Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada.
Queen's University, Belfast, Northern Ireland, UK.
Adv Health Sci Educ Theory Pract. 2018 Oct;23(4):833-851. doi: 10.1007/s10459-018-9829-y. Epub 2018 May 14.
Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity.
定性证据综合（QES）是一套将定性技术与定性知识综合相结合的方法。它们特别适用于医学教育，因为这些方法汇集了来自原始定性研究的发现，同时关注背景和理论发展。尽管在健康专业教育（HPE）中越来越多地使用复杂的定性初级研究方法，但在 HPE 中使用二次定性综述的情况仍不发达。本研究检查了应用于医疗保健中临床人本主义的 QES 方法，以推进一般 HPE 中 QES 使用的思维。系统搜索策略确定了符合纳入标准的 49 项综述。元研究用于开发对方法特征、理论作用和 QES 综述中使用的综合过程的分析性总结。十五项综述使用了既定的方法，十七项综述清楚地解释了从数据提取到综合的过程。八项综述采用了特定的理论视角。作者很少描述他们与数据的反思关系。认识论立场往往是暗示的，而不是明确的。二十五项综述包括某种形式的质量评估，尽管作者如何根据其结果采取行动往往不清楚。评论员在他们的评论方法中报告的定性方法较少，并且往往侧重于与定量证据综合更相关的系统性和清单质量评估等元素。一个核心问题是，来源材料的价值维度很少被考虑，更不用说在使用的综合技术中得到考虑了。QES 可以在 HPE 研究中使用，但只有在仔细注意保持价值完整性的情况下才能使用。
