Recognizing and Responding to Ethically Important Moments in Qualitative Research

The Challenge

Why is my health professions education qualitative study required to go through an ethics review process when there is little risk to participants? Many of the questions on the ethics review forms seem irrelevant to my qualitative study. When I receive ethics approval, does that mean the study is inherently ethical?

What Is Known

All researchers have a responsibility to conduct their work ethically. The ethics of qualitative education research certainly relate to those of quantitative education research, yet they also present unique challenges. To ensure the ethical practice of qualitative research in the field of health professions education, researchers must attend to the ethical nuances involved in what is an iterative and dynamic process.

Prior to conducting any research study involving participants, researchers must comply with their institution's ethics review process, a process referred to as procedural ethics.¹ Procedural ethics require researchers to articulate the purpose and significance of their project, the ways they will minimize harm to their participants, and their data management practices. In health care settings, qualitative research is typically reviewed by ethics boards designed for and familiar with biomedical research. Qualitative education researchers may find the questions on such forms irrelevant to their work and thus view the ethics approval process as an arbitrary hurdle. As a consequence, this process often fails to adequately prepare researchers for practical ethics—those difficult, subtle, and usually unpredictable situations that arise during research practice.¹ Practical ethics require an immediate response from the researcher(s) and at times necessitate deviations from planned procedures. Researchers' responses to both procedural and practical ethics will influence the integrity of their research.

Reflexivity can help researchers both appreciate the importance of procedural ethics and respond thoughtfully to practical ethics.^1,2 Reflexivity means critically analyzing the research process itself, and explicitly attending to how the researcher's perspective, assumptions, and actions are interacting with the research process and the emerging findings.^3,4 Careful study preparation and reflexive practices can enable qualitative researchers to navigate ethics issues when conducting qualitative research.²

Reflexive Questions for the Qualitative Researcher

Ethics issues pervade all aspects of the research process, from design to dissemination. The following questions may be appropriate for any researcher, but, arguably, have particular salience for qualitative education researchers due to the dynamic and iterative nature of qualitative research practice, and the particularities of education contexts wherein researchers may also be clinicians, teachers, or administrators. The questions can be categorized as (1) representation of participants; (2) roles and relationships between researcher and participant; and (3) researcher responsibilities. This list is not exhaustive; rather, these questions prompt reflexive considerations and offer researchers a springboard from which to develop additional questions specific to their own qualitative work (provided as online supplemental material).

1. How Will You Represent Your Participants Authentically While Remaining True to Your Research Question?

Usually, researchers think about representation in terms of how to protect participant identity (eg, assigning pseudonyms for anonymity). In qualitative research, representation is complex. Since sample sizes are often small and findings frequently include interview excerpts, participants may remain identifiable despite deidentification. The researcher must carefully negotiate between giving voice to the unique experiences of participants and preserving participants' anonymity or privacy. For instance, the decision to maintain a participant's gender identity in the choice of pronoun (eg, she) must be thoughtfully weighed against the possibility that participants may be recognizable to their community. These decisions become more difficult in instances where gender plays a pivotal role in the analysis.

2. How Will You Ensure Issues of Power Are Minimized?

Issues of power pervade the entire research process—from decisions about the topic to study, to decisions about how to disseminate findings. Many concerns about power differentials center on the relationship between the researcher(s) and participant(s). There are ethical implications in the way the researcher presents himself or herself during recruitment, data collection, and dissemination activities. Researchers must carefully consider whether any current or previous relationships with participants will influence the participant's decision to engage in the study and the data they will offer (eg, a supervisor/resident relationship). Researchers should also consider how much personal narrative to share when building rapport with participants and how this may influence participants' willingness to disclose their own experiences. The boundaries delineating the researcher role require constant attention (reflexivity). Researchers should prepare for the unexpected (eg, what to do if a participant becomes distressed or discloses sensitive information about an unsafe situation during an interview). These important moments often occur without warning, and the researcher must be prepared to make ethically sound decisions.

3. How Do You Fulfill Your Responsibility as a Researcher to Advance Worthwhile Knowledge?

To ensure the quality of the work, researchers must consider whether the choice of methodology is appropriate for the research question (see Qualitative Rip Outs 1, 2, and 3) and whether the research team is suited to the job (eg, do they have the appropriate methodological and content expertise). In the pursuit of worthwhile knowledge, it is imperative to avoid “helicopter research”⁵—that is, a situation where a researcher enters into a context, collects data, and leaves, potentially leaving participants feeling used. Instead, consider how you might attend to the contextual needs of your participants and aim to reciprocate their generosity.

How You Can Start TODAY

As a first step, review the ethics rules at your own institution as they relate to qualitative research. In addition, when you write a research protocol, develop a flexible reflexive question guide that your research team can revisit individually and collectively during team meetings.

What You Can Do LONG TERM

Consider qualitative research as a practice, which includes important moral obligations. Embody reflexivity in all facets of your research practice, which will enable you to identify and navigate ethically important moments as they arise.