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Lara Onbaşi
#3 | 16th May 2022
"The value and potential of qualitative methods in neurosurgery from the perspective of a fourth year medical student"
by Samin Davoody, Shahid Beheshti University of Medical Sciences, Iran

This is Samin Davoody, a 4th-year Medical Student at Shahid Beheshti University of Medical Sciences in Tehran, Iran. Throughout my academic journey, I had the chance to be engaged in the fabulous NEUROQUAL Team and then more deeply learned about qualitative research in Neurosurgery. After going through the released content on NEUROQUAL, to be honest, I realized how limited and stereotyped my knowledge on Qualitative Research was! For example, I used to think qualitative research, might be less valuable than studies associated with statistical analysis! I think some of these misunderstandings might also happen to my other peers as well! If this holds true for you, in this short article, I am trying to share some interesting points I read and highlighted in the recent and great paper by Dr. Whiffin(1); the paper really helped me become aware of my comprehension about the issue, as it aims to resolve some of the misunderstandings regarding qualitative research and review or somewhat question the research designs used in the field of Neurosurgery! By the way, this paper is titled “The Value and Potential of Qualitative Research Methods in Neurosurgery” recently written by Dr. Charlie Whiffin et al.!

As a quick review, we recall that qualitative research explores participants' experiences by using in-depth, non-numerical data collection methods(2). Did you know that one of the advantages of qualitative research over quantitative research is the potency of it to share important insights and the participants’ own perception of a particular treatment or intervention??!! I wondered qualitative research might be helpful, but was not very well aware how! I think this way of impact is also very useful in research, since it helps clinicians to understand the patient perspective directly! Moreover, clinicians benefit in understanding the patients' perspective and be more aware of the treatment options and outcomes, communication and decision making, and medical errors. Now, Khu and Midha‘s(3) endeavor to encourage researchers to conduct more qualitative research makes sense to me! Additionally, did you know that the other advantage of qualitative research the beneficial use of it for understanding phenomena not observed naturally?

As I told earlier, before starting to explore the useful content about qualitative research in Neurosurgery, I had the thought that qualitative research may be less valuable than quantitative research. I think some journal boards may still think the same way, since there are not many published papers on qualitative research in Neurosurgery, considering them unscientific or anecdotal. However, the interesting point I read in this paper was that both qualitative and quantitative research had the same academic impact according to a bibliometric and altimetric analysis(4). One of the misunderstandings that we might have about qualitative studies is that we would consider this type of research similar to case series or case reports. However, I very well realized that case reports and case series are 'publication types', whereas qualitative research is ' a systematic form of empirical inquiry based on explicit sampling and in-depth analytical approaches. '! This is interesting, isn’t it?

I also wondered how qualitative research can be used efficiently in the field of neurosurgery. I was like “okay, I got how good also this type of research is, but please just tell me how this will be good for my favorite field of science as well?!” The paper answers very well, and compares qualitative methods (the mere collection of qualitative data and associated techniques) and qualitative methodology (the application of these techniques within a qualitative paradigm) and refers to them as ' small q versus big Q'. Dr. Whiffin states that the use of qualitative techniques but not incorporating qualitative thinking in some studies, and the use of qualitative theory to enhance a research design in other ones would be helpful to consider and understand the heterogeneity within the field of qualitative inquiry. To make the context easy, the paper brings up a good example reading below:

For example, researchers may want to know more about patient acceptability of a neurosurgical intervention while participating in a randomized control trial. Researchers in this study may value the quantification of relevant themes or concepts to answer their research question. In contrast, researchers may want to understand the lived experience of surviving severe head injury. This research is more likely to value in-depth interpretive themes to answer the research question, relying less on quantification and more on meaning, and as such be designed within a qualitative paradigm.

I found a good answer to my question after this, what about you?!

References

  1. Whiffin CJ, Smith BG, Selveindran SM, Bashford T, Esene IN, Mee H, Barki MT, Baticulon RE, Khu KJ, Hutchinson PJ, Kolias AG. Qualitative Research Methods in Neurosurgery: An Unexplored Avenue. World Neurosurg. 2021 Dec 18:S1878-8750(21)01884-2. doi: 10.1016/j.wneu.2021.12.040. Epub ahead of print. PMID: 34929363.
  2. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15:398-405.
  3. Khu KJ, Midha R. Editorial: Qualitative research in brachial plexus injury. J Neurosurg. 2015;122: 1411-1412.
  4. Retrouvey H, Webster F, Zhong T, Gagliardi AR, Baxter NN. Cross-sectional analysis of bibliometrics and altmetrics: comparing the impact of qualitative and quantitative articles in the British Medical Journal. BMJ Open. 2020;10:e040950.

Yusuf Docrat
#2 | 18th November 2021
"Qualitative Methods in Medicine: The perspective of a South African medical student"
by Yusuf Docrat, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa

A large proportion of my understanding of qualitative methods came from conversations with my grandmother- an academic clinical psychologist and aunt- a social sciences researcher. Throughout my experience in medical school it appeared as though qualitative research methodologies were championed by the health professions education academics and the allied health professions, most prominently, occupational therapy graduates who regularly create publishable qualitative research in pursuit of their honours degrees. This high standard of qualitative research is significantly lacking in undergraduate medicine classes, and consequently at the registrar level, when specialising post-graduates are required to complete their masters’ theses.

Varied research methodologies are incrementally being brought into focus in our syllabus, as global health has risen in research output and academic interest internationally - especially since the COVID-19 pandemic. During our undergraduate years, we predominantly focus on quantitative methods and interpreting information from literature in biostatistics and epidemiology topics. These comprised parts of theory modules, with the outcome being the creation of clinicians versed in interpreting academic literature, not necessarily synthesising and disseminating it. Little emphasis was placed on the practicalities of conducting research, let alone qualitative methods. While I may sound critical of this minute flaw in an otherwise well-run programme (I choose to ignore the late notice clinical rotation scheduling and delays in receiving our marks), it’s important to remember the system in which we are training.

Our healthcare system, like several other sub-Saharan countries, suffers the so-called “quadruple burden of disease” – a cocktail of colliding epidemics: Human Immunodeficiency Virus (HIV) and Tuberculosis (TB); a lack of maternal and child health services; the immense burden of non-communicable disease; as well as violence and injury. In addition, the severely restricted human, physical and financial resources further worsen the morbidity and mortality outcomes of populations that the system primarily serves – disadvantaged socio-economic and racial groups. The focus within these systems, generally, is the optimisation of resources, which has a major quantitative component, hence a large focus on quantitative research within medicine in lower-middle income countries (LMICs).

The collective systemic struggles are not restricted to any one discipline. Africa is responsible for 15% of the global neurosurgical burden yet has access to only 1% of the global neurosurgical service.1 Although the number of neurosurgeons in Africa is concentrated in Northern Africa and South Africa, there exists a clear deficit of neurosurgeons within South Africa, compared to higher-income nations in the global North.2 Consequently, this negatively influences research output from these African centres for neurosurgery which is reflective of other medical disciplines in several academically active LMICs.

Emphasis placed on quantitative studies has been the prevailing trend within medicine. Quantitative methods are seen to provide “reliable” and “actionable” information to make rapid changes in response to healthcare system challenges. A problem with this method is that one should not consider patients as numbers. The quality of care, patient perceptions, their thoughts and feelings are exceedingly important facets of a patient’s health. These facets are easily neglected in the continued struggle to improve access to care in a stressed healthcare system that may often be very numbers driven. The qualitative research output is further confounded by academic culture that regards quantitative studies more generative of citations and providing “higher quality” data.

A quick literature search on PubMed and Google Scholar yields very few qualitative studies of high standards within neurosurgery that are uniquely South African or led by researchers in any LMIC, for that matter. This can be attributed to many things, most notably the lack of neurosurgical resource access in LMICs. This aside, the fact remains that there exists a need for support and development of qualitative research within neurosurgery, especially in LMICs. That’s where I feel that Neuro_Qual could be incredibly beneficial.

With a ground-up approach, this invaluable resource effectively provides researchers new to qualitative paradigms, with the tools they need to plan, execute, and contribute valuable qualitative research to the growing international body of work. Those looking to delve deeper into the world of qualitative research can rest assured that the information and support Neuro_Qual provides will be superior by effectively working as a constantly updated online, open-sourced, multimedia textbook supported by experts and international contributors. For the development of African health research capabilities, the impact of this resource is endless. I look forward to following the development of the resource and how it influences qualitative research output across the African continent.

References

  1. Dewan, M. C. et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. Journal of Neurosurgery130, 1055–1064 (2019).
  2. Khamlichi, A. E. African Neurosurgery. Surgical Neurology49, 342–347 (1998).

Lara Onbaşi
#1 | 14th October 2021
"Using NEURO_QUAL as a medical student"
by Lara Onbasi, Hacettepe University Faculty of Medicine, Ankara, Turkey

As a medical student, I believe one of the most important aspects of medical practice for me to learn is the qualitative aspect of research and treatment. I see this as a very crucial part of my training because it will help me understand patient experiences and how change can be implemented in different areas of medicine. So, I find it very exciting whenever I see new research published on the qualitative aspects of neurosurgery, since it is a specialty that I am very interested in, and try to keep up with the increasing knowledge in this field as much as I can. That is how I found Neuro_Qual and as soon as I saw the vision for this project, I knew that I wanted to be a part of it. It is incredible to be a part of the team working on Neuro_Qual, which will undoubtedly be an invaluable resource for neurosurgeons and neurosurgery & research enthusiasts around the globe.

Even though we are taught about many different medical specialties and get to have some experience in most of them throughout our education, it is unfortunately less often that we get the chance to explore the intricacies and the meaning behind different research paradigms. This is especially pronounced when it comes to qualitative research. I see the opportunity to learn about this subject and its overall importance very valuable, since it has incredible potential to help us explore, understand, and improve our approaches to different parts of medical practice. Having access to a comprehensive resource to learn about this is truly amazing.

The fact that the content of this resource is supported with podcasts and the approach to the topics are from a really interesting and fundamental point of view, will help make it even more useful. It has made me motivated to be involved in qualitative research, especially since I am starting to build my knowledge on this subject with a methodological perspective through Neuro_Qual. I also see this project as having the potential to reach many people and encourage them to explore and engage in qualitative research. I hope that many people working in the field of neurosurgery or just interested in this specialty get to benefit from Neuro_Qual and learn about the importance and principles of qualitative research in neurosurgery. I am also looking forward to using and discovering more about the field that I am interested in with Neuro_Qual myself, of course!