Introduction to Methodology

The term methodology can be defined as “the philosophical framework and the fundamental assumptions” that underpin all research (Creswell & Plano Clark, 2007, p. 4). All research studies contain assumptions about the world (i.e., a particular

worldview) and about how to capture the knowledge that is sought. Possessing a worldview or a paradigm is central to the research process because it incorporates a belief system (i.e., how we view the world) and a framework that guides all research (i.e., how we undertake research) (Creswell & Plano Clark, 2007).

Crotty (1998) identified four key elements for consideration when designing a study: the philosophical assumption (epistemology, ontology) of how knowledge is acquired; the theoretical stance (e.g., social science, feminist) that a researcher may or may not use, which is informed by the former; the methodological approach or research design (experiment, mixed methods, ethnography); and the methods (interviews,

surveys, instruments) used to gather, analyse and interpret data from the study (Creswell & Plano Clarke, 2011).

Given that the purpose of this study is to explore anatomy retention in students enrolled in a graduate-entry MBBS course, two worldviews or assumptions about anatomy retention were made, which ultimately formed the philosophical foundations for this research.

The first follows the epistemological view of post-positivism, which states that there is an objective reality that can be measured, controlled and predicted according to patterns of observations. Therefore, the phenomenon observed is “hard, real and

view is primarily based on the assumption of determinism, which states that “events have causes and events are determined by other circumstances” (Cohen et al., 2007, p. 11). Therefore, a cause-and-effect relationship takes place in the world, and “these causal links can be uncovered and understood” (Cohen et al., 2007, p. 11). The term

event refers to anatomy knowledge, causes refers to anatomy teaching in the medical curriculum (e.g., time, duration, type), and effect refers to retention of anatomy knowledge in medical students. Therefore, under this view, the teaching of anatomy (which is largely determined by circumstances such as program duration, money, time, resources and university initiatives) in the medical curriculum could be seen to affect students’ knowledge and retention of anatomy in the later clinical years; thus, this potential causal link is explored further through appropriate research methods. As Creswell and Plano Clarke (2011) state, “postpositivism is often associated with quantitative approaches” (p. 40), and its aim is that of theory verification through deductive reasoning. The hypothesis tested in this study is that the more anatomy teaching a student is exposed to over the course of their MBBS degree, or the more recent their formal anatomy instruction, the better their retention of anatomy knowledge.

The second epistemological view associated with this study is that of

constructivism, which is defined by Spratt et al. (2004) as:

a theory which holds that social phenomena and their meanings are constructed by the people involved in using them, rather than being external objects existing independently of them, in contrast to positivism. (p. 7)

That is, participants’ views and experiences in a situation are important for exploring the interactions and outcomes that these individuals have with the world (Cohen et al., 2007). Thus, the assumption here is that any phenomenon observed can

only be understood through the subjective reality of participants and their views. These views are usually shaped by participants’ social interactions with the world and their own past experiences (Cohen et al., 2007; Creswell & Plano Clarke, 2011). Therefore, good or poor retention of anatomy knowledge may depend on students’ experiences in the pre-clinical and clinical years, as well as their motivation and interest in anatomy and their priorities at the time. Thus, using qualitative methods, an in-depth description and exploration of these issues can be observed from multiple perspectives, and a bottom–up, inductive reasoning approach can be applied to generate broad patterns and understandings of anatomy retention among participants (Creswell & Plano Clarke, 2011).

Using the two philosophical assumptions as the basis for this research, and considering the research questions posed, a mixed-methods research approach is employed to answer the three research questions:

 How does anatomy knowledge differ among students in the pre-clinical and clinical years of the MBBS course?

 To what extent do medical students retain anatomy knowledge?

 What factors may account for the loss or retention of anatomy knowledge across a student’s medical degree?

Mixed-methods research dates to the late 1980s and early 1990s, when several authors documented their approach to using both quantitative and qualitative strands in a single study (Brewer & Hunter, 1989; Bryman, 1988; Creswell, 1994; Fielding & Fielding, 1986; Greene, Caracelli, & Graham, 1989) to provide a comprehensive picture of complex research problems (Creswell & Plano Clark, 2011). Despite the

incompatibility thesis controversy, which suggests that researchers are doomed to fail when they employ two research methods together because of the incongruity of the

principal paradigms underlying each of the methods (Tashakkori, 2003), many

researchers have demonstrated that a “peaceful coexistence of multiple methodologies is possible” (Venkatesh et al., 2013, p. 22).

Today, mixed-methods research is known as the “third methodological movement or paradigm” (Venkatesh et al., 2013, p. 21) because more than one worldview can be used in a mixed-methods study. Further, the adoption of multiple paradigms often relates to the type of design chosen in a mixed-methods study (Creswell & Plano Clark, 2011).