Abstract
In this paper the authors discuss their experiences as graduate students using qualitative approaches to conduct health research. They explore how their engagement with qualitative research has related to feelings of humility, the desire to honor research participants' stories, challenges of pacing and other practical considerations, experiences of isolation and uncertainty, struggles with method and methodology, and moments of elation and discovery. They offer practical suggestions for students who are beginning similar academic endeavors. Supervisors might also find this paper of interest as they mentor and guide graduate students who are using qualitative methods.
Keywords
Introduction
Our motivation in writing this paper was to offer a student response to the panel discussion entitled Mentoring Students in Research Methodologies That Go “Against the Grain” of Conventional Health Research (McGill Qualitative Health Research Group Conference, Ensuring Quality in Qualitative Research, Montreal, April 5, 2007). The three of us are health professionals at different stages of our doctoral studies at McGill University, where we are engaged in qualitative research projects: LC has recently completed her coursework and is writing her research proposal, MH is in the midst of data collection and analysis, and AM is in the process of analyzing her data and writing up her findings. MH is a physiotherapist and a student in the Division of Experimental Medicine, and AM and LC are nurses and students in the School of Nursing.
In health research quantitative methodologies predominate. As clinicians engaging in graduate studies and using qualitative methods we have experienced challenges in using methods that go against the grain in our applied health disciplines. In our discussions with other graduate students in similar programs our experiences seem far from unique. For some people, choosing to use a qualitative method might simply be a matter of upholding the maxim of allowing your research question to determine study design. For us, this process has not always been straightforward and has involved many challenges, including being introduced to and becoming engaged with a completely different knowledge base and paradigm, muddling through different kinds of methodological questions than peers who work within a more quantitative world, deviating from strong quantitative traditions in our respective faculties; reflecting on what it means to “collect data” and cocreate findings with participants, and, finally, learning to pace ourselves and deal with times of uncertainty and feeling alone. In this paper we briefly explore various issues related to being graduate students doing qualitative health research. These include feelings of humility, the desire to honor participants' stories, the challenges of pacing and real-world considerations, feelings of isolation and uncertainty, struggles with method and methodology, and moments of elation and discovery. We then draw on our experiences to offer practical suggestions for students who are beginning similar academic endeavors.
Our hope is that other students conducting qualitative health research will relate to some of our reflections and experiences and, in so doing, feel less isolated. Supervisors might also find this paper of interest as they mentor and guide graduate students using qualitative methods. As we were writing this paper, it became clearer to us that we were not alone with our struggles; simply sharing these common experiences proved to be a beneficial exercise.
Humility
Learning to conduct qualitative research can be a humbling experience. For us, such humbling moments have occurred when attempting to absorb all of the knowledge that was required to be able to address our research topics and when faced with the task of entering into the worlds of other people's experiences. An important source of humility is the awareness of the role we play as researchers in sorting out these stories, making sense of them, and then drawing our own conclusions from them. Another humbling aspect of the research process is the realization that you cannot know everything about your topic or about research methods. We have had to familiarize ourselves with a broad literature, including readings from philosophy, anthropology, and sociology as well as our own research and professional domains. Just how much knowledge is required? It seems clear that the process of doing a doctorate requires developing and broadening one's knowledge base. This has meant that we are confronted by the realization that there is a lot of knowledge that we do not have and did not even realize we needed. Before beginning, it can be difficult to imagine the amount of material there is to learn, yet it seems that as you read and come to know more, you realize how much more there is to learn.
Honoring the Stories
When conducting our qualitative projects, we have felt deeply privileged when we are invited to hear people's stories. Doing qualitative research involves “getting up close and personal” with participants, and we recognize that this involves an important commitment from them as well. These people take time out of their lives to share their stories, relate meaningful and sometimes difficult experiences, respond to challenging questions, and even allow us to accompany them throughout some of these experiences. We have felt fortunate to share these stories and have struggled with the responsibility of how best to convey them in an authentic manner. In our past experience as health care providers, the idea of honoring the stories was accomplished differently. Previously, honoring the stories was understood in more clinical terms: conducting an assessment and formulating a care plan, followed by an evaluation or follow-up. As we move from this clinical role to research, at times we worry that we might have less to offer as we no longer provide “care.” Where we once practiced competently, we now struggle as novices. However, it is this same clinical experience that has stimulated each of us to conduct our research projects, bringing with us our unique perspectives and experiences as health care providers. These particular positions carry their own “baggage” while driving the kind of studies we want to do: striving to better understand processes, experiences, and health care cultures, whether in the home, the hospital, or on the international scene.
Pacing and “real–world” concerns
One of the challenges of graduate school is finding a reasonable pace at which to move through the various steps: coursework, comprehensive exams, data collection and analysis, dissertation writing and defense. The rhythm and pace of qualitative research overlays on this a whole host of considerations. In our experience, the “right” pace for moving through graduate school (and getting on to the next “thing”) sometimes conflicts with what might be best for the research process and with what feels comfortable. Even when the pressures of grad school are not at play, keeping a good rhythm to your work can be difficult: We have sometimes tended to rush through things over which we should have spent more time but at other times lingered on parts of the process that, in retrospect, we probably should have completed more quickly.
Isolation and uncertainty
Qualitative research begins as the curiosity to understand a particular phenomenon. We do not know what will be learned when we set out on the research process. We begin with questions and a focus on something that interests us but the way in which we understand and frame even these most basic questions will shift and change throughout the research process. This is potentially one of the most satisfying aspects of this type of inquiry as perceptions of an issue evolve over time. This evolution of your thinking is necessary and usually represents a deepened understanding of the phenomenon under investigation. At the same time, there is an inherent uncertainty to this process. It can be a challenge to work through this uncertainty, given the unpredictability of how things can unfold and how you as a novice researcher will respond. Each of us has struggled at times with feelings of isolation in our academic journey. Prior to beginning our graduate degrees we had all worked as health professionals, and the counterpoint between clinical practice and independent research has been significant. Health care work is primarily a team-based endeavor. Although everyone functions as an autonomous professional, there is usually a multidisciplinary approach to caring for patients and families. Shifting from the world of the clinician to that of the student researcher has resulted in changes in what it means to “go to work.” In our discussions about being graduate students using qualitative research approaches, there were frequent references to the ways in which we can feel isolated and how isolation contributes to feelings of uncertainty. Indeed, in our experience isolation and uncertainty seem closely related.
Struggling with methods and methodology
The process of entering into qualitative research has required a huge amount of preparatory reading and study that our prior training and experience as health care professionals did not provide. It is striking to look back and realize how much our understanding of qualitative research has expanded over the years of our graduate programs. In talking together, it has also been quite clear how much we do not understand. In particular, it has been challenging to move our theoretical understanding of methods into the analytic, inductive processes of research. Developing an appreciation of why and how things are important can present a particular challenge. With mountains of data it can be difficult to train yourself to identify the critical elements. Clearly, this is a developed skill that is learned through practice and mentoring. It is important to be patient, both with yourself and with the data.
“Oh yeah!” and “aha!” moments
There are great moments when you realize how much you do know and how much you have learned. These include reaching particular milestones in the research process, putting together a piece of the analytic puzzle, and reflecting back on the journey already taken. Each step, each milestone, along the process is a success worthy of celebration. We have found taking this sort of satisfaction in milestones very helpful. Some of the greatest moments come when you begin to see patterns in the data and especially when you find something that so beautifully illustrates the experience you are seeking to understand. The creation of categories, the contemplation of relationships within the data, and the gradual visualization of how it all fits together contribute to a sense of achievement. These “oh yeah!” moments remind you of the importance of what you're doing. Many of our oh yeah! moments have come as we reflected on how far along the process of our doctorates we have already come. Such moments occur when we recognize the knowledge gained from coursework translated into the real world of research. All of a sudden what you read and tried to understand becomes what you are actually doing. Moments of excitement may also come from seeing the potential for contributing to a better understanding of a phenomenon in a way that will increase knowledge and eventually make a difference to the population that is involved.
Suggestions
The following six suggestions outline strategies that we have found helpful as graduate students responding to the challenges of doing qualitative research in the health sciences.
Develop a support network
In our research journeys we have found that community and support have helped us to carry on when things were difficult. Support from supervisors, mentors and fellow students has been crucial in helping us overcome obstacles. The tendency to hole up in the library or always work from home can contribute to feelings of isolation, whereas proximity to fellow (like-minded) students and professors has helped ground us. It can be particularly useful to seek out other students who are also doing qualitative work. Although it can be productive to talk with them about your respective research projects, it might be even more important to have the opportunity to discuss the experience and challenges of being student researchers. In our case, being invited to join the McGill Qualitative Health Research Group has created an instant support group with students and mentors sharing, teaching, and learning from each other.
Pace yourself comfortably
A crucial factor in getting pacing “right” is the support and guidance of supervisors and mentors. Finding a reasonable way of organizing your time and stewarding your energies and resources is not simple. Steps, such as setting realistic deadlines and having regular meetings to monitor progress, can help. When it works, it can be a real benefit in moving forward in the work and sustaining the energy to continue.
Value your individuality: Resist comparing yourself with others
It can also be tempting to compare your pace with other students to see how you measure up. The three of us are all at different stages in our research, so it is natural to look at where we all are and feel pressured to meet the same schedule or produce the same type of results. With qualitative research, however, the questions we are asking, although equally important, are distinctive in nature. Furthermore, we are all addressing our research questions in different ways. We are three different students using three different qualitative methodologies, so it follows that our journeys might overlap, but they are also dissimilar in other respects. Although it can be motivating to look at the progress and accomplishments of others, it is critical to remind yourself that everyone's project might have unique preparatory work to be done in terms of coursework, readings, or practical experiences. The individuality of your project and the fact that you are answering “your” question means you will be doing it your way, and that is perfectly fine.
Do not let your project consume you: Maintain your identity
Becoming absorbed by your readings, your interviews, or the analysis of your data is perfectly natural. In fact, it sometimes feels as though nothing will move forward if you do not completely surround yourself with piles of work from your study. Although it is true that you will be spending a great deal of time doing your research, you do not need to let your project consume you. A change of thinking, a pleasant diversion, or even a complete day off can actually be quite helpful. We all acknowledge taking a day (or two) off, but we also admit that we felt guilty doing so. However, we have felt that when we return to work on our projects, our minds are better able to function and that sometimes a step back can lead to that gentle creative push that had previously been eluding us.
Immersing ourselves in the worlds of others is necessary to understanding people's experiences. It is sometimes hard to remember that we are all still part of our own separate worlds when we are in this process of trying to explore, understand, and sometimes explain the worlds of others. Maintaining connections with our own lives can help to remain grounded and also make us more effective at understanding others. It is important to keep good boundaries. Ultimately, it is up to us to preserve our sanity.
Celebrate those “oh yeah!” and “aha!” moments
The journey of a doctoral student new at qualitative research can be both frustrating and exciting. Although it seems perfectly natural to brood over the low points, we forget that we should take the time to acknowledge the victories (even small ones) and those moments that eventually bring us closer to the answers we are seeking. It sometimes feels that because we are often isolated and immersed in our projects, external validation of our work is rare. It then becomes our responsibility to celebrate the progress we are making and to remind ourselves that there is indeed great pleasure and satisfaction in what we are trying to do.
Train yourself: Develop your knowledge and skills as a researcher
It goes without saying that hard work is necessary for achievement in pursuing a doctoral degree. Each doctoral program is also different and has different requirements for students. We have found that sometimes the basic curriculum, although meeting the general requirements for foundational knowledge, does not always meet individual needs. In these situations seeking out courses in other departments and finding supervisors with different expertise has helped to broaden both our knowledge base and our perspective. For example, many qualitative methodologies have their roots in philosophy, anthropology, and sociology, which might not be areas in which most health sciences students have strong backgrounds. Taking courses or reading seminars in these departments, or enlisting the help of a mentor in one of these fields may be helpful in becoming better versed in these areas and gaining a deeper understanding of the methodology you are employing.
Conclusion
In this paper we have reflected on some of our experiences as health professionals using qualitative research methods in our doctoral projects. There is considerable diversity among the three of us, yet there is also significant common ground to what we have experienced in our graduate programs. We have attempted to communicate these common experiences of humility, isolation, and uncertainty, “oh yeah!” moments, pacing issues, and struggles with methodology. Out of these experiences we have also generated some suggestions that we hope other students following similar academic paths might find helpful.
We hope that this paper will be a source of encouragement and support for other students, provide insight for supervisors, and contribute to discussions among health professionals who have chosen research methods that “go against the grain” of traditional research paradigms in health science research.