Mary Ellen Macdonald

An open letter to The BMJ editors on qualitative research

Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

Faculty development: a ‘Field of Dreams’?

Objectives  Participants in faculty development workshops often comment that ‘those who need faculty development the most attend the least’. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers’ needs.

Faculty development: if you build it, they will come.

Medical Education 2010: 44: 900–907

The Osler Fellowship: an apprenticeship for medical educators.

Purpose As part of a renewed focus on the physician as healer and professional at McGill University, faculty members were recruited to teach in a four-year, longitudinal doctoring course called Physician Apprenticeship. The goal of this study was to examine the impact of this experience and the accompanying faculty development program on the teachers, known as Osler Fellows. Method An interviewer conducted semistructured interviews with 23 clinicians to understand their experiences as Osler Fellows and ascertain their views on how the workshop-based faculty development program, designed to mirror student experiences, differed from other professional development activities. Results The notion of connection and reconnection with the profession emerged as a major theme, consisting of four subthemes: the joy of working with students, the desire to make a difference, the process of reflection and renewal, and the building of community. Distinctive aspects of the faculty development program included the value of a common purpose, content that corresponded with core values, a sense of continuity, peer mentorship, and the emergence of a community of practice. Teachers also reported a sense of honor in being associated with Oslers name and a feeling of privilege in accompanying students on their journeys of discovery. Conclusions Participating in the Osler Fellowship, an example of situated and work-based learning, resulted in a sense of connection with students, medical education, core professional values, and colleagues. As medical educators continue to develop longitudinal mentoring programs, the authors hope that these findings will offer insights on faculty development, recruitment, and renewal.

The interpretation of systematic reviews with meta-analyses: an objective or subjective process?

BackgroundDiscrepancies between the conclusions of different meta-analyses (quantitative syntheses of systematic reviews) are often ascribed to methodological differences. The objective of this study was to determine the discordance in interpretations when meta-analysts are presented with identical data.MethodsWe searched the literature for all randomized clinical trials (RCT) and review articles on the efficacy of intravenous magnesium in the early post-myocardial infarction period. We organized the articles chronologically and grouped them in packages. The first package included the first RCT, and a summary of the review articles published prior to first RCT. The second package contained the second and third RCT, a meta-analysis based on the data, and a summary of all review articles published prior to the third RCT. Similar packages were created for the 5th RCT, 10th RCT, 20th RCT and 23rd RCT (all articles). We presented the packages one at a time to eight different reviewers and asked them to answer three clinical questions after each package based solely on the information provided. The clinical questions included whether 1) they believed magnesium is now proven beneficial, 2) they believed magnesium will eventually be proven to be beneficial, and 3) they would recommend its use at this time.ResultsThere was considerable disagreement among the reviewers for each package, and for each question. The discrepancies increased when the heterogeneity of the data increased. In addition, some reviewers became more sceptical of the effectiveness of magnesium over time, and some reviewers became less sceptical.ConclusionThe interpretation of the results of systematic reviews with meta-analyses includes a subjective component that can lead to discordant conclusions that are independent of the methodology used to obtain or analyse the data.

Patients' perspectives on physicians' roles: implications for curricular reform.

Purpose To elucidate the perspectives of patients on the conceptual framework for a new undergraduate medical curriculum organized around the healer and professional roles of the physician (their physicianship), and to illustrate how these perspectives can affect program development. Method In 2006, using an adapted interpretive description design and semistructured interviews, the authors collected data from a sample of 58 patients receiving care in a major academic medical center. Results Three findings were particularly salient. (1) The concepts of the physician as healer and professional, although central to the curriculum, did not resonate strongly with patients. The words professionalism and healer occasionally accrued negative connotations. There was little concordance between the lexicon patients use to describe ideal physician behaviors and a faculty-defined list of core physicianship attributes. (2) The listening skills of physicians were highly valued and seen as an “essentia” of ideal doctoring. (3) Being treated as a number by physicians represented a threat to patients’ personal identity. Conclusions This study found important differences between patients’ and physicians’ perspectives on key curricular concepts. Understanding these differences represents an important resource for program design and development. The findings also suggest avenues for future research on highly topical issues such as professionalism.

Gender imbalance in pediatric palliative care research samples.

We assessed the sampling performance of research on parental perspectives in pediatric palliative care and examined if and how gender imbalance was treated. We undertook a systematic review of parental perspectives research in pediatric palliative care using MEDLINE, CINAHL, and PsycINFO. Study selection inclusion criteria were: (1) published between 1988 and 2008; (2) in English; (3) conducted in North America; (4) focused on parents of children aged 0—18 years who were expected to die or had died; (5) had ‘parent’ in the title; and (6) focused on parents’ experiences or on parents’ perspectives regarding the child’s illness/death. Keyword searches produced a list of 2103 studies, of which 45 met the criteria for inclusion. The ratio of mothers to fathers participating in the studies was examined. We found that there has been an increase in research on parental perspectives in pediatric palliative care over the last 5 years, but what constitutes ‘parental’ in this literature continues to be primarily ‘maternal’. Mothers constituted 75% of the overall sample of parents. In only four studies was the gender imbalance addressed as one of the limitations of the study. There is a growing interest in parental perspectives in pediatric palliative care, but the research does not equally reflect the experiences and needs of mothers and fathers. Gender can shape experiences of both parenthood and grief; balanced gender sampling and accurate analysis is essential for research on ‘parental perspectives’. Gender imbalance in research samples, designs, recruitment strategies, and data gathering methods must be addressed.

The limitations of language: male participants, stoicism, and the qualitative research interview.

The semistructured, open-ended interview has become the gold standard for qualitative health research. Despite its strengths, the long interview is not well suited for studying topics that participants find difficult to discuss, or for working with those who have limited verbal communication skills. A lack of emotional expression among male research participants has repeatedly been described as a significant and pervasive challenge by health researchers in a variety of different fields. This article explores several prominent theories for men’s emotional inexpression and relates them to qualitative health research. The authors argue that investigators studying emotionally sensitive topics with men should look beyond the long interview to methods that incorporate other modes of emotional expression. This article concludes with a discussion of several such photo-based methods, namely, Photovoice, Photo Elicitation, and Visual Storytelling.

Death and grief on-line: Virtual memorialization and changing concepts of childhood death and parental bereavement on the Internet

Abstract ‘Virtual memorials’ intended to memorialize the lives of children imply significant shifts in the conceptualization of death, particularly for grieving parents. Created by parents in memory of their deceased children, on-line memorials constructed using templates reflect strong cultural beliefs about the nature of childhood deaths, grief and the development of a kind of digital afterlife. Virtual memorials create a new social value for the deceased, and shift death and bereavement from private into more public experiences. Building upon this work, we describe a kind of ‘on-line immortality’ created through virtual memorials where the virtual presence of the deceased in text and images, and practices intended to sustain a relationship with the deceased, can extend bereavement and the social lives of the dead indefinitely. While such memorials can offer solace, they also potentiate business opportunities for those hoping to create lasting customers. As such, they may also extend mourning indefinitely. This may be especially true for certain kinds of deeply problematic deaths, such as those of children.

Signs of life and signs of death: brain death and other mixed messages at the end of life.

Brain death is a medical, legal and cultural category constructed to fill an important need created by evolving medical technologies and practices. However, managing life and death via organ transplants and brain death criteria is not without controversy; there remains much confusion and ambivalence in both lay and medical populations regarding both organ donation and the diagnostic category of brain death. By way of a case study of cranial trauma taken from a larger study of bereaved parents, this article discusses how, from a parents perspective, brain death and organ donation are neither morally nor medically straightforward concepts. The case study presented in this article demonstrates the necessity for more research and clinical training in communication issues regarding brain death and end-of-life care with families in critical care situations.