Qualitative synthesis and systematic review in health professions education

Abstract

I want to thank Bearman and Dawson (1) for indicating the value of qualitative synthesis type for the field of education. I was, however, somewhat disappointed in the lack of an in-depth point of view on issues such as merging findings from different qualitative study approaches, particularly because the authors include realist synthesis as a ‘qualitative synthesis technique’. The authors state that a number of higher educational scientists critique authors of qualitative evidence synthesis (QES) for summarizing findings generated from diverse qualitative methodologies, arguing that such a process may discourage thoughtful analysis and are derived from a positivist stance. To my personal understanding reviewers operating within a positivistic stance most of the time only draw on well-defined methodological design, such as RCT’s or quasi RCT’s, before and after studies or time series with a clear baseline measure. Many of these authors conduct sensitivity analyses, separating effect measurements retrieved from RCT’s from effect measures retrieved through other study designs, to evaluate whether this alters the review results. I see no reason to associate the idea of drawing from a variety of methodologies to positivism. I agree with the authors that the qualitative research community has not yet established a coherent point of view on whether or not to lump findings from qualitative studies using different qualitative approaches. Bearman and Dawson give voice to the opponents of the lumping technique and argue that lumping potentially distorts the findings, but don’ t elaborate on this point. I personally see value in a synthesis approach that concentrates on the findings from an original research paper –often reported by authors as themes, categories, theoretical concepts, metaphors or viewpoints- as the unit of data extraction. I do not think there is a valid argument for QES authors to distinguish between methodologies and theoretical assumptions or to discourage them to synthesize findings from studies using radically different, even competing methodological designs for a well defined topic of interest. These methodologies often share a similar set of epistemological assumptions. Most QES would benefit from adopting a pluralist position that values viewing a particular phenomenon or topic of interest from different perspectives. This is in line with Walsh and Downe’s (2) argument that “bringing together qualitative studies in a related area enables the nuances, taken-for-granted assumptions, and textured milieu of varying accounts to be exposed, described and explained in ways that bring fresh insights”. (1) Bearman M & Dawson P. Qualitative synthesis and systematic review in health professions education. Medical Education 2013; 47: 252–260. doi:10.1111/medu.12092 (2) Walsh D, & Downe S. Meta-synthesis method for qualitative research: a literature review. Journal of Advanced Nursing 2005; 50: 204–211. doi: 10.1111/j.1365-2648.2005.03380.xstatus: publishe