme checklist. Data were extracted and presented narratively based on research objective, design justification and consistency, theoretical framework, sampling method and sample size, data collection method, data analysis approach and presentation of findings.
Results
One hundred and three studies were included in the review. Overall, the characteristics of the studies are mostly consistent with Husserl's phenomenology approach in terms of research objectives, the use of other theoretical frameworks, sampling and data collection methods. However, the findings revealed several inconsistencies between research design and data analysis techniques, the lack of design justification and the lack of mention of bracketing.
Conclusions
Apart from the need for more research and standardized guidelines to clarify the various qualitative research methods, future nurse researchers are urged to provide more methodological details when publishing a descriptive phenomenological study so that readers can examine the effectiveness and quality of the method.
Qualitative research relies on nuanced judgements that require researcher reflexivity, yet reflexivity is often addressed superficially or overlooked completely during the research process. In this AMEE Guide, we define reflexivity as a set of continuous, collaborative, and multifaceted practices through which researchers self-consciously critique, appraise, and evaluate how their subjectivity and context influence the research processes. We frame reflexivity as a way to embrace and value researchers' subjectivity. We also describe the purposes that reflexivity can have depending on different paradigmatic choices. We then address how researchers can account for the significance of the intertwined personal, interpersonal, methodological, and contextual factors that bring research into being and offer specific strategies for communicating reflexivity in research dissemination. With the growth of qualitative research in health professions education, it is essential that qualitative researchers carefully consider their paradigmatic stance and use reflexive practices to align their decisions at all stages of their research. We hope this Guide will illuminate such a path, demonstrating how reflexivity can be used to develop and communicate rigorous qualitative research.
Anecdotal evidence suggested that hopelessness and helplessness (HH) were often reported by undergraduate medical students. It is known that medical students are more susceptible to high levels of stress and depression than other student groups. There is currently concern about suicide rates in students and high drop-out rates in junior doctors. But what can be said of HH within this population? This study was aimed at eliciting medical students' experiences of HH. An interpretive phenomenological approach was adopted. Participants were recruited from a single medical school. Loosely structured, audio-recorded interviews were carried out. Recordings were then transcribed verbatim, then underwent an interpretive phenomenological analysis. Three participants were recruited. Their stories report some devastating experiences-ranging from social isolation to homelessness and suicidal ideation. Our cases complement the existing literature. Awareness of the issues raised in these cases may help medical educators to better understand and support others in similar situations. These may also benefit those experiencing HH themselves. We hope that this exploratory project paves the way to further study.
Introduction
As a research methodology, phenomenology is uniquely positioned to help health professions education (HPE) scholars learn from the experiences of others. Phenomenology is a form of qualitative research that focuses on the study of an individual’s lived experiences within the world. Although it is a powerful approach for inquiry, the nature of this methodology is often intimidating to HPE researchers. This article aims to explain phenomenology by reviewing the key philosophical and methodological differences between two of the major approaches to phenomenology: transcendental and hermeneutic. Understanding the ontological and epistemological assumptions underpinning these approaches is essential for successfully conducting phenomenological research.
Purpose
This review provides an introduction to phenomenology and demonstrates how it can be applied to HPE research. We illustrate the two main sub-types of phenomenology and detail their ontological, epistemological, and methodological differences.
Conclusions
Phenomenology is a powerful research strategy that is well suited for exploring challenging problems in HPE. By building a better understanding of the nature of phenomenology and working to ensure proper alignment between the specific research question and the researcher’s underlying philosophy, we hope to encourage HPE scholars to consider its utility when addressing their research questions.
In the UK, changes to the higher education system have increased the range of stressors experienced by students above those traditionally associated with the transition to university. Despite this, there is little qualitative research examining how students experience and cope with the adjustment to university. The experience of the transition was investigated in depth amongst 10 first year UK undergraduates. Purposive sampling resulted in a group with demographics similar to national statistics on UK undergraduates. Semi-structured interviews were used beginning with a content specific vignette to develop rapport. Interpretative phenomenological analysis was utilised to analyse the transcripts and quality checks were implemented to increase the validity of the analysis. Five main themes were identified: all the change, with subthemes of independent living, homesickness, differences between post-compulsory education and university; expectations of university; academic focus with subthemes of self-discipline, motivation, learning from experience; support network with subthemes of establishing a support network, support for coping with problems; and difficulties with subthemes of difficulties experienced with housemates, finances and employment, and academic difficulties. Students used a range of coping strategies.By identifying the role of positive psychological strengths such as optimism, hope, self-efficacy and self-control in coping with stress and facilitating positive adaptation, the study locates positive psychological strengths within a transactional understanding of stress and provides depth and relevance to their role in facilitating adjustment. Such qualitative research is rare in the positive psychology and stress literature. Suggestions for easing the transition are made.
Background:
Interdisciplinary collaboration and communication during dental training has become an increasingly influential idea within dental schools, both in the United Kingdom and European contexts. Research into this curriculum innovation has provided evidence to argue that benefits accrue both in terms of professional understanding and the development of dental professional learning dispositions.
Objective:
This study investigates the interactions within a trainee dental team. In particular, the paper reports the professional experiences and development of trainee dental technicians and undergraduate dental students during a prolonged shared learning exercise in a combined UK university dental school and hospital.
Methods:
Using a qualitative approach with a phenomenological framework, data sources included reflective diaries, focus group interviews and participant feedback.
Results:
Eleven major domains were identified that accurately characterised the participants' beliefs, thoughts and practices. The results indicate that both trainee dental technicians and undergraduate dental students were pragmatic but positive in terms of their expectations of shared learning. In particular, they regarded the exercise as useful in terms of communication and understanding each other's role. Evidence also indicated the presence of original elements such as crisis of confidence and feelings of awkwardness that do not arise in other studies.
Conclusions:
The implications for dental education are that for effective professional collaboration during training to take place a merger of interests among educators and policy developers in dental education must occur, and the challenges encountered within practice cultures must somehow be overcome. Therefore, more investment in evaluating research into interprofessional learning in dentistry would contribute to our knowledge about the place and role of interprofessional education in the professional dental curriculum and beyond.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
This article contributes to the debate about phenomenology as a research approach in nursing by providing a systematic review of what nurse researchers hold as phenomenology in published empirical studies. Based on the assumption that presentations of phenomenological approaches in peer-reviewed journals have consequences for the quality of future research, the aim was to analyze articles presenting phenomenological studies and, in light of the findings, raise a discussion about addressing scientific criteria. The analysis revealed considerable variations, ranging from brief to detailed descriptions of the stated phenomenological approach, and from inconsistencies to methodological clarity and rigor. Variations, apparent inconsistencies, and omissions made it unclear what makes a phenomenological study phenomenological. There is a need for clarifying how the principles of the phenomenological philosophy are implemented in a particular study before publishing. This should include an articulation of methodological keywords of the investigated phenomenon, and how an open attitude was adopted.
In this article, the author explores the uses of poetic forms in qualitative health research, analyzing the matically a poem written from a patient's perspective of being treated in an emergency room. From the themes identified, he created two “research poems” using two formal poetic structures: the French-Malaysian pantoum, and the Japanese-inspired American tanka. The author contextualizes this research through an exploration of the arts and poetry as qualitative research.
Opportunities to learn about education theory underpinning medical education are limited in both undergraduate and graduate medical education and predominantly focus on “student as teacher.” Key components of education theory relevant to medical education, including learning theory, curricular design, and assessment design, are rarely included in student-as-teacher training. Opportunities for medical students to co-create curricula with faculty are scarce.
We present the case study of a month-long, seminar-style course titled, Applications and Foundations of Education in Medical Education. We describe the course, report student feedback, and identify the value of curriculum co-creation expressed in student reflections. The course was designed by a faculty member with formal medical education training; students co-created their own learning outcomes through self-selected articles and personal reflections on the topics: How do people learn; what is the best way to teach; what is a curriculum; and how should students be assessed?
Forty-seven post-clinical students completed the course; 28 completed course evaluations. They strongly agreed that the class met its stated goals (4.89/5) and that faculty teaching (4.93/5) and supervision (4.93/5) were appropriate. Themes from student reflections expressed that the co-creation process was insightful about the profession itself, from the perspective of their own participation in learning how to become a member of the profession.
This course offered a unique opportunity for medical students to learn medical education beyond the skill of teaching. The course allowed deep immersion into current literature and offered the chance to plan and execute one’s own learning.
The conceptualisation of “good” medical education research as hypothesis testing to identify universal truths that are generalisable across contexts has been challenged. Joining this conversation, the field of health professions education research is complex and contextual and there are ways of examining and reporting locally based activities and innovations which can be of general value. This position leads to a focus on case study research (CSR); inquiry bound in time and place that generates thick descriptions and close interpretations to reach explanations. CSR has grown in sophistication in recent years and can inform practice and advance the science of medical and health professions education. The authors evaluated the current state of the science of CSR in the medical education literature by identifying and reviewing 160 papers. Most articles presented as “case studies” were not in fact CSR. Moreover, most articles failed to go beyond a ‘we did this’ account. The authors explore definitions of CSR, they examine dominant CSR methodologists, Yin, Stake and Merriam, and their respective approaches to CSR. They then set out some of the basic tenets of CSR (case definition, methods of data collection and analysis) and consider the logics of CSR (its structures, purposes, assumptions and symbols). CSR challenges are considered next (such as emic and etic perspectives; ethical complexities; generalizability; quality; and reporting and reflexivity. The authors conclude that context is a mechanism which needs to be understood and rigorous CSR provides the structures and criticality to do so, opening up new areas of understanding and inquiry.
Background:
Collecting data in phenomenological research can be difficult and an often under-explored area of data collection is the use of diaries.
Aim:
To enable the reader to understand how diaries can be used to collect data in phenomenological research.
Discussion:
The author discusses how diaries can provide unadulterated insight into a phenomenon.
Conclusion:
Diaries can be useful to gain a personal insight into a phenomenon.
Implications for practice:
Diaries can be a challenge for those maintaining them, but offer a personal insight which can be useful as a data collection method and also cathartic for the participant.
The aim of this study was to explore the ways in which student nurses use self-authored poems to think about important aspects of nursing practice. Being a nurse can be rewarding in that it affords opportunities to care for and communicate with others. However, it can also yield challenges, and nurses are often faced with practice filled with uncertainty, grief and loss. Our findings suggest that students can use poetry writing to meaningfully explore nursing practice, engage with critical thinking and consider the feelings of others. Of particular note were the ways in which students use metaphor to explore emotional and relational aspects of practice and the technique of self-distancing when describing difficult and angering events. The work has implications for nurse education and practice. Proactively encouraging students to adopt particular ways of expressive writing might be beneficial for student health and wellbeing. Such an approach has the potential to improve quality care provision and support the emotional health of student nurses, which might lead to a reduction in compassion fatigue, stress and attrition.
Demand for kidneys from deceased donors far outstrips supply. Despite this, there appears to be little research that focuses solely on the experience of waiting for a kidney from a deceased donor. This study uses the qualitative methodology interpretative phenomenological analysis to explore the lives of 10 people on the transplant list, with the aims of illuminating the potential psychological challenges those on the list may face during this time, and providing information to help clinicians more fully support such people in the future. Two themes connected to the experience of waiting - adjustment to the uncertainty of waiting and thinking about receiving a kidney from a living donor - are presented here. Participants describe a sense of confusion and uncertainty around life on the list, and discuss their strategies for dealing with this. Novel complexities around the ambiguous challenge of receiving an organ from a deceased donor are revealed. It is recommended that health care teams provide a forum for this patient group to work through these feelings of confusion and ambiguity.
Cover Blurb: Researching Lived Experience introduces an approach to qualitative research methodology in education and related fields that is distinct from traditional approaches derived from the behavioral or natural sciences—an approach rooted in the “everyday lived experience” of human beings in educational situations. Rather than relying on abstract generalizations and theories, van Manen offers an alternative that taps the unique nature of each human situation.
The book offers detailed methodological explications and practical examples of hermeneutic-phenomenological inquiry. It shows how to orient oneself to human experience in education and how to construct a textual question which evokes a fundamental sense of wonder, and it provides a broad and systematic set of approaches for gaining experiential material that forms the basis for textual reflections.
Van Manen also discusses the part played by language in educational research, and the importance of pursuing human science research critically as a semiotic writing practice. He focuses on the methodological function of anecdotal narrative in human science research, and offers methods for structuring the research text in relation to the particular kinds of questions being studied. Finally, van Manen argues that the choice of research method is itself a pedagogic commitment and that it shows how one stands in life as an educator.
Abstract Medical educators need to understand and conduct medical education research in order to make informed decisions based on the best evidence, rather than rely on their own hunches. The purpose of this Guide is to provide medical educators, especially those who are new to medical education research, with a basic understanding of how quantitative and qualitative methods contribute to the medical education evidence base through their different inquiry approaches and also how to select the most appropriate inquiry approach to answer their research questions.
Professional identity formation plays a crucial role in the transition from medical student to doctor. At McMaster University, medical students maintain a portfolio of narrative reflections of their experiences, which provides for a rich source of data into their professional development. The purpose of this study was to understand the major influences on medical students' professional identity formation.
Sixty-five medical students (46 women; 19 men) from a class of 194 consented to the study of their portfolios. In total, 604 reflections were analysed and coded using thematic narrative analysis. The codes were merged under subthemes and themes. Common or recurrent themes were identified in order to develop a descriptive framework of professional identity formation. Reflections were then analysed longitudinally within and across individual portfolios to examine the professional identity formation over time with respect to these themes.
Five major themes were associated with professional identity formation in medical students: prior experiences, role models, patient encounters, curriculum (formal and hidden) and societal expectations. Our longitudinal analysis shows how these themes interact and shape pivotal moments, as well as the iterative nature of professional identity from the multiple ways in which individuals construct meaning from interactions with their environments.
Our study provides a window on the dynamic, discursive and constructed nature of professional identity formation. The five key themes associated with professional identity formation provide strategic opportunities to enable positive development. This study also illustrates the power of reflective writing for students and tutors in the professional identity formation process.
Counseling psychologists face many approaches from which to choose when they conduct a qualitative research study. This article focuses on the processes of selecting, contrasting, and implementing five different qualitative approaches. Based on an extended example related to test interpretation by counselors, clients, and communities, this article provides a detailed discussion about five qualitative approaches— narrative research; case study research; grounded theory; phenomenology; and participatory action research—as alternative qualitative procedures useful in understanding test interpretation. For each approach, the authors offer perspectives about historical origins, definition, variants, and the procedures of research.
This paper reflects on the development of interpretative phenomenological analysis (IPA) as one particular qualitative approach to psychology. After a brief introduction to IPA, the paper outlines what can be described as its characteristic features: idiographic, inductive, interrogative, illustrating each feature with examples from studies which have been conducted with IPA. The paper then considers the different levels of interpretation, which are possible with IPA and discusses the notion of when an interpretation is ‘good enough’. It goes on to consider issues around the types of topics for which IPA is suitable and the emerging pattern of work using the approach. The next section considers how IPA studies can widen the type of participants included and also examines the suitability of different data collection methods. The paper finishes by bringing together some thoughts on the future development of IPA.
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