Theoretical Perspectives

The purpose of this section is to highlight the different theoretical

perspectives (also called research philosophies or stances) and to highlight the assumptions that are made about the creation of knowledge in research (Guba and Lincoln, 2005). The study of the natural world aims to explain phenomena (e.g. gravity) using methods that are repeatable and

generalisable in order to understand and make predictions (Illing, 2013). Concern has focused on whether it is appropriate to use the same methods for studying the natural world when studying the social world, for example gravity versus trainees who are having difficulties progressing in their

training. Research that can make generalisations and is predictive in terms of laws and cause and effect and measurement is often considered superior to other forms of knowledge. The methods used to study the natural world do not fit easily with the methods used to study the social world. The debate starts with the study of being – ontology. This is concerned with the structure of existence and reality. The focus starts with a researcher’s assumptions of the basis of reality i.e. there is a real reality (gravity) or there are multiple realities (views of trainees) (Illing, 2013).

The next stage epistemology is to consider the theory of knowledge and how we access this. If we assume that there is a real reality, then we can also assume that the human researcher can have access to it objectively.

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However, if we assume that there are multiple realities then we become aware of the subjectivity of the researcher, and others views (Illing, 2013). There are several main theoretical perspectives within research: positivism, post-positivism and constructivism. These theoretical perspectives underpin the researcher’s methodology and are governed by the researchers’

assumptions that they make about the social world. The different theoretical perspectives change depending upon assumptions made about social reality (Illing, 2013). The three main theoretical perspectives will be summarised in the following section.

2.2.1 Positivism

A positivist approach looks at the explanation of what the human behaviour is. It tries to be predictive and prove or disprove a theory or hypothesis. Positivists view the social world as essentially the same as the natural sciences and researchers aim to identify patterns and rules, which would determine an individual’s behaviour and social behaviour. This assumes that there is a reality and the aim is to explain the natural and social world by cause and effect thus having an objective view of the world can be achieved (Illing, 2013). Methods utilised in this approach are mainly quantitative.

2.2.2 Post-positivism

This perspective came about due to disillusionment with positivism because the outputs were often theoretical, rather than observed, providing a

perspective rather than truth (Illing, 2013). The post-positivist approach still seeks objectivity, like positivism, but it is not absolute. It is recognised that by

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studying something, one can change the phenomena. Collecting of both qualitative and quantitative data is encouraged to help answer the research question. Quality is assessed by using the same standards as positivism, such as validity, reliability and generalisability. New knowledge is added to old in the same way as it is in the positivist paradigm. For example, a

systematic literature review would be considered post-positivist as it attempts to define a method that is standardised (by rating the quality of the research design and methods), repeatable (by following a clear exclusion and

inclusion criteria), but subject to the human researcher who may interpret data differently from another researcher. Phase One (scoping exercise) and Phase Two (literature review) drew on this theoretical stance in answering research questions which were aiming to identify indicators that are

associated with doctors who are experiencing difficulties with progression during their postgraduate medical training and aiming to identify a consensus about the risks and vulnerabilities. Similarly, in Phase One the aim was to identify which specialty trainees had difficulty progressing through their annual review by interrogating retrospective ARCP data to identify characteristics and demographics.

2.2.3 Constructivism

In contrast, a constructivist approach believes that knowledge is constructed between the researcher and the data, with multiple views of reality. The researcher must be aware that they cannot be neutral and that they bring their own experience, knowledge and values to the research whilst working towards uncovering a new understanding (Illing, 2007). Constructivists

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believe that all meaning is socially constructed (Illing, 2013). A constructivist approach tries to understand, and make some sense from, human behaviour (Illing, 2007).

Constructivists do not begin with a theory (as with positivists and post- positivists), rather they: "generate or inductively develop a theory or pattern

of meanings" (Creswell, 2003, p.9) throughout the research process. Reality

depends upon how it is perceived by an individual, who may interpret things differently from another individual. This perception of reality can change over time depending upon, for example, experiences or knowledge. Therefore, constructivists approach reality as subjective. The knowledge gained from the research is a new concept but seen through the lens of the researcher (Illing, 2013). A constructivist researcher is most likely to rely on qualitative data. My research question for Phase Three was to identify trainer and trainee perceptions of the barriers and facilitators to progression through specialty training. Here I am collecting data about the subjective views of the trainers and trainees about specialty medical training, and I am adding my own interpretation and constructing new meaning about this data.

The final research objective was to develop a model that will help identify which doctors are most at risk of adverse ARCP outcomes, in order to improve support for them, and this was drawing on the data collected in Phase Three and informed by Phases One and Two.

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