. 2019 Mar 28;7(2):e000086. doi: 10.1136/fmch-2018-000086

Table 3.

Steps in a mixed methods survey investigation as illustrated by the Sonnenberg study

Steps in the investigation	Illustration from Sonnenberg et al ¹²
Step 1. Articulate the rationale for mixed methods study.	In the resident physician competencies mixed methods study,¹² the authors state that it was important to understand the context. Because they were studying the behaviours of residents, they state that subjective experience and perceptions could not be fully captured in the quantitative survey. This rationale for the use of mixed methods was located in the section of the methods where the authors first introduce the qualitative methods.
Step 2. Create the quantitative and qualitative databases.	In the resident physician competencies mixed methods study, rigorous procedures were used.¹² The quantitative data consisted of an on-line Adobe Survey sent to MDs and to interprofessional (IP) clinicians (N=45). The characteristics of the sample was reported in a table. The online survey was carefully described in terms of the learning objectives, the scales used and the coding procedure. Frequencies, means and SD were calculated for each item, and the items were clustered into two variables, one on observable skills and one on assessable skills. T-tests were used to compare the MDs with the IP team responses. The qualitative data consisted of an interview guide administered to focus groups. The interview guide was based on the survey results. Qualitative data analysis consisted of theme analysis proceeding through several steps to generate the themes.
Step 3. Identify a mixed methods design.	In the resident physician competencies mixed methods study, the authors announced early in the study abstract that the explanatory sequential design was used in the study. A diagram was not presented that would be helpful in understand the study. The authors do say that the qualitative interviews built directly from the quantitative data collection and analysis. Further, the explanatory sequential design is not defined for the reader, a definition that would have been helpful for beginning researchers.
Step 4. Analyse and report the results of the quantitative and qualitative databases.	In the resident physician competencies mixed methods study,¹² the report of the results does mirror the design with the quantitative results first followed by the qualitative findings. We find that there was no significant difference between the MDs and the IP clinicians in terms of observable and assessable skills. For the qualitative results, a table shows an example of one theme with codes and quotes. Four themes became headings in the qualitative results discussion.
Step 5. Present and show Integration.	In the resident physician competencies mixed methods study,¹² the authors only mention the value of collecting qualitative data to develop a contextual understanding of the survey results. There was no joint display that would have shown how the authors used the survey results to develop the qualitative interview guide. Thus, integration lies largely hidden in this project although we know that the quantitative survey built into the qualitative data collection.
Step 6. Explicate the value of using mixed methods	In the resident physician competencies mixed methods study,¹² it is mentioned that the qualitative data added insight into the differences between the MDs and the IP clinical teams as they viewed the skills of residents. The culture did shape the expectations placed on the residents.