Background. Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. Objective. To develop a checklist for explicit and comprehensive reporting of qualitative studies (indepth interviews and focus groups). Methods. We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Results. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Conclusions. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups

Basics of qualitative research: Grounded theory procedures and techniques

Experience and Educationis the best concise statement on education ever published by John Dewey, the man acknowledged to be the pre-eminent educational theorist of the twentieth century. Written more than two decades after Democracy and Education(Dewey's most comprehensive statement of his position in educational philosophy), this book demonstrates how Dewey reformulated his ideas as a result of his intervening experience with the progressive schools and in the light of the criticisms his theories had received. Analysing both "traditional" and "progressive" education, Dr. Dewey here insists that neither the old nor the new education is adequate and that each is miseducative because neither of them applies the principles of a carefully developed philosophy of experience. Many pages of this volume illustrate Dr. Dewey's ideas for a philosophy of experience and its relation to education. He particularly urges that all teachers and educators looking for a new movement in education should think in terms of the deeped and larger issues of education rather than in terms of some divisive "ism" about education, even such an "ism" as "progressivism." His philosophy, here expressed in its most essential, most readable form, predicates an American educational system that respects all sources of experience, on that offers a true learning situation that is both historical and social, both orderly and dynamic.

经验与教育 = Experience and education

According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

American physicians and dentists conduct approximately 140 000–160 000 patient interviews in a practice lifetime, making the interview the most frequently performed medical procedure. Over the past 75 years, a steadily growing stream of scientific research has confirmed the fact that patient–clinician communication affects the course, direction, and both biomedical and functional outcomes of care. The field of clinical communication research has matured from anecdotes and aphorisms about ‘bedside manner’ to sophisticated randomized control trials and evidence-based outcomes that have been translated into reliable practice guidelines. Several key skills or habits of practice have been identified and studied in terms of their efficacy and effectiveness. These include the importance of agenda-setting, eliciting patients' perspectives about the nature of their ailments, communicating caring and concern, and testing for patient comprehension and agreement with proposed treatments. In addition to being effective, interpersonal communication can be deeply satisfying as well as offering a lower probability of law suits in the event of an adverse outcome.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/odi.12250

The secret of the care of the patient is in knowing and applying the evidence about effective clinical communication.

Background: Low rates of partner violence inquiry and detection are reported in the medical setting. Purpose: To determine if a teaching module with a mnemonic improves interviewing skills. Method: Prospective randomized trial. A total of 43 medical students were assigned to either the intervention group (teaching module with guided discussion and practice highlighting use of a mnemonic) or the control group (general discussion and provision of the mnemonic at the end of the session). These students subsequently interviewed simulated patients. Results: A total of 75% of the intervention group and 62% of the control group reported the mnemonic was helpful. A total of 68% of the intervention group and 45% of the control group asked a direct question about partner violence. Students who obtained a history of abuse consistently asked direct, nonjudgmental question(s). Conclusions: Students learn to perform desired interviewing skills more frequently when they have the benefit of guided discussion, practice, a...

Structured practice opportunities with a mnemonic affect medical student interviewing skills for intimate partner violence

Objective—To understand high-performing frontline employees’ values as reflected in their narratives of day-to-day interactions in a large health care organization. Methods—A total of 150 employees representing various roles within the organization were interviewed and asked to share work-life narratives (WLNs) about value-affirming situations (i.e. situations in which they believed their actions to be fully aligned with their values) and valuechallenging situations (i.e. when their actions or the actions of others were not consistent with their values), using methods based on appreciative inquiry. Results—The analysis revealed 10 broad values. Most of the value-affirming WLNs were about the story-teller and team providing care for the patient/family. Half of the value-challenging WLNs were about the story-teller or a patient and barriers created by the organization, supervisor, or physician. Almost half of these focused on “treating others with disrespect/respect”. Only 15% of the value

/pdf/understanding-values-in-a-large-health-care-organization-5dqj7v1a24.pdf

Understanding Values in a Large Health Care Organization through Work-Life Narratives of High-Performing Employees.

Coulehan and Williams 1 have provided a thoughtful framework to explain the widely noted phenomenon whereby medical students lose their idealism as they are socialized into being physicians. Although I don’t believe theirs is the whole story, detachment, entitlement, and non-reflective professionalism certainly characterize parts of the professional persona that doctors adopt during clinical training. Young physicians in training also are inculcated with a strong sense of responsibility to provide excellent clinical care to their patients, no matter the long hours and emotionally straining work. One question is whether these two sets of values are tradeoffs. Must the young physician become detached and non-reflective in order to develop his or her sense of responsibility and ability to care for patients? I do not believe there is necessarily a tradeoff, nor do I think that the solutions suggested by Coulehan and Williams fully take into account the experience and evidence to date regarding solving this problem. They dismiss medical ethics and humanities teaching ‘‘in the majority of medical schools’’ as having generally limited impact. I believe the limited impact results from a lecture-style format, and from timing the courses in the first two years of medical school, not from an inherent impotency of medical education to create a reflective practitioner. Coulehan and Williams embrace the family medicine, primary care, and generalist movements as potentially valuable in maintaining students’ commitment to moral and professional values. Here, I agree and would argue that these movements accomplish much chiefly because they often do offer educational interventions aimed at teaching human values during the clinical years. Coulehan and Williams also discuss managed care and the possibility of more socially relevant clinical experiences as additional antidotes against loss of idealism. Without a long discussion, I would note that managed care is losing some of its impetus at present, and that if its chief impact on physicians is to undermine their professional commitment to taking responsibility for the care of individual patients, then it will be destructive mostly of professionalism in medicine. Socially relevant clinical experiences should be tried, but there are few examples that I know that have been well organized and integrated into the clinical curriculum. Rather, these rotations carry the danger of being ‘‘show and tell’’ experiments at various community facilities. What I want to get to is the documented impact of educational interventions that occur during the clinical years and are designed to counterbalance the non-reflective aspects of clinical training. Such interventions have been under way for more than ten years. I believe the common feature of effective intervention in the clinical years is small-group teaching facilitated by highly respected faculty role models that allows students to reflect on their values, beliefs, and experiences in a safe and intimate setting on a regular basis. Most successful programs have combined the opportunities for reflection with learning patient–doctor communication skills. Extensions of these programs beyond medical school into residency training also seem to me to be necessary to achieve their full impact. This educational approach counterbalances non-reflectiveness with reflectiveness. To do so requires the safe, smallgroup environment so that students or residents can freely express their feelings and concerns regarding patient care in a mutually supportive atmosphere. It is also necessary to reinforce the impact of small-group discussions with highly effective bedside teaching of humanism. Evidence suggests that intensive educational interventions such as these improve physicians’ abilities to convey fundamental values of the medical profession, such as compassion and respect, to their patients. My concern is that despite the proven impact of such programs, they continue to be given lip service by the leaders of medical education in most medical schools, who have yet to commit the resources to mount and evaluate large-scale interventions despite clear evidence that there is a problem needing to be addressed and a means available to address it. Furthermore, I fear that emphasis on too many options and alternatives to address the problem of non-reflectiveness and loss of values and idealism will disperse efforts in a non-focused way, leading to the prolongation of impotence in this component of medical education. Thus, I suggest that medical schools commit the needed resources to counteract what Coulehan and Williams so aptly term ‘‘vanquishing virtue.’’ A final word on the resources needed. There are enough clinical faculty at most medical schools to provide smallgroup facilitators for medical students and housestaff. The chief lack is the will to implement such programs, and the understanding that untrained faculty require a well-designed faculty development program if they are to be useful guides, role models, facilitators, and mentors for their students and residents.

Small-group Teaching Emphasizing Reflection Can Positively Influence Medical Students' Values

Background: Patient perspectives are valuable for clinical care and teaching. Purpose: To understand personal and programmatic effects of using HIV-infected persons as teachers in courses about care of HIV-infected people. Methods: Semistructured interviews with HIV-infected faculty for New England AIDS Education and Training Center (NEAETC), addressing teaching decision and its personal, medical, and psychological consequences. Interview transcripts were analyzed via iterative, consensus building. Results: Participants reported consequences of teaching that benefited them as patients (finding health care providers, increasing their knowledge base, and receiving tangible rewards such as gifts). A deeper level of benefit was realized personally, increasing control over their life and disease. Relationships, personal and professional, changed, from unilateral to mutual, heightening a sense of their own empowerment. Teaching built support networks and aided in coping with difficult issues raised (negative em...

Richard M. Frankel

Papers

The secret of the care of the patient is in knowing and applying the evidence about effective clinical communication.

Structured practice opportunities with a mnemonic affect medical student interviewing skills for intimate partner violence

Understanding Values in a Large Health Care Organization through Work-Life Narratives of High-Performing Employees.

Small-group Teaching Emphasizing Reflection Can Positively Influence Medical Students' Values

Challenges and opportunities for patients with HIV who educate health professionals.