Chapter 2 Methodology Chapter
2.6 Methods
The previous sections within this chapter have discussed the research paradigm and the methodological approach taken for this thesis. The
following section of this chapter provides a summary of the methods used to collect and analyse the data. A more in-depth methods section is provided under each of the findings chapters (Chapters 3, 4 and 5).
Data was collected using a mixture of retrospective observation of ARCP data, aliterature review and in-depth interviews with trainees who had received an adverse ARCP outcome, and with trainers in secondary
specialty training. In utilising a mixed method approach, I could follow where the data took me and follow up on gaps in the data. Initially, I had planned to use a survey technique to see why trainees were having difficulties, at what stages, and why they were having difficulties progressing. However, one of the findings from the literature review was that previous research in this area had mostly used surveys. I wanted to understand what was going on in more depth rather than know what the problems were. I had a hunch that issues were not one-dimensional and that there were interconnected multi-
dimensional issues and factors at play. Therefore, I decided to use in depth one to one interviews with trainees and trainers to explain some of the indicators that had emerged from the literature review but also allowing new ideas to emerge from the interview data.
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The following data collection methods were used: 1. Retrospective Observational Study
2. Literature Review
3. Interviews with trainers and trainers in Specialty training
2.6.1 Mixed Methods Approach
A mixed methods approach was used in this research as it was deemed the best approach to answering the research question and objectives of the study.
“Conducting mixed methods research involves collecting, analysing, and interpreting quantitative and qualitative data in a single study or in a series of studies that investigate the same underlying phenomenon”
(Onwuegbuzie and Leech, 2006, p.474)
One of the benefits of using mixed methods is being able to be flexible and follow where the data takes you, which is ideal for Grounded Theory. By combining methods, you can gain both greater internal validity through qualitative methods and greater external validity through quantitative methods. One can reach a balance of being able to use controlled
environments with replicable measures in the quantitative methods whilst being able to gain a knowledge of the context, its meaning and the
relationships in the qualitative research (Yardley and Bishop, 2009).
A mixed methods approach is beneficial for this research as the qualitative data adds meaning to the quantitative data and helps to understand and
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explain the data more fully and provide a deeper understanding (Bryman, 2006; Bryman 2008; Illing, 2007).
Individual methods for each phase of the study will be explained within each data chapter. However, a summary will be given for explanation under each phase of the study in this chapter.
2.6.2 Phase 1- Retrospective Observational Study Method
The overall aim of Phase One was to identify which specialty trainees have difficulty progressing through their annual review and reasons why over a five-year period (2009-2013).
To help achieve the aim of this scoping exercise the following methods were adopted:
1. Meetings with key members of staff at Health Education England regional office to investigate what data and information was held about trainees who have had extended periods of training.
2. Analysis of retrospective observation of data held by HEE regional office on doctors in training who had received adverse ARCP outcomes during their training.
2.6.2.1 Database Information
Data was interrogated in one HEE regional office to establish if there were any patterns or characteristics such as gender, age, ethnicity, or country of medical school qualification, which related to trainees receiving adverse ARCP/RITA outcomes. Analysis also attempted to explore why an adverse
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ARCP/RITA outcome was received. A trainee could receive an adverse outcome for a single reason or for multiple reasons (see Chapter 3, Table 3 for a list of reasons). An in-depth description will be given in Chapter 3 detailing the method and analysis undertaken in Phase One of the research.
2.6.3 Phase 2 – literature review
A systematic literature review was undertaken to examine the literature and identify the indicators that are associated with doctors who are experiencing difficulties with progressing during their postgraduate medical training. A full overview of methods used in Phase Two will be outlined in Chapter 4.
2.6.4 Phase 3 – Qualitative interviews with trainees and trainers
The aim of Phase Three was to identify trainer and trainee perceptions of the barriers and enablers to progressing through specialty training using a
Constructivist Grounded Theory approach. A more in-depth methods overview will be given in Chapter 5.
2.6.4.1 Triangulation
The researcher can look at and combine different ways of looking at a
phenomenon (Silverman, 2005). Triangulation occurred through interviewing both trainees and trainers and by using different methods through
interrogating the training data in Phase One (see Chapter 3) and also through use of a systematic literature review in Phase Two (see Chapter 4). The use of a mixed methods approach also helps with triangulation as it seeks convergence or corroboration of results across quantitative and
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qualitative methods (Yardley and Bishop, 2009). A mixed methods approach was used within this research.
The constant comparison method used in grounded theory can also aid with research rigour and trustworthiness because the researcher is seeking to look at data from other sources, compare, and contrast that data. This research used a constructivist Grounded Theory approach and data and themes were compared to ensure that the findings were grounded in the data.
During this research, findings have been presented at several local, national and international medical education conferences and research discussions, and the findings have been discussed and supported with practitioners and medical educationalists. Despite the diversity in medical education and health systems globally, there were some similarities in the findings in other parts of the world when presented at international conferences. Having the opportunity to be able to present and discuss findings at various stages of my research enabled me to critically reflect on the findings and analysis and try to test out my theories and develop my ideas further. This was especially useful in Phase Three of my thesis.
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