Chapter 7
Introducing Interpretivist Approaches in Health Professions Education Research
Lynn V. Monrouxe,
Megan E.L. Brown, Ella Ottrey, Lisi J. Gordon,
Lynn V. Monrouxe
The University of Sydney, Camperdown, New South Wales, Australia
Search for more papers by this authorLynn V. Monrouxe,
Megan E.L. Brown, Ella Ottrey, Lisi J. Gordon,
Lynn V. Monrouxe
The University of Sydney, Camperdown, New South Wales, Australia
Search for more papers by this authorBook Editor(s):Charlotte Rees,
Lynn Monrouxe,
Bridget O'Brien,
Lisi Gordon, Claire Palermo,
Charlotte Rees
The University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorLynn Monrouxe
The University of Sydney, Camperdown, New South Wales, Australia
Search for more papers by this authorBridget O'Brien
University of California San Francisco, San Francisco, California, USA
Search for more papers by this authorSummary
This chapter summarises the common interpretivist methodologies in health professions education research (HPER). It explains the main philosophical underpinnings of relativist ontology and subjectivist epistemology, and discusses the core aspects of interpretivist methodology and the values of subjectivity, researcher involvement, and multiple meanings gained from language, actions, and objects. Building on the notion that knowledge is constructed, interpretivist research is underpinned by a subjectivist epistemology, recognising that HPE researcher, are integral to the process. The chapter also explains the issues of quality when engaging with interpretivist perspectives including: credibility and authenticity; transferability; dependability; confirmability; reflexivity; transparency; and internal coherence. It discusses the strengths and challenges of interpretivist approaches for HPER. The chapter provides real-world examples of research using different interpretivist approaches, including a narrative review, a longitudinal qualitative research study, a phenomenology study, and a study conducted within an ethnomethodological framework.
References
- Gall M , Borg W , Gall J . Educational Research: An Introduction . White Plains, NY : Longman ; 1996 .
- Schwandt T . Three epistemological stances for qualitative inquiry: interpretivism, hermeneutics and social constructionism . In NK Denzin , YS Lincoln , eds. Handbook of Qualitative Research , 2nd ed. Thousand Oaks, Calif .: SAGE ; 2000 : 189 – 214 .
- Schwartz-Shea P , Yanow D . Interpretive Research Design: Concepts and Processes . Armonk, NY : Taylor & Francis Group ; 2011 .
- Ryan G . Introduction to positivism, interpretivism and critical theory . Nurse Res . 2018 ; 25 ( 4 ): 14 – 20 .
- Smith B , Sparkes AC . Contrasting perspectives on narrating selves and identities: an invitation to dialogue . Qual Res . 2008 ; 8 ( 1 ): 5 – 35 .
-
Willis JW
.
Foundations of Qualitative Research: Interpretive and Critical Approaches
.
Thousand Oaks, Calif
.:
SAGE
;
2007
:
95–146.
10.4135/9781452230108 Google Scholar
- Amineh RJ , Asl HD . Review of constructivism and social constructivism . J Soc Sci Lt Lang . 2015 ; 1 ( 1 ): 9 – 16 .
- Rees CE , Crampton PES , Monrouxe LV . Re-visioning academic medicine through a constructionist lens . Acad Med . 2020 ; 95 ( 6 ): 846 – 850 .
- Brown ME , Anderson K , Finn GM . A narrative literature review considering the development and implementation of longitudinal integrated clerkships, including a practical guide for application . J Med Educ Curric Dev . 2019 ; 6 : 2382120519849409 .
- Ottrey E , Rees CE , Kemp C , et al. Exploring health care graduates' conceptualisations of preparedness for practice: a longitudinal qualitative research study . Med Educ . 2021 ; 55 ( 9 ): 1078 – 1090 .
- Rees CE , Ottrey E , Kemp C , et al. Understanding health care graduates' conceptualizations of transitions: a longitudinal qualitative research study . Acad Med . 2022 ; 97 ( 7 ): 1049 – 1056 .
- Brown MEL , Proudfoot A , Mayat NY , et al. A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry . Adv Health Sci Educ . 2021 ; 26 ( 4 ): 1229 – 1253 .
- Elsey C , Challinor A , Monrouxe LV . Patients embodied and as-a-body within bedside teaching encounters: a video ethnographic study . Adv Health Sci Educ . 2017 ; 22 ( 1 ): 123 – 146 .
-
Elsey C
,
Monrouxe LV
,
Grant A
.
The reciprocal nature of trust in bedside teaching encounters
. In
K Pelsmaekers
,
G Jacobs
,
C Rollo
, eds.
Trust and Discourse: Organizational Perspectives
.
Amsterdam
:
John Benjamins Publishing Company
;
2014
:
45
–
70
.
10.1075/dapsac.56.03els Google Scholar
- Palermo C , Reidlinger DP , Rees CE . Internal coherence matters: lessons for nutrition and dietetics research . Nutr Diet . 2021 ; 78 ( 3 ): 252 – 267 .
- Berger PL , Luckmann T . The Social Construction of Reality: A Treatise in the Sociology of Knowledge . New York : Anchor Books ; 1966 .
-
Carter SM
.
Enacting internal coherence as a path to quality in qualitative inquiry
. In
J Higgs
,
N Cherry
,
R Macklin
, et al., eds.
Researching Practice: A Discourse on Qualitative Methodologies
. Practice, Education, Work and Society Series, Vol.
2
.
Rotterdam
:
Sense Publishers
;
2010
:
143
–
152
.
10.1163/9789460911835_017 Google Scholar
- Denzin NK , Lincoln YS . Handbook of Qualitative Research . 3rd ed. Thousand Oaks, Calif .: SAGE ; 2005 .
- Pring R . Philosophy of Educational Research . London and New York : Continuum ; 2000 .
-
Ismaeel M
.
Philosophical paradigms underlying discourse analysis: methodological implications
. In
J Crossman
,
S Bordia
, eds.
Handbook of Qualitative Research Methodologies in Workplace Contexts
.
Cheltenham
:
Edward Elgar
;
2021
:
47
–
66
10.4337/9781789904345.00009 Google Scholar
- Webb C . The use of the first person in academic writing: objectivity, language and gatekeeping . J Adv Nurs . 1992 ; 17 ( 6 ): 747 – 752 .
- Timmermans S , Tavory I . Theory construction in qualitative research: from grounded theory to abductive analysis . Sociol Theory . 2012 ; 30 ( 3 ): 167 – 186 .
-
Philipsen K
.
Theory building: using abductive search strategies
. In
PV Freytag
,
L Young
, eds.
Collaborative Research Design: Working with Business for Meaningful Findings
.
Singapore
:
Springer Singapore
;
2018
:
45
–
71
.
10.1007/978-981-10-5008-4_3 Google Scholar
-
Littlejohn SW
,
Foss KA
.
Encyclopedia of Communication Theory [Internet]
.
Thousand Oaks, Calif
.:
SAGE
;
2009
:
https://sk.sagepub.com/reference/communicationtheory
(accessed 23 January
2022
).
10.4135/9781412959384 Google Scholar
- Biedenbach T , Jacobsson M . The open secret of values: the roles of values and axiology in project research . Proj Manag J . 2016 ; 47 ( 3 ): 139 – 155 .
-
Kivunja C
,
Kuyini AB
.
Understanding and applying research paradigms in educational contexts
.
Int J High Educ
.
2017
;
6
(
5
):
26
.
10.5430/ijhe.v6n5p26 Google Scholar
-
Burr V
.
Social Constructionism
.
3rd
ed.
London and New York
:
Routledge
;
2015
.
10.4324/9781315715421 Google Scholar
-
Pillay R
.
Ethnomethodology
. In
P Liamputtong
, ed.
Handbook of Research Methods in Health Social Sciences
.
Singapore
:
Springer Singapore
;
2019
:
269
–
283
.
10.1007/978-981-10-5251-4_68 Google Scholar
- van Manen M . Researching Lived Experience: Human Science for an Action Sensitive Pedagogy . 2nd ed. London and New York : Routledge ; 2016 .
- Neubauer BE , Witkop CT , Varpio L . How phenomenology can help us learn from the experiences of others . Perspect Med Educ . 2019 ; 8 ( 2 ): 90 – 97 .
- Wimpenny P , Gass J . Interviewing in phenomenology and grounded theory: is there a difference? J Adv Nurs . 2000 ; 31 ( 6 ): 1485 – 1492 .
-
McAuley J
.
Hermeneutic understanding
. In
C Cassell
,
G Symon
, eds.
Essential Guide to Qualitative Methods in Organizational Research
.
London
:
SAGE
;
2004
:
https://sk.sagepub.com/books/essential-guide-to-qualitative-methods-in-organizational-research
(accessed 4 July
2022
).
10.4135/9781446280119.n16 Google Scholar
- Atkinson P , Pugsley L . Making sense of ethnography and medical education . Med Educ . 2005 ; 39 ( 2 ): 228 – 234 .
- Arreciado Marañón A , Isla Pera MP . Theory and practice in the construction of professional identity in nursing students: a qualitative study . Nurse Educ Today . 2015 ; 35 ( 7 ): 859 – 863 .
- Carey MC , Chick A , Kent B , et al. An exploration of peer-assisted learning in undergraduate nursing students in paediatric clinical settings: an ethnographic study . Nurse Educ Today . 2018 ; 65 : 212 – 217 .
- Bridges SM , Chan LK , Chen JY , et al. Learning environments for interprofessional education: a micro-ethnography of sociomaterial assemblages in team-based learning . Nurse Educ Today . 2020 ; 94 : 104569 .
- Gordon L , Rees CE , Ker J , et al. Using video-reflexive ethnography to capture the complexity of leadership enactment in the healthcare workplace . Adv Health Sci Educ . 2017 ; 22 ( 5 ): 1101 – 1121 .
- Monrouxe LV . Negotiating professional identities: dominant and contesting narratives in medical students' longitudinal audio diaries . Current Narratives . 2009 ; 1 ( 1 ): 41 – 59 .
- Monrouxe LV . Solicited audio diaries in longitudinal narrative research: a view from inside . Qual Res . 2009 ; 9 ( 1 ): 81 – 103 .
- Gordon L , Rees CE , Jindal-Snape D . Doctors' identity transitions: choosing to occupy a state of ‘betwixt and between’ . Med Educ . 2020 ; 54 ( 11 ): 1006 – 1018 .
- Balmer DF , Teunissen PW , Devlin MJ , et al. Stability and change in the journeys of medical trainees: a 9-year, longitudinal qualitative study . Acad Med . 2021 ; 96 ( 6 ): 906 – 912 .
- Hermanowicz JC . The longitudinal qualitative interview . Qual Sociol . 2013 ; 36 ( 2 ): 189 – 208 .
- McCoy LK . Longitudinal qualitative research and interpretative phenomenological analysis: philosophical connections and practical considerations . Qual Res Psychol . 2017 ; 14 ( 4 ): 442 – 458 .
- Balmer DF , Varpio L , Bennett D , et al. Longitudinal qualitative research in medical education: time to conceptualise time . Med Educ . 2021 ; 55 ( 11 ): 1253 – 1260 .
- Gordon L . Making space for relational reflexivity in longitudinal qualitative research . Med Educ . 2021 ; 55 ( 11 ): 1223 – 1224 .
- Gordon L , Jindal-Snape D , Morrison J , et al. Multiple and multidimensional transitions from trainee to trained doctor: a qualitative longitudinal study in the UK . BMJ Open . 2017 ; 7 ( 11 ): e018583 .
-
Squire C
,
Davis M
,
Esin C
, et al.
What Is Narrative Research?
The ‘What is?’ Research Methods Series.
New York
:
Bloomsbury Academic
;
2014
:
1
–
22
.
10.5040/9781472545220 Google Scholar
- Bruner J . The narrative construction of reality . Crit Inq . 1991 ; 18 ( 1 ): 1 – 21 .
- Crossley M . Introducing Narrative Psychology . Buckingham : Open University Press ; 2000 .
- McAdams D . Identity and the life story . In R Fivush , C Haden , eds. Autobiographical Memory and the Construction of a Narrative Self: Development and Cultural Perspectives . Mahwah, NJ : Lawrence Erlbaum Associates ; 2003 : 187 – 208
- Bamberg M . Positioning between structure and performance . J Narrat Life Hist . 1997 ; 7 ( 1–4 ): 335 – 342 .
- De Fina A , Georgakopoulou A . Analyzing Narrative. Discourse and Sociolinguistic Perspectives . Cambridge, UK : Cambridge University Press ; 2012 .
-
De Fina A
,
Georgakopoulou A
.
The Handbook of Narrative Analysis
.
Hoboken, NJ
:
John Wiley & Sons, Inc
;
2015
.
10.1002/9781118458204 Google Scholar
- Gordon L , Rees CE , Ker JS , et al. Leadership and followership in the healthcare workplace: exploring medical trainees' experiences through narrative inquiry . BMJ Open . 2015 ; 5 ( 12 ): e008898 .
- Samuriwo R , Bullock A , Webb K , et al. ‘Nurses whisper.’ Identities in nurses' patient safety narratives of nurse–trainee doctors' interactions . Med Educ . 2021 ; 55 ( 12 ): 1394 – 1406 .
- Monrouxe LV , Rees CE . “It's just a clash of cultures”: emotional talk within medical students' narratives of professionalism dilemmas . Adv Health Sci Educ . 2012 ; 17 ( 5 ): 671 – 701 .
-
Ferrari R
.
Writing narrative style literature reviews
.
Medical Writing
.
2015
;
24
(
4
):
230
–
235
.
10.1179/2047480615Z.000000000329 Google Scholar
- Green BN , Johnson CD , Adams A . Writing narrative literature reviews for peer-reviewed journals: secrets of the trade . J Chiropr Med . 2006 ; 5 ( 3 ): 101 – 117 .
- Greenhalgh T , Thorne S , Malterud K . Time to challenge the spurious hierarchy of systematic over narrative reviews? Eur J Clin Invest . 2018 ; 48 ( 6 ): e12931 .
- Grant MJ , Booth A . A typology of reviews: an analysis of 14 review types and associated methodologies . Health Info Libr J . 2009 ; 26 ( 2 ): 91 – 108 .
- Gough D , Thomas J , Oliver S . Clarifying differences between review designs and methods . Syst Rev . 2012 ; 1 : 28 .
- Dyrbye L , Shanafelt T . A narrative review on burnout experienced by medical students and residents . Med Educ . 2016 ; 50 ( 1 ): 132 – 149 .
- Koea J , Rahiri J-L , Ronald M . Affirmative action programs in postgraduate medical and surgical training—a narrative review . Med Educ . 2021 ; 55 ( 3 ): 309 – 316 .
- Schmidt HG , Mamede S . How to improve the teaching of clinical reasoning: a narrative review and a proposal . Med Educ . 2015 ; 49 ( 10 ): 961 – 973 .
- Somporn P , Ash J , Walters L . Stakeholder views of rural community-based medical education: a narrative review of the international literature . Med Educ . 2018 ; 52 ( 8 ): 791 – 802 .
- Lewis GM , Neville C , Ashkanasy NM . Emotional intelligence and affective events in nurse education: a narrative review . Nurse Educ Today . 2017 ; 53 : 34 – 40 .
- Daniels AL , Morse C , Breman R . Psychological safety in simulation-based prelicensure nursing education: a narrative review . Nurse Educ . 2021 ; 46 ( 5 ): E99 – E102 .
- Ritchie J , Spencer L . Qualitative data analysis for applied policy research . In A Bryman , R Burgess , eds. Analysing Qualitative Data . London and New York : Routledge ; 1994 : 173 – 194 .
- Ajjawi R , Higgs J . Using hermeneutic phenomenology to investigate how experienced practitioners learn to communicate clinical reasoning . Qual Rep . 2007 ; 12 ( 4 ): 612 – 638 .
- Bynum W , Varpio L . When I say … hermeneutic phenomenology . Med Educ . 2018 ; 52 ( 3 ): 252 – 253 .
- Rizan C , Elsey C , Lemon T , et al. Feedback in action within bedside teaching encounters: a video ethnographic study . Med Educ . 2014 ; 48 ( 9 ): 902 – 920 .
- Marshall C , Rossman GB . Designing Qualitative Research , 5th ed. Thousand Oaks, Calif .: SAGE ; 2011 .
- Monrouxe L , Ajjawi R , Verma AK . Observing, interviewing, diarising: understanding personal and professional identities in health professions education . Med Educ . 2010 ; 44 : 40 – 49 .
- Rees C . Drawing on drawings: moving beyond text in health professions education research . Perspect Med Educ . 2018 ; 7 ( 3 ): 166 – 173 .
-
Ritchie J
,
Spencer L
.
Qualitative data analysis for applied policy research
. In
AM Huberman
,
MB Miles
, eds.
The Qualitative Researcher's Companion: Classic and Contemporary Readings
.
Thousand Oaks, Calif
.:
SAGE
;
2002
:
305
–
330
.
10.4135/9781412986274.n12 Google Scholar
- Rees CE , Monrouxe LV . “I should be lucky ha ha ha ha”: the construction of power, identity and gender through laughter within medical workplace learning encounters . J Pragmat . 2010 ; 42 ( 12 ): 3384 – 3399 .
- Guba EG , Lincoln YS . Paradigmatic controversies, contradictions, and emerging confluences . In NK Denzin , YS Lincoln , eds. The SAGE Handbook of Qualitative Research , 3rd ed. Thousand Oaks, Calif .: SAGE ; 2005 : 191 – 215 .
- Haraway D . Situated knowledges: the science question in feminism and the privilege of partial perspective . Fem Stud . 1988 ; 14 ( 3 ): 575 – 599 .
-
Lincoln YS
,
Guba EG
.
Naturalistic Inquiry
.
Newbury Park, Calif
.:
SAGE
;
1985
.
10.1016/0147-1767(85)90062-8 Google Scholar
- Amin MEK , Nørgaard LS , Cavaco AM , et al. Establishing trustworthiness andauthenticity in qualitative pharmacy research . Res Social Adm Pharm . 2020 ; 16 ( 10 ): 1472 – 1482 .
- Rees CE , Monrouxe LV . Theory in medical education research: how do we get there? Med Educ . 2010 ; 44 ( 4 ): 334 – 339 .
- Varpio L , Ajjawi R , Monrouxe LV , et al. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking . Med Educ . 2017 ; 51 ( 1 ): 40 – 50 .
- Alvesson M , Sköldberg K . Reflexive Methodology: New Vistas for Qualitative Research , 3rd ed. Thousand Oaks, Calif .: SAGE ; 2018 .
-
Vettraino E
,
Linds W
,
Downie H
.
Embodied reflexivity: discerning ethical practice through the Six-Part Story Method
.
Reflective Practice
.
2019
;
20
(
2
):
218
–
233
.
10.1080/14623943.2019.1575197 Google Scholar
- Barry CA , Britten N , Barber N , et al. Using reflexivity to optimize teamwork in qualitative research . Qual Health Res . 1999 ; 9 ( 1 ): 26 – 44 .
- Varpio L , O'Brien BC , Rees CE , et al. The applicability of generalisability and bias to health professions education's research . Med Educ . 2021 ; 55 ( 2 ): 167 – 173 .
- O'Brien BC , Harris IB , Beckman TJ , et al. Standards for reporting qualitative research: a synthesis of recommendations . Acad Med . 2014 ; 89 ( 9 ): 1245 – 1251 .
- Tong A , Sainsbury P , Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups . Int J Qual Health Care . 2007 ; 19 ( 6 ): 349 – 357 .
- D'Souza DM , Sade RM , Moffatt-Bruce SD . The many facets of research integrity: what can we do to ensure it? J Thorac Cardiovasc Surg . 2020 ; 160 ( 3 ): 730 – 733 .
-
Stewart Jr CN
.
Research Ethics for Scientists: A Companion for Students
Chichester
:
John Wiley & Sons, Ltd
;
2011
.
10.1002/9781119978862 Google Scholar
-
Poff DC
,
Ginley DS
.
Publication ethics
. In
R Iphofen
, ed.
Handbook of Research Ethics and Scientific Integrity
.
Cham
:
Springer International Publishing
;
2020
:
107
–
126
.
10.1007/978-3-030-16759-2_61 Google Scholar
-
Lacey AJ
.
Novice researchers' nightmare journey of paradigms and methodologies: ‘It's hard to know what is right or wrong’
. In
A Costa
,
L Reis
,
F Souz
, et al. eds.
Computer Supported Qualitative Research: Second International Symposium in Qualitative Research (ISQR 2017)
. Advances in Intelligent Systems and Computing, Vol.
621
.
Cham
:
Springer
;
2018
.:
204
–
212
10.1007/978-3-319-61121-1_18 Google Scholar
-
Monrouxe LV
,
Sweeney K
.
Between two worlds: medical students narrating tensions
. In
C Figley
,
P Huggard
,
C Rees
, eds.
First Do No Self-Harm: Understanding and Promoting Physician Stress Resilience
.
New York
:
Oxford University Press
;
2013
:
44–66.
10.1093/acprof:oso/9780195383263.003.0003 Google Scholar
- Mallard G , Lamont M , Guetzkow J . Fairness as appropriateness: negotiating epistemological differences in peer review . Sci Technol Human Values . 2009 ; 34 ( 5 ): 573 – 606 .
- Bressers G , Brydges M , Paradis E . Ethnography in health professions education: slowing down and thinking deeply . Med Educ . 2020 ; 54 ( 3 ): 225 – 233 .
- Andreassen P , Christensen MK , Møller JE . Focused ethnography as an approach in medical education research . Med Educ . 2020 ; 54 ( 4 ): 296 – 302 .
- Monrouxe LV , Ajjawi R . Ethnography, methodology: striving for clarity . Med Educ . 2020 ; 54 ( 4 ): 284 – 286 .
-
McMullin C
. Transcription and qualitative methods: implications for third sector research.
Voluntas
;
2021
;
34
(
1
):
140
–
153
.
https://doi.org/10.1007/s11266-021-00400-3
(accessed 20 November
2022
).
10.1007/s11266-021-00400-3 Google Scholar
- Mack L . The philosophical underpinnings of educational research . Polyglossia . 2010 ; 19 : 5 – 11 .
- Vogl S , Zartler U , Schmidt E-M , et al. Developing an analytical framework for multiple perspective, qualitative longitudinal interviews (MPQLI) . Int J Soc Res Methodol . 2018 ; 21 ( 2 ): 177 – 190 .
- Hunt MR . Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work . Qual Health Res . 2009 ; 19 ( 9 ): 1284 – 1292 .
- Ataro G . Methods, methodological challenges and lesson learned from phenomenological study about OSCE experience: overview of paradigm-driven qualitative approach in medical education . Ann Med Surg . 2020 ; 49 : 19 – 23 .
-
Olave-Encina K
,
Moni K
,
Renshaw P
.
Exploring the emotions of international students about their feedback experiences
.
Higher Educ Res Dev
.
2021
;
40
(
4
):
810
–
824
.
10.1080/07294360.2020.1786020 Google Scholar
-
Garrick J
.
Doubting the philosophical assumptions of interpretive research
.
Int J Qual Stud Educ
.
1999
;
12
(
2
):
147
–
156
.
10.1080/095183999236222 Google Scholar
- Cleland J , MacLeod A , Ellaway RH . The curious case of case study research . Med Educ . 2021 ; 55 ( 10 ): 1131 – 1141 .
