In response to changing research practice during the COVID-19 pandemic, an international workshop on the teaching of QR online was convened by KI and MT in October 2020. This article arose from discussions at the workshop concerning the need to explore individual teaching styles through critical dialogue, and to find space in which to locate and examine our own feelings, uncertainties and creativities regarding teaching QR methods to students who traditionally have different ontological assumptions. Both KI and MT have designed and delivered courses for QR to postgraduate students in health and medicine in the UK and Australia and share a combined 32 years of QR and 16 years of teaching QR methods experience between them. EE and SW, both social scientists working in health sciences and medicine in Australia and the UK respectively, were invited to join the collaboration.
Interest in the use of autoethnography grew during the pandemic in response to public health infection control measures that mandated physical distancing and restricted more conventional in-person approaches to QR (Roy and Uekusa 2020). This article focuses on the outcomes of collaborative autoethnography (CAE); a multivocal approach whereby two or more researchers share and pool stories, and explore, unpack, and synthesize individual and collective experiences (Blalock and Akehi 2018). CAE is an iterative, systematic process comprised of ongoing discussions and critical reflection over time, with the key aim of fostering ‘intentional and purposeful dialogue’ (Blalock and Akehi 2018, Roy and Uekusa 2020). In CAE, data comprises self-narratives and reflections that can be generated through a variety of means including, as used in this article, collective interviews and more informal discussions and group reflections (Roy and Uekusa 2020). CAE was deemed appropriate for this exploration of cross-country pedagogies, as we sought to share, compare and understand our own experiences of teaching QR methods in different countries, albeit united by a wider neo-liberal context.
Data generation
Data generation comprised a series of in-depth interviews along with more informal group discussions and reflections. At the outset, KI and MT wanted to explore their individual teaching styles through critical dialogue, and to find space in which to locate and examine their own feelings, uncertainties and creativities regarding teaching QR methods to students, many of whom have been exposed to/working with different ontological assumptions. KI’s undergraduate background is in pharmacy and biomedical sciences which is heavily dominated by quantitative training, however her interest in patient’s experiences and voices prompted her to pursue postgraduate training in QR and applied health research. MT’s background in exercise physiology, health promotion, epidemiology and gerontology brought with it a large portion of quantitative training, though MT always sought to focus on QR alone. MT welcomed her conversations with KI over time, finding a like-minded qualitative advocate and colleague in whom to confide about teaching QR methods.
To formalize conversations via a qualitative method of inquiry, a third colleague, SW, with significant experience in QR methodologies and methods was invited to bring her expertise to the conceptualization of the endeavor and to the CAE approach. SW is a social scientist with 20 years’ experience of QR. Framed by feminist constructionism, much of her work has been in inter-disciplinary teams straddling the social and biomedical sciences. This has encouraged SW to be cognizant of the way dominant epistemologies in different (sub)disciplines shape how QR is construed, undertaken, and valued. SW led three interactive interview sessions with KI and MT between January and March 2021 to discuss their pedological positioning and their experiences in teaching QR methods including any challenges. The emphasis in these sessions was on what can be learned from interaction within the interview setting as well as on the stories and reflections that each person brought to the research encounter. SW developed a semi-structured interview guide to facilitate the interview sessions. The guide was, in part, informed by the conceptual-empirical typology of social science research methods (Nind and Lewthwaite 2020). Although designed for, and with those teaching advanced research methods in the social sciences, it has wider application as a tool for thinking about and developing pedagogic practice. The typology focuses on four aspects of pedagogy: i) the philosophies or values underpinning the educator’s approach; ii) the strategies adopted to deliver the approach; iii) the tactics employed to convert the strategies into practice, and also respond to factors arising in context; and iv) the tasks or activities assigned to learners. Accordingly, the interviews sought to understand these different aspects of pedagogy. We focused on our own journeys through learning QR methods, our teaching histories, experiences and pedagogical approaches; how we conceived of our learners’ diverse interests and needs; the value and place of QR methods within the disciplines, departments and faculties in which we are located including reflections on perceptions of dominant epistemologies, methodologies and pedagogies; approaches to designing courses, sessions and modes of assessment; perspectives on ‘what works’ in practice as well as constraints; the inter-connections between teaching and research; the training needs of educators and our colleagues; and future imaginings of QR methods pedagogy in health sciences and medicine.
Originally, virtual interviews were to be conducted with KI and MT, facilitated by SW. Following the first interview, it became apparent that the discussions were more in-depth when three people were involved. SW, as moderator, seamlessly used her own experience and knowledge of QR to incorporate more technical questions for KI and MT, including brief vignettes to stimulate further discussion. Each online interview was video recorded via Microsoft Teams and the live transcript saved.
Data analysis
At this stage, EE joined the team to lead data analysis and, in so doing, contributed further to CAE, bringing her own experiences and reflections of being a woman of colour and early career researcher conducting QR in an Australian health service and university context. EE’s work is primarily grounded in critical race theory, feminist and decolonizing theoretical perspectives. Through the lens of cultural safety, EE examines the interplay between institutional structures, governance processes, culture and individual agency and how these elements combine to create and reproduce patterns of inequality. EE was introduced to the QR group by MT after the first three interviews had taken place and was tasked with undertaking a thematic analysis of the interview recordings. Following team discussions, the interviews were analyzed using a collaborative ethnobiographic reflective lens in an iterative process of critical-reflection, discussion, and collaboration (Méndez 2013).
All members of the team contributed to the process, with each bringing different subjectivities, interests, and disciplinary backgrounds to the analytic endeavor. Transcripts of our discussions were coded and analyzed thematically. A list of main codes and categories were then presented initially by EE to KI, MT and SW in a virtual meeting to discuss the findings and reflect on whether they represented their experiences and stories. The process was iterative and recursive involving all four researchers meeting virtually on four occasions to discuss and refine the codes/themes based on collective in-depth discussions in which each researcher outlined their interpretations of the material. Emphasis was also placed on multiple and/or contradictory narratives within each account. Themes were then constructed from “patterns of shared meaning underpinned or united by a core concept” (Braun and Clarke 2019).
Findings
Drawing on 12 hours of discussion and reflection, we discuss three main themes identified through our analysis: i) making meaningful contributions from a marginalized position; ii) finding our pedagogical feet; and iii) recognizing the translational applicability and value of qualitative research.
Making meaningful contributions from marginalized positions
Our CAE work reiterated the commonplace feeling that QR methods inhabit a marginalized position in medical and health sciences teaching. This, in part, stems from how QR methods are perceived in terms of their potential to make meaningful contributions to the kind(s) of knowledge valued in such disciplines, as well as understandings of scientific rigour. Our discussions were peppered with examples of the challenges (and sometimes, exasperations) faced, that we often attributed to enduring tensions between qualitative and quantitative epistemologies. For example, KI described the challenge of engaging students already engrained in quantitative epistemologies:
‘We try and make them switch their mindset to a different method, a different mindset and way of thinking ...’ (KI).
Along similar lines, MT asks her students to reflect upon the research paradigm they are most comfortable working within, and then discusses “... retraining your brain...” towards a more qualitative sensibility. For QR educators, this is especially challenging as not only are we required to teach a range of complex interpretive and critical concepts and skills, but there is also the added hurdle of encouraging students to acknowledge and challenge their own preconceptions of QR as something conceptually different, less scientific, or even less useful to their current studies and/or future professions, than the quantitative methods with which they are more likely to be familiar.
In describing the challenges of teaching QR methods, KI and MT referred to an enduring hierarchy of research methods, that they themselves had been introduced to many years prior, in which quantitative approaches were favoured and positioned as higher status or more ‘credible’ whilst QR methods were undervalued and perhaps misrepresented. When referring to such a hierarchy SW commented that ‘…its already set up that way, what is valid and valuable’ (SW). In so doing, she alluded to the influence of the broader neo-liberal context shaping Higher Education, where quantitative approaches have generally taken precedence over qualitative techniques. KI spoke of something so simple, such as wrangling the meaning of hypothesis in QR:
“...it's really interesting how I'm reflecting by just talking to you both now.... I had a conflict conversation ages ago with a speaker, the one who's speaking giving the presentation saying, so when we are giving this presentation, we are giving the impression that every research [project] has to have a hypothesis. In qualitative research, we don't have a hypothesis. We start with the research question. And then we have objectives and aims, but we don't have a hypothesis.…” (KI).
Teaching QR methods to students enrolled in medical and health science courses felt like an undervalued pursuit. We shared our constant struggle to prove the legitimacy of QR courses to our institutions, faculties, colleagues, and students. This conflict was characterised by KI and MT as an uphill battle where their individual expertise was often un(der)appreciated by colleagues and the significance of QR methods marginalized. Throughout our interview discussions, both KI and MT characterised a constant friction omnipresent during their teaching, using somewhat combatant language such as ‘defending’, ‘cheer’, ‘punch’ and ‘fighting’, to signify the prolonged campaign in which they have engaged to gain recognition of the legitimacy of QR methods and their place within their courses:
‘You are in a position where you are always defending the methods’ (KI).
‘… it takes us so much work... to wave and cheer ... and say do you know what we do for a living is actually valid, it’s incredibly important... It’s incredibly technical and complex. It doesn’t have to be one way there can be another way – we are just fighting for it all of the time’ (MT).
Connected to the 'usefulness’ ascribed to QR methods, KI and MT shared stories of feeling their labour was undervalued as they were regularly asked to undertake additional, unrecognized and unpaid QR work:
‘Once people know what you can do and how easy you are to speak to...you can see them physically relax and go oh, I didn’t know that, I’m so glad that I spoke to you. But of course, they’ve spoken to you for at least an hour and then they’ve gone (and) that’s sort of paid time that you could’ve been doing something else’ (MT).
MT’s example highlights more hidden forms of teaching, such as informal mentoring, performed often by QR experts in departments and faculties where such work is marginalized, but who wish to advocate for students conducting QR. Our passion for QR was a key motivator driving our willingness to teach and support others, particularly our desire to ensure that the value of QR is recognized in health research and within our departments and faculties:
‘In terms of the teaching, the driver is really my passion about educating people and making people aware of the methods and to make them think that this is a valid method to teach in or to use in research and especially in healthcare research’ (KI).
Recognising the value of qualitative approaches, and teaching QR methods, EE had accepted the invitation to join the group as she is passionate about elevating the status of QR in the health context particularly, as it is essential for culturally safe research, the topic of her own PhD. In the Australian healthcare context, cultural safety primarily provides a decolonising model of practice based on communication, negotiation, power sharing and self-determination for First Nations Peoples. Whether or not an experience is culturally safe or not can only be determined by the recipient of care. It is this conceptualisation of cultural safety, using a process of ongoing critical self-reflection and power sharing that EE brought to the analysis.
Finding our pedagogical feet
Our first discussion commenced with recollections of the serendipitous circumstances that led us to teaching QR methods. MT was asked to join an existing team of public health educators in her School, teaching QR methods in health research. Rather a case of ‘be careful of what you wish for’, MT started her qualitative teaching with... “the notes from the previous person, and I just rewrote it not knowing at all what I was doing…. I started to teach.’ (MT). KI nodded and followed with a similar story of learning on the job: ‘It’s the same with me. No one told me or taught me what to do or how to teach qualitative research.’ (KI).
Both had completed under- and post-graduate degrees in health-related disciplines and had not undertaken formal training in teaching QR methods. Both described a similar process of being self-taught, with the focus of their teaching scaffolded by their own experiences as qualitative researchers. As the conversation progressed MT and KI were asked how they viewed themselves as educators, with both hesitating before answering. The use of CAE helped the authors reflect on and draw out salient experiences and practices that they had not considered before:
‘When I started, I had no idea what teaching was, so I brought all of my research bad habits with me and just thought I’m just going to share them and be enthusiastic... So in my committee meetings with my colleagues, they would talk about certain pedagogical frameworks and philosophies and authors and I’m sitting there writing down words thinking what the bloody hell is that? I had to reflect on why I did things a certain way and who I was trying to be… I’m just wanting my students to be their fullest self. That’s it. (MT)
KI went on to describe her approach to teaching:
‘I teach qualitative research the way I do research. So, I get them into a journey of how to do qualitative research. These are the kind of questions that you can answer. This is how we choose our sample. This is how many people we need in our sample. This is how we do our interviews, so I give them the skills of doing the interviews or the focus groups or the observation. This is how we do the analysis ... This is how we present the data. So, it’s like teaching someone who’s never had the experience before in qualitative research, how to do a simple piece of qualitative work ‘. (KI).
Both MT and KI reflected and reported how they developed their teaching pedagogies, in the field, based on self-reflection and student feedback as they taught their courses. MT characterised her teaching style as authentic, student-centred, reflexive and critically reflective, having to change between critical or ‘avant-garde’ when the situation calls for it. She emphasizes epistemological and ontological principles from the first week of teaching, finding that her post-graduate students are unaccustomed to introspection. MT teaches her course twice each year, for a Trimester and then a Semester, which provides up to 12 weeks each time for deeper dives into advanced qualitative concepts and epistemological soundness. Conversely, KI saw her approach as pragmatic. Governed largely by the limited time afforded to QR methods in her student’s courses (one week for the postgraduate master’s course and only one day for undergraduate courses), she spoke of taking a prescriptive and pragmatic approach to instilling a basic range of methodologies, methods and skills that could then be applied to a basic QR project and/or clinical practice. Teaching both undergraduate medical students and postgraduates with healthcare professional degrees such as pharmacists, doctors, allied health professionals, her pedagogical approach is active, experiential, and student-centred and underpinned by the discipline-relevant pedagogy and realist/pragmatic paradigm that she employs in her own applied health research.
In terms of teaching online, these different teaching styles and QR pedagogies needed to be reconciled against changing student expectations. KI and MT discussed online post-graduate course design, and how it may enable greater numbers of clinicians and health professionals to study QR methods, which in turn can challenge further the educator to advocate for the prestige associated with QR as a valued methodology. KI had to shift teaching QR to online platforms during the pandemic. Although this shift allowed greater time to be allocated to QR teaching in her course, she found virtual teaching was inflexible and challenging. KI had to adapt her in-person teaching activities and align them with her pragmatic teaching style. For example, she replaced lectures with pre-recorded sessions that comprised integrated quizzes and activities, break-out rooms for group work on designing qualitative topic guides and coding exercises and used online fora and drop-in sessions for answering questions. Conversely, MT’s qualitative methods in health research content has always been online, and she embraced the flexibility in expression that online teaching can afford (such as coding via iPad onscreen and micro-lectures) plus the ability to have more one-on-one student interactions. MT describes her experiences as:
‘I do quite like online...in those large lecture theatres I didn’t feel entirely happy at the front.... I feel whatever I had put into the lecture was so rehearsed it didn’t give the students all the learning options that perhaps I could have. So online by introducing more sort of face-to-face sessions as we would go along and whoever could turn up does turn up. Um I have learnt to sort of let go of some of the initial complete terror in not being able to improvise. So now it’s just... alright you can ask me whatever you want to ask me and we will see how we go. I’ve let the students drag me kicking and screaming into another place in my research teaching life that’s a little bit freeing... not so terrifying any more. And it means I’m just more authentic, more normal, more open to the students on the course. And it means I’m not just giving them this option because that’s all I feel happy with.’ (MT).
Even though both KI and MT had slightly different approaches to teaching there were many commonalities, that became apparent during the CAE, in teaching QR within health and medical science courses – especially taking a student-centred approach.
KI: “I really like the idea that qualitative research is taught by active engagement with the students.”
MT: (nodding in agreement with KI) “Yeah, I find that my students are most fascinated by coding. It’s just up to them (but they) sometimes have no idea what on earth they’re supposed to do. So, a lot of mine are micro lecture examples that are pre-recorded.
KI: “The way we teach qualitative research for (medical program) healthcare professionals who are working in practice is different from the teaching I do for medical students…. I always try to use examples that fit in with their interests.”
KI and MT described being reflexive in their teaching and being guided by student’s needs and interests. Both talked about how they seek to engage students by teaching them skills that will be both useful for QR and that can be applied in a broader health context. Throughout the interviews both emphasized how they research and try different teaching techniques to make students appreciate the complexity and value of QR methods and their relevance to healthcare contexts and clinical practices. They both described employing a range of novel teaching approaches aimed at "retraining” students’ minds from a quantitative-dominant perspective to introduce greater curiosity and inquiry to allow appreciation of the significance of learning QR in health and medical sciences. These approaches included an exercise to identify one’s conceptual underpinnings, role play activities to practice listening and interviewing skills, coding exercises using existing data, visual inquiry, and introducing an “unessay” as assessment.
The content of QR courses and the choice of teaching activities were informed by the time and space available for QR teaching. For example, MT teaches QR as a standalone course over 12 weeks and uses creative methods that allow deeper student engagement (for example, offering a creative ‘unessay’ as formative assessment) and encourage wider understanding of different QR approaches. Alternatively, KI has limited time for QR teaching which sits in a module that covers a wide range of research methods. Therefore, she focuses on one specific QR method of data generation (e.g. interviews, focus groups and observations) and analysis (e.g. thematic analysis) and employs applied practical individual and group exercises to promote learning and uses structured assignments.
Recognizing the translational applicability and value of qualitative research
Throughout our discussions we all spoke passionately about the value of QR methods to research in medical and health sciences. At the heart of KI’s and MT’s motivations were the critical translational importance that QR can add such as amplifying the voices of health service end-users, elevating lived experiences within a medical model, and enhancing quality of care. Critical self-reflection was identified as one of the unique skills taught through QR methods that could not only improve research in these areas but also workplace practices. In response to SW’s question about ‘what do you hope learners will gain from your course?’ MT recognized the difference between a clinical and qualitative interview and responded simply “That they do it safely….. Honour your participants, be there for the right reasons.” MT went on to describe her educational approach as much more than just teaching technique, passing on information or imparting new skills. MT shared that she works to instil a sense of value and self-reflection in students about the position of power that they hold as researchers, and the ethical obligations that this poses in terms of power sharing dynamics with research participants. KI mentioned:
“….you have to be reflexive in all types of research not just qualitative. If you do diabetes research and you have a diabetes diagnosis yourself, that will shape your research. We don’t talk about this in other research methods. It is mainly attached to qualitative research” (KI).
MT described her own experiences regarding an emerging discourse between the apparent undervaluing of QR while at the same time an increasing recognition of its translational value with consumer led medical research. She said:
“There is not a lot of status allocated to qualitative or interpretive work. But suddenly a lot of grants want lived experience, they want co-design and co-production... And I’m sitting there going ‘oh by the way guess what I can do?... guess what I have done?... and guess what I’ve been doing?’ and so there’s this big scurry to learn what this stuff is so they can put it on a grant” (MT).
Evident in MT’s account is her frustration of qualitative work being overlooked as value work, under resourced and her skills as a qualitative health researcher being depreciated. However, at the same time she observes an emerging shift in how QR has been viewed in the past and is beginning to be recognized more for its translational research value in health and medical sciences. MT goes on to note that this subtle shift in recognition is part of a change in the traditional researcher/ consumer power dynamics, saying:
“…they will just have to throw away the rule book in general and so researchers are not the experts, they (can help) other people be enabled to participate in things, it might be in a community or group...” (MT).
The efforts of both MT and KI to raise the profile of QR in their own institutions resulted in some recognition by both faculties. For example, the time allocated to QR teaching in the course that KI leads increased from 3.5 hours in-person in 2018 to 12 hours online in 2020. She also introduced for the first time a qualitative assignment to the module which has equal weight (30% of the total mark) to the other two assignments (quantitative analysis and project proposal). KI also won the Dean’s award for Education because of her wider QR teaching activities at under- and post-graduate levels and has been invited as a qualitative supervisor/ co-applicant to several doctorate and clinical research grants. Furthermore, the qualitative network that she established and has led (since 2018) has grown dramatically in 2020 indicating the increasing awareness of the value of QR in health and medical research and the interest of researchers in understanding and learning more about the methodology. MT is also an award-winning educator, and the passage of time has meant even greater popularity for her as a sought-after supervisor for doctoral candidates completing qualitative studies, and by research teams internal to the University as well as external organizations seeking her expertise for capacity building in qualitative research design and conduct. Recognized for her honesty in explaining QR methods and breaking down ‘jargon’ she is mentoring more clinicians than ever, in their qualitative pursuits and projects.
