Presenting qualitative research in a quantitative world

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When we developed our research questions a couple of years ago, most of my EdD cohort picked topics that are very, very ‘qualitative’. Most of us are investigating issues that we feel a deep personal or emotional connection to, be they indigenous leadership, refugees’ experiences of “home” or parenting a chronically ill child. We want to be involved in the research, perhaps tell our stories alongside our participants and to make a difference in the world. This fits very well at UBC, where no one blinks an eye at this sort of work. We were told (perhaps anecdotally) about a dissertation that was written entirely without punctuation. Previous cohorts in the program have produced plays, used songs as data, and used art such as photographs and so on. My “I want to write stories and use them as my results section” was barely a blip on the radar.

 Last weekend I presented my EdD research for the first time to my peers at RTi3 –  a radiation therapy conference – a great event but staunchly grounded in the positivistic domain. My first hurdle was to fit what I have done into the standard “intro/methods/results/discussion” abstract submission process. After a lot of rewriting I had something that sort of worked and sent it off. Some highly ranked abstracts are selected for 30 minute slots, the rest get 10 minutes or a poster. I’ve been a judge before and I knew my abstract wouldn’t fit the rubric, so was happy to get selected for a 10 minute talk, despite wondering how on earth I could fit it in.

Advice for presenting qualitative work usually involves ‘bringing your data to life’ in a dynamic way. For example, Petra on the blog “The Research Companion” asks “Can any of the work lend itself to poetry, or musical interpretation? Might it become the basis of a song, rap or other spoken word performance?” Further ideas are podcasts, infographics, video abstracts, webinars, Ted-style talks and more.

There’s also the viewpoint that the presentation of qualitative work should align with the genre or methodology. Bekker and Clarke say that researchers should avoid “formulaic presentations based on normative presumptions and practices” (p. 3) and pay attention to the embodied act of presenting. One of the central tenants of qualitative work is engagement with the audience (or reader). We have to show them (through ‘thick description’, reflexivity and/or an engrossing and evocative story) that the work matters. The researcher-storyteller should surface the voices of the participants, rather than disembodied ‘data’, and elicit an emotional reaction to engage both hearts and minds. This is hard to do in a ‘ten-minutes-plus-two-for-questions-and-the-moderator-will-wave-a-red-card-at-you-if-you-go-over’ scenario. I was worried!

 The norms and social contexts of typical conferences rely heavily on PowerPoint. We all know the sinking feeling of staring at text-heavy slides, presenter comments like “I know you won’t be able to see that…” and people who simply read their bullet points. But that’s what we expect, in some form or other.  This conference was no different, some slides were better than others but all speakers stood behind a podium and relayed information to the audience using PowerPoint. I decided that rather than use a slide deck, I would read one of the stories that constitute my dissertation results section.

So what happened? I confess I did four quick slides (with minimal text) to outline my research questions and methodology, then I read the story. I rehearsed A LOT. Two minutes max for my slides left me eight for the story. I blacked out the screen, put on my glasses and read. It was a story about a radiation therapy department, written for an ‘outsider’ audience, and described some common issues that lesbian and gay therapists might face. I think the unexpectedness of having to actively listen and react were surprising, people were unsure of what to do.  The room was very quiet, there were a lot of smiles but no one laughed at the funny bits (maybe they weren’t as funny as I had thought!) I was asked what surprised me about the research. I said, that things didn’t seem to have changed much in twenty years, people were still reluctant to come out in the conservative healthcare environment. I did get a lot of people afterwards tell me that they enjoyed it, that it made them think, that they would like to hear more. Perhaps the best comment was from an old friend who gave me a hug and said that the research was “really me” – I hope so!

As I write this there is a lively conversation on Twitter started by Janice St John. Janice’s learning difficulty (dyslexia) makes it hard for her to present results in a written form. This conversation has veered from that to other ways to present, and other “ways of knowing” beyond the usual third person written format. Better and (importantly) more engaging ways to share research would benefit more than just qualitative researchers! It’s not easy – but disseminating our work is an important part of our scholarly activities and we should be pushing the boundaries.

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Radiation therapists, workplace and culture

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I’m trying to write about radiation therapists. Not the tasks that we do, that’s pretty easy, although most people don’t have much of a clue. I’m trying to explain the relationships we have with each other and what our day-to-day working environment is like. I suspect both are unique. We’re not like our diagnostic radiographer colleagues who can work by themselves. We don’t do that. Our workplace culture is based on tight-knit teams—not only the doctor-physicist-therapist triad but the team that works on the treatment unit.

The closest model I can think of is an operating room. The nurses, anesthetists, surgeons have to work in a kind of dance. This dance relies on what Lorelei Lingard has called collective competence, being able to effectively work and communicate with others. Verbal interaction is key, most errors can be traced back to not talking to each other. It’s similar for radiation therapists. We have innumerable checks and balances, quality assurance steps and protocols, and many of them are verbal. But we also have to, fundamentally, have each other’s backs. It’s a dance of physical movement (moving the patient, moving the treatment couch, moving the equipment) and verbal interaction (I’m doing this now, this next, have you done that?). When we do it well, it flows seamlessly, between ourselves and the patient. When not done well it can cause friction, delays, a lack of patient care and, sometimes, errors.

There may be three of us on a treatment unit, or sometimes more. With breaks and shifts, sometimes just two at a time. If we don’t get on, talk to each other, the work gets harder. We don’t have a choice of who we work with, and we may be working with someone for months at a time. We sit close to them (the treatment consoles are small), check their work (and they check ours), lift and move patients together, and arrange our days (this patient is new, this one is finishing, we need to follow up on this, did you call about the weird noise the machine is making?) We have to trust each other, we have to know the steps.

If you work with someone like this for a few weeks, you often get to know a lot about them. What TV shows they watch, how their commute went, what they have for lunch, what their weekend plans are, their kid’s activities and their upcoming vacation plans. Between patients we chat, we get to know each other, we pass the time, we build our relationship. Our “private” and “professional” lives are not binary – they merge into each other. We need these interpersonal bonds when it gets stressful, when that patient breaks our heart a little, when we have to vent.  They can help sustain us. When we don’t get on, or when we can’t be ourselves at work, it makes what we do harder as well as less safe. The dance slows down, we stumble.

Why am I mulling this over? Because as I write my dissertation I’m remembering times when I was careful what I said at work, the religious co-worker who “didn’t approve of my lifestyle” and an older therapist who ignored my tentative coming out speech and referred to “my husband” (when he talked to me at all). I’ve had recent conversations with gay, bisexual and lesbian (GBL) therapists who have said they “keep themselves to themselves” at work, or “just don’t go there” with some people. There’s ample evidence that having to manage sexual identity at work (to monitor when it’s safe to come out) is common in healthcare, with colleagues as well as patients. GBL workers report more stress and less social support than their heterosexual peers. Covering up who they are is a reality for many, and they are less likely to talk about their partners or life outside work.

Does it matter for radiation therapists? I think it does. We’re not exempt from the same pressures that affect GBL physicians, nurses, pharmacists, other allied health care professionals and our trainees. I might argue that the way we work makes these issues more important. We need to be able to bring our full selves to work, to be able to fully join the dance.

Writing the dissertation

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After my results section was written (a series of stories) I felt that I’d done most of the creative work, the rest of the dissertation was just framing really, pretty straightforward. I am here to tell you that this was somewhat misguided.

I started with the discussion section next because the results, stories and transcripts were still very much in my head. That was a good idea, but I struggled on a couple of levels. The first was that I kept finding big gaps in my literature review (from my original proposal). My section on “coming out” for example, was about a thousand words. As I wrote, I realised that probably wasn’t enough depth for a doctorate on …. coming out. So, I hit the books again and started to rewrite that section. Turns out there are a lot of models and theories on coming out, that section ended up being half my literature review and about 7,000 words. Cue two months of work.

I also struggled with how to write the discussion. In most projects you’d recap the results and bring in other people’s work to support them as well as revisit your research questions. But I was confused – was my data the interview transcripts or the stories I had written from them? I started off trying to fit them both in and it was a hot mess! My supervisor saved the day by telling me to look at the interviews as the raw data (if we were being positivistic) and the stories as the interpreted and shaped data.

In the end, I set the discussion aside and went back to finish the literature review. It did become a bit of a monster – what ISN’T important when you’re setting the scene? It’s hard to know! I have a lot of words but, damn it, they are good words and I don’t want to slash any! I know there will be an editing session in my future as I get a better sense of what’s extraneous and as my introduction comes together, but for now that massive chunk of wordage represents months of slog and it’s staying.

Next, because I was still scared of the discussion section I wrote the methodology. I did have some text from my proposal but of course had to add what I DID as opposed to what I had planned to do. It wasn’t the same, things didn’t work out as planned, so I had to explain that. I also added a section on reflexivity and this blog was very handy for reflecting back and what I had been thinking as I pondered my research question and how to tackle it. I added sections from the blog as well as my research journal.

I’ve had some issues with my referencing software – it has a mind of its own. I also routinely forget how to format a reference manually despite having done a gazillion. So, I rely on the goodwill of the magical Word plug in. My references are supposed to be APA, mostly it seems to get it right – but what the hell are you doing to my DOIs Mendeley? When I send the drafts to my supervisor they are full of caveats like “I am SO SORRY…I will fix these terrible references!” I can sense her gritted teeth from a few thousand miles away as she once again points out that you don’t capitalise book names (why, though??)

I’m currently on a writing leave and yesterday I sent a draft discussion section to my supervisor. Yes, it contains terrible references as always, but it’s a good start and a weight off my shoulders. I readdressed my research questions and (somewhat surprisingly) found I’d actually mostly answered them. I’m currently reading about truthfulness and credibility as I missed that in my methods. Full disclosure – rereading about subjectivity and standpoint epistemology is actually why I am procrasti-blogging!

There’s a way to go. I have to do a conclusion and introduction next but they don’t loom as large as the discussion section did. So there’s a chance I’ll be defending this year – wish me luck!

 

A blog about a paper about a tweet chat about a paper…

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A couple of years ago I was deep in a policy class at UBC as part of my EdD. My final paper was about policies in LGBTQ healthcare – from global (like the WHO resources) to local (what my department didn’t have and why). Tracing the web of policies, legislation and guidelines around LGBTQ health was fascinating and depressing. Canada is one of the best countries in the world when it comes to anti-discrimination laws and every hospital has a statement about diversity. However, there are still lesbians who avoid screening appointments because of their past experiences with healthcare, trans patients who get treated terribly in the ER and gay men with cancer who can’t find local resources that include them and their loved ones.  Polices and legislation are great, but we also need healthcare professionals who understand what the issues are, know how to work with LGBTQ patients and work towards fixing some of the systematic gaps that some of our patients fall through.

I adapted the work I’d done in the policy class and the sought the insight and lived experience of UK radiographer Sean Ralph to co-author a paper that was a kind of “LGBTQ health issues 101 (and how you can help)” for Radiography. It was packed with references and we hoped it would be used by people wanting an overview of the issue. It was the first paper about LGBTQ issues in any of the three major radiography journals. In the meantime, our Twitter journal club (MedRadJClub) was getting going. The paper that Sean and I had written was suggested for one of the monthly chats. One of the regular chat participants was Sophia Thom, a student diagnostic radiographer from the UK. We’d met in real life at a conference (UKRCO) where I’d been talking about my EdD research – and we’d gone out with Sean to Canal Street in Manchester to drink gin and talk about research, coming out in healthcare and the perils of online dating. Sophia wanted to do some research but wasn’t sure where to start. I said something like “Oh, we’re doing a MedRadJClub chat later this year about our LGBTQ paper, why don’t we use the data from that and submit it to a conference – how about UKRCO next year?”

So we did. In this case we were interested in how much education the participants had received around LGBTQ people and healthcare, and what was going on in their departments. We had 44 people join the chat and a lot of conversation. We weren’t surprised that most people hadn’t had a lot of formal education – although participants shared an amazing list of self-found resources. We co-wrote the conference abstract in the fall with Julia Watson (a MedRadJClub friend) and Kim Meeking (Kim’s research area is social media) and submitted it to UKRCO with crossed fingers. When it was accepted we analysed the chat data and Google Drive’d the poster design together complete with Sophia’s rainbow Twitter symbol! As we’d done the analysis it seemed wasteful to stop there. There’s very little in print about this – and someone, somewhere might need citeable evidence. So we wrote the paper based on the tweet chat, based on the paper based on the policy class.

I think this process illustrates a few points. Firstly, if you want to get started use the resources you have, projects, essays, people and connections – the inspiration and material for writing a paper can come from many different sources. If you’re a new researcher, reach out to people who can help. Most of us are happy to give advice, edit, cheerlead or (sometimes) collaborate with you. Finally, if you’re an established researcher and have the skills, bring a few people along for the ride next time you do a project or write a paper. There’s a lot out there to investigate and we need more people to help!

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Explosive Knowledge: Freddie Mercury and my Literature Review

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I am deep in my literature review. Having finished (for now) my results section I made an attempt to write the discussion. It was a sad effort. My results section is my stories, written very much from the heart and from being immersed in the transcripts from my participant interviews. I got very lost in the discussion section, trying to tie the stories back to the literature review I had done for my proposal, about ten million years ago. I kept writing little notes to myself like “add a section on how cancer care is gendered” and “stick in lots more about coming out”. Then I’d get sidetracked for days reading more about cancer and gender (that stuff is interesting!) and forget what I’d been doing.

My supervisor advised me to continue with the discussion – I had the stories in my head, she said, it’s the ideal time to put them in context, relate them back to your research questions. I do have the stories in my head. It’s reassuring. I read about patients being misidentified as sisters, not partners, and I think “oh, that happened to Lisa and Alex” – as if I know them instead of having invented them as characters in a story. It wasn’t enough though – there were big gaps to fill back at the literature review section.

The part I’m building at the moment is on coming out. I originally had a couple of pages in my proposal, which looked fine to me at the time, discussing the metaphor of the closet and how coming out isn’t a one-time act. That small section has grown to many, many pages. I might know more about coming out at this point than anyone in Edmonton (in theory anyway). Watching Bohemian Rhapsody last weekend, I found myself categorising Freddie Mercury’s identity management strategies in my head. He didn’t exactly hide it, most of the time, but used a combination of non-verbal disclosure such as covering and using clues to signal affiliation with a non-heterosexual identity. He was possibly one of the most queer rock stars in history, but some of his fans didn’t pick up the clues, the social context of a rock band served to mute the effectiveness of the message. Similar to Freddie, most LGB people use a combination of methods to come out, a process which is both continual and contextual. See how much fun I am to go to the movies with?

One thing that has struck me, as I wade through my papers, is how this is still very relevant. I did wonder, starting out, if being LGB was still (sometimes) something to be managed at work, or out in the world. In the last few days my news feed has popped up stories about two women being asked to leave a concert for kissing (in EDMONTON!) and a woman in Ontario being kicked out of her church for being in a same-sex relationship. Coming out, for them, had consequences. Watching TV, Drag Race is full of coming out stories, and Transparent is a study in coming out as trans*. At one-point Maura (the lead character, a transwoman) is told not to tell Grandma Rose because it would kill her. “Hey, that’s called ‘explosive knowledge’” I told my fascinated partner, “the idea that coming out could blow up a relationship** and/or cause physical or emotional violence!”

So, the take home message is mainly that I watch a lot of gay stuff, but also that I am mentally and physically immersed in my literature review. I think it was a good decision to do this before my discussion. I hope I will have both the theory and the emotional resonance of the stories available to me when I get there. I’m certainly seeing a lot of connections and hoping I won’t have to do a lot of backfilling if and when I come across an idea or theme I hadn’t  included. Knowledge, explosive or not, that will help me get to the end of this dissertation journey.

 

*I  know, I can’t believe it has taken this long for me to watch it!

** Orne, 2011