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doi: 10.1097/ALN.0b013e3181b43948

Paradigm Consciousness: A New Approach to Understanding Anesthesia Knowledge and Education

Edler, Alice A. M.D., M.A., M.P.H.

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To the Editor:—

Kudos to Waisel et al. for his recent contribution to our journal, “Anesthesiology Trainees Face Ethical, Practical and Relational Challenges in Obtaining Informed Consent.”1 And also to our editors, for highlighting the usefulness of nonbiomedical research paradigms. Waisel et al. used narrative analysis, one genre of qualitative research methods, to deepen our understanding of the theory that underlies obtain informed consent in the practice of anesthesiology. Narrative analysis is only one of many accepted methodologies included in the realm of qualitative research. Others include biographical methods, critical theory development, hermeneutics, action research, and historiography. Qualitative methods, in any form, are both similar and different from our more familiar, quantitative, statistically based methods.
In both quantitative and qualitative methods there is an initially defined research question; optimal data sampling is based on known population characteristics; data collection and analysis follows rigorously defined protocols; and all sampling, data collection, analysis, and dissemination are in compliance with accepted research ethics.2
However, unlike hypothesis testing and statistical methods, qualitative research employs an inductive approach; the aim of qualitative research is to generate a theory grounded in both confirming and disconfirming evidence, such as observation, interviews, and documentation. These methods for theory generation are more useful in situations of complex social interactions where reductionist, statistical methods cannot adequately encapsulate all social confounds into one testable hypothetical premise, to the exclusion of all others. Qualitative research methods have been a mainstay of social science and educational and psychological research for close to a century. And within the past two decades, they have been successfully merged with quantitative methods, especially in educational research, to both generate and confirm theory.2,3 This innovative methodology is termed “mixed methods research.”4
For those more interested in understanding and using complimentary qualitative methods, several outstanding and readily accessible reference texts are available.2 In addition, both PubMed and the Education Resources Information Center have medical subject headings that allow the reader to identify literature that employs qualitative methods. Hopefully the paradigm wars are indeed over, and the era of paradigm cooperation has begun in anesthesiology as well.
Alice A. Edler, M.D., M.A., M.P.H.
Department of Graduate Medical Education, Stanford Hospitals and Clinics, Stanford, California.
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1. Waisel DB, Lamiani G, Sandrock NJ, Pascucci R, Truog RD, Meyer EC: Anesthesiology trainees face ethical, practical, and relational challenges in obtaining informed consent. Anesthesiology 2009; 110:480–6

2. Denzin NK, Lincoln YA: Handbook of Qualitative Research. Thousand Oaks, California, Sage Publications, Inc., 1994

3. Gage NL: The paradigm wars and their aftermath: A “historical” sketch of research on teaching since 1989. Educational Researcher, 1989; 18:4–10

4. Johnson RB: Mixed methods research: A research paradigm whose time has come. Educational Researcher 2004; 33:14–26

© 2009 American Society of Anesthesiologists, Inc.

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