Grounding Qualitative Medical Research in Coherence, Not Standards

Qualitative research publications have become more prominent in medical journals. However, in medical discourse, those researchers who are adhere to postpositivist (quantitative) paradigm often criticize diverse qualitative inquiry for a perceived lack of rigor. We suggest that qualitative research, just like quantitative research should be guided by methodological coherence rather than prescriptive standards. Coherence is defined as an alignment between epistemology, theoretical perspective, methodology, methods, and research questions. In the medical field, a lack of training in methodological diversity, a long-held post-positivist privileging, and insufficient methodological dialogue, promulgates reliance on quantitative analyses. Neglecting to articulate sufficient methodological detail has caused other researchers to assert that qualitative research lacks rigor. Providing methodological details permits study replication. Qualitative researchers have been discussing the necessity for this scholastic imperative for decades, although it is relatively new in medical discourse. The authors' interest in this topic stems from an analysis of rigor within qualitative medical educational articles since 2012 (CI), and reviewing grant proposals, doctoral research studies, and publishing in medical journals (LBH, CI). During out work, we observed that while the literature reviews in these submissions are frequently excellent, the method and results sections often lacked the essential linkages that are needed to support methodological coherence. Owing to our interest, we undertook a critical review while using deductive content analysis of forty qualitative articles in a top-tier medical journal. The purpose of this paper is to provide examples of coherence with the qualitative medical article reviewed. Our aim is to provide scholarly guidance to novice medical researchers and practitioners. The authors believe that this information will support increased scholarly integrity and coherence in the qualitative research publications, specifically in medical education and more generally in other discipline-related qualitative studies. We believe that both researchers and readers of qualitative research in academic medicine need to know about these issues so they can capably provide evidence of coherence.