Integrating Theory Into Qualitative Medical Education Research

Abstract

“Theory” as a construct can be ambiguous. Those who wish to conduct a qualitative study for the first time may struggle to see how theory can be used to support and enrich qualitative scholarship and research.Explicitly applying theory to strengthen qualitative research studies is increasingly required by journals and reviewers. However, individuals new to qualitative research may struggle to grasp the central importance of theory and to choose amidst the huge array of existing theories.Theory is defined as “a symbolic depiction of aspects of reality that are discovered or invented for describing, explaining, predicting, or prescribing responses, events, situations, conditions, or relationships.”1 In other words, a theory is a set of ideas about how the world works. Theory informs various stages of the research process and can clarify the scope and nature of a problem; it also guides the development of research questions and contextualizes the insights drawn from the analysis of data. Researchers must consider choices about theory as part of a strategy for generating understanding of the events or conditions being studied. Thus, it is important to consider how applying theory to the research process will shape the conclusions drawn, and to question how the articulation of the way the world “works” makes particular knowledge claims possible while simultaneously foreclosing others. For a discussion of the importance of being reflexive with regard to the role researchers' play in the creation of reality, see Qualitative Rip Out “Research Design Considerations.”2The thoughtful use of theory in medical education research allows us to (1) build on one another's work in order to engage in innovative scientific conversation; (2) deepen our understanding of the problems with which we grapple with in the field; and (3) comprehend the fractured, multiple, intersecting, complex contexts of medical education and care provision. Theory is essential to the scientific enterprise because it connects local, specific phenomena to similar ones elsewhere; it enables cumulative knowledge production through the refinement or reconsideration of our understanding of the world; and it brings people into a conversation about the nature and value of our theories and associated practices.Researchers need a deep grasp of theory to engage in rigorous medical education research. However, the requirement to use theory can be overwhelming because there are hundreds of theories in use, each associated with a particular discipline and tradition. For example, there are 3 levels of theory: grand theories (focused on abstract concepts); mid-range theories (focused on cultural and contextual variation); and micro theories (focused on interplay of individual experience, action, interaction, and context), all with different foci and explanatory power.3 There is also a difference between “formal theories” (eg, social network theory) that are abstract and discrete from the specific settings being studied and “substantive theories” (eg, a situated model of clinical learning4) generated from researchers' own data and the phenomena studied.5Those unfamiliar with theory might find it difficult to assess the “quality” of a theory, and to tell whether it is “relevant” to the framing of the problem, research questions asked, and implications drawn. To further add to this complexity, across the social sciences—as in other types of science—some theories have (1) been proven to be false and have thus been replaced by more accurate ones; (2) been challenged and refined; and (3) coexisted and employed simultaneously in considering different aspects of a research question.Qualitative researchers may draw on a single theory or multiple theories when designing a study. This serves to highlight aspects of processes, activities, events, and interactions in the context of medical education and practice. The theory or theories ultimately chosen should fit the phenomena being studied. In the literature, there are many thoughtful descriptions of how conceptual frameworks can be applied in qualitative medical education research.3,6–9Given the above complexities, choosing and applying theory requires thoughtful consideration.Research quality and rigor can be enhanced through the integration of theory.10 We suggest you begin theory integration using 3 simple steps:Your work should move the field of medical education forward by simultaneously advancing theoretical and empirical knowledge. We present 4 tips that can help enhance your scholarly work in the field of medical education over the long term.