5 hours in qualitative research

A recent article published in Physiotherapy Theory & Practice found that US-based physical therapy programs allocate, on average, just five hours to teaching qualitative research."

The article by Michelle Wormley and a team of US-based academics, including the venerable Gail Jensen, reported on a descriptive qualitative study of time spent learning about qualitative research across 70 US physical therapy programs.

Of those 70 programs, six had no qualitative research content whatsoever, and the remaining 64 had on average only five hours teaching in the subject. Half of this content — perhaps three hours? — was given in year one, which means the 2nd and 3rd year students had about an hour on the subject each year.

If the three years equates to roughly 5,000 hours of learning, that’s just 0.1% of their curriculum given to qualitative thinking.

Now, as someone with a bit of experience of this, it’s always been my belief that the amount of time given to qualitative research in physiotherapy curricula is a good measure of how the profession is maturing. So the results of this recent study doesn’t sound particularly encouraging.

I started teaching qualitative research at Sheffield Hallam University in the early 90s when all approaches to research were embryonic in the profession. And I continued teaching it for nearly 15 years after we’d emigrated to Aotearoa New Zealand in 2000. So I know first hand how hard it is to chisel time out of the over-stuffed physiotherapy curriculum to teach this content.

I also know how hard it is to compete with the quant researchers who, justifiably I believe, feel the pressure of evidence-based practice and want their students to be hearty and capable research consumers when they graduate.

But this isn’t the biggest problem one faces when trying to teach qualitative research.

The primary issue lies in the overwhelming influence of the rest of the physiotherapy curriculum on students. It’s only when you come to teach something counter-cultural that you realise just how deeply saturated in quantitative, reductive, objective, positivistic, and instrumental thinking the rest of the PT curriculum is.

So it’s not the 3 hours spent teaching the students about correlation coefficients or how to use ANOVAs that’s the problem; it’s the hours, days and weeks they spend learning the origins and insertions of the muscles of the lower leg; it’s the time they spend wrestling with oxygen dissociation curves and the pathology of tissue injury; it’s in the cognitive real estate they’re expected to devote to learning the biomechanics of the hip, the right way to conduct apprehension tests of the shoulder, and five techniques for balance training in people at risk of falls.

Even if there was 50 hours given over to qualitative research it would make little difference, because almost everything else the students experience about physiotherapy is Quantitative (with a capital Q).

Will, fishing for mackerel, Newlyn. Source.

So many times when I was teaching qualitative research I’d have to start by confronting this problem. Over the course of 25 years, I discovered only two inadequate solutions to this problem.

The first was to give the students an authentic experience of a qualitative world from the get-go, in the hope that they’d be seduced by the possibilities of thinking otherwise and want to know more. I’d show them examples of great qualitative health research and talk about qualitative thinking applied to physiotherapy with ideas like embodiment, intentionality and pain, the fear of living with chronic breathlessness, disability stigma, the gendering of their profession, and so on. There would be a bit of methods teaching, but the emphasis was on how to think qualitatively.

The second tried to tap into their existing, albeit limited, experience of clinical practice and show them how qualitative research often looked a lot like patient work. They’d learn why qual studies made use of bias and small sample sizes, they’d have a go at thematically analysing some real data, they’d think about what constituted rigour, and we’d talk about ways of writing up their findings. There would be a bit more philosophy and the methods teaching would look a bit like quant-lite, but at least it built on an instrumental way of thinking they were more familiar with.

Neither of course worked very well, and I always felt I was trying to explain why qualitative researchers could justify being so different, while everything else around them was about biological processes, reliably objective measurement, facts about the body, and treatment efficiency.

Some instinctively got it, and you could see it had a minor effect on others, but for the majority it was only ever a curious indulgence or, most depressingly of all, an annoying departure from ‘real’ physiotherapy.

More than anything I found it exhausting to teach, and I always felt it took twice as much energy and effort to coax the students through the learning than anything else I taught.

It took so much out of you in part because of the limited time you were given. Teaching something counter-cultural is one thing if you have time to staircase the learning. It’s a different thing altogether if the shock of the new has to be accomplished in a few short hours.

So I have only the greatest sympathy for the lecturers who are attempting to engage the students in thinking qualitatively in just five hours over three years.

Looking at the way qualitative research is described in the article — and here the emphasis on supporting evidence-based decisions-making is perhaps key — I’d say much of what is taught is denuded of any truly qualitative thinking anyway. And its true that it’s easier to teach a bloodless form of qualitative research than a fully realised one. But there’s no doubt from my experience that when you teach qual like this, the students misses out.

The real kicker here, though, is that physiotherapists have been talking for years now about wanting to move away from a reliance on the body-as-machine, and many have recognised that the answer lies in more subjective, inter-relational, existential, socially constructed and critical ways of thinking: exactly the things that qualitative research excels at.

Plus ça change, plus c'est la même chose.