Editors’ Guidance for Submitting Qualitative Research to the Journal of Graduate Medical Education Open Access

Titles should be engaging but avoid using catchy phrases that don’t have clear relevance to the study itself. The title should clearly and accurately convey the study topic and content. Titles generally should be 15 words or less.

As for all JGME research papers, the importance and relevance (to JGME’s audience) of the problem should be presented. The evidence gap—what exists in the literature to date and what does not—must be clear to the reader; however, the Introduction is not an extensive review of the literature. References should support the importance and relevance of the issue and the gap in the literature used for the study. Note that we will check that each reference does actually support a statement; be sure your citations are relevant.

This evidence gap should lead seamlessly to the research question or study aim and align with the conceptual framework in which the study is situated. Researchers can use conceptual frameworks constructed from theory, models, or evidence-based practices, in multiple ways to make sense of their data.¹⁰  A useful metaphor for conceptual frameworks is a map of the United States. Maps distributed by the US Park Service will highlight national parks like Yellowstone and Arcadia. Maps distributed by Amtrak will highlight train routes like the Carolinian and Lake Shore Limited. Both maps are useful and will highlight some things (national parks, train routes), but not other aspects (baseball parks, highways). More important than which conceptual framework (map) researchers choose is understanding how the framework aligns with the evidence gap, research question or study aims, and research methods.

Qualitative studies should clearly state the paradigm and methodology applied. A paradigm is a set of beliefs or assumptions about reality, how reality is known, and how knowledge about reality is built. Paradigms influence what is worth studying, how a study should be conducted, how the results should be interpreted, and, importantly, what counts as rigor or quality.^4,11  Thus, it is important that researchers identify the paradigm within which they are working, rather than leaving it up to readers to deduce. Paradigms commonly used in qualitative research are constructivism, pragmatism, and critical theory, among many others. The paradigm will influence the choice of qualitative methodology, or approach, such as constructivist grounded theory, reflexive thematic analysis, or case study. Implementation details will be in the Methods section, but the reader should understand from the Introduction how the problem, gap, and research question align with the espoused paradigm, methodology, and implementation methods for the study. The Table differentiates among conceptual frameworks, paradigms, methodologies, and data collection methods for an exemplar GME phenomenon.

For many JGME research papers, the organizational order is setting and participants, interventions or actions, analysis, and institutional review board (IRB) statement. For qualitative research, this order may not apply. Every qualitative paper should include a description of the setting and participants, qualitative methods, and IRB statement, but content for these sections will differ from that in quantitative papers. In the end, the flow of the Methods section should be that which best supports readers’ understanding of the research process.

The study setting should be described with sufficient contextual information for readers, as this could affect their ability to transfer findings to their own setting. Is the setting a residency program, hospital-based simulation center, or community clinical rotation? The participant sampling strategy and rationale for that strategy should be identified. Sampling strategies might use typical case, deviant case, critical case, maximum-variation case, confirming-disconfirming, snowball, and other approaches.¹⁴  It is important to explain how a sufficient sample size was determined. For example, how did the researchers engaging in a reflexive thematic analysis study know that thematic sufficiency was achieved?¹⁵ 

For qualitative research, submissions should usually include a reflexivity section: What assumptions do the researchers bring to the study, based on their training or beliefs?¹⁶  How might that training experience or those beliefs shape and potentially strengthen the research? Is there a power dynamic between the researchers and participants, such as exists between a program director and fellows, or between senior faculty and more junior faculty? As with all research, steps that were taken to protect subjects from risk and ensure confidentiality should be described.

Methods require a clear, concise description of how data were generated or collected. Common strategies include one-on-one interviews, focus groups, observation, and document analysis. Authors should also consider how data collection aligns with the phenomenon of interest, paradigm, and research question.^14,17  Often the researchers will have developed interview guides or observation checklists to generate data. These should be described and made available in supplementary material, along with information about piloting and revisions. Information about the depth of the dataset should be included as well. For example, how long were interviews? If open-ended comments were a data source, what was the average comment length—a few words, a few sentences, a few paragraphs? Note that this is not about quantifying data but rather describing the sufficiency of the dataset.

The process for analyzing the data should also be articulated, starting with what analytical process was used and why. Describe how codes were generated: inductively from the data, deductively from existing sources like the conceptual framework, or both? Most qualitative research submitted to JGME involves reporting themes. How were themes generated? Are they topic areas derived directly from interview questions or were they derived from a higher level of abstraction? Also, state whether and how qualitative software was used.

In qualitative research, data collection can and often should overlap with data analysis. The iterative nature of qualitative inquiry is a strength, but this may make neatly separating data collection from data analysis challenging when organizing and writing methods.

The Methods section should also address rigor or quality in regard to trustworthiness. How trustworthiness is conceptualized will depend on the paradigm. In general, trustworthiness refers to how readers will know that the data analysis is credible.⁹  Were codes and themes constructed by the researchers, in conversation with participants, and do themes resonate with the participants (ie, consistent with constructivism)? Were data coded independently, by members of the research team, and were themes confirmed by participants in member-checking (ie, consistent with post-positivism)? Regardless of paradigm, findings should be richly described to facilitate transferability: the contextualization of the study for readers to judge the extent to which findings might transfer to their own setting.¹⁶ 

As with all research, transparency in the Methods section is critical. This often means enhancing Methods with supplementary material like data displays.

While some qualitative research uses data to describe phenomena (What did you find?), other qualitative research involves data interpretation (What meaning do participants make of their experience?) and synthesis (Based on the data and meaning, what new understanding is developed for the phenomenon?). Results should not just rehash what participants said or did. Authors should add understanding, without going beyond what the data can support. It is often helpful to link results to data, such as exemplary quotes, either in the body of the Results section or in tables.⁵ 

It takes experience to determine how best to communicate findings, whether via text, tables, or figures. There exists a delicate balance between burying readers in verbiage (eg, quotes) vs communicating how the story evolves, from data and meaning to your interpretations, in a way that is both clear and credible to readers. The goal is to persuade readers that your story (1) follows from the research question; (2) reflects the participants’ voice; and (3) makes sense, at this time and place, and by these researchers. For this reason, it is essential to have individuals unfamiliar with the project, interested in the topic, and ideally with qualitative experience read your work before submission to a journal. In the peer-review process, reviewers and editors can help you tell the story, but if the manuscript requires too much work, the quick decision may be to reject.

JGME requests that the first paragraph of the discussion includes a short summary of the main findings. This may seem repetitive, but it can be helpful to reengage readers and highlight the results that the authors find most surprising, relevant, or important. For complex qualitative papers, this paragraph may require up to 3 sentences.

Next, the authors will place their findings in the context of others’ work in this area, which may have been referenced in the Introduction. Compare and contrast what you found with what was previously known—in GME if it exists, in other fields if not. Dive deeper into interesting or surprising findings. Discuss how the results change our understanding of the phenomenon under study, perhaps for certain settings or situations. Here, if labeled as such, the authors can offer opinions as to the meaning and potential implications of their findings in medical education and GME.

A discussion of how the key study limitations may have affected the findings is important. Transparency enhances study credibility with readers, reviewers, and editors. This limitations section should not be a list of potential weaknesses, but rather an analysis of potential effects of methods choices on the findings. Qualitative researchers need not describe inherent aspects of qualitative work, like purposive samples or how their stance might have shaped the analysis as limitations: these are unique strengths of qualitative methods. Indeed, if qualitative researchers espouse a constructivist paradigm but then identify bias as a limitation, reviewers may question the study credibility.

JGME discussions do not include a description of the strengths of the study. The strengths are found in the clear description of methods and their rationale.

A final short paragraph will suggest next research steps that could follow from your study findings. This is usually 1 to 3 sentences and should include specific recommendations, not generalities like “imposter syndrome should be studied further.”

The Conclusions section of the manuscript should summarize the key findings, usually in no more than 3 sentences. For JGME, do not include next steps or future recommendations here. Do not editorialize or overreach. Reviewers and editors can always ask for stronger statements. The Conclusions should leave the reader with a clear understanding of the study’s take-home message.

JGME provides a suggested word count of 3500 words for qualitative methods papers. The actual word count will be what it takes to communicate the work. Some narrowly focused work will be shorter, and more complex papers will be longer. We often find that authors use more words than needed to communicate clearly and that extra verbiage interferes with readers’ understanding. Usually, the Introduction and Discussion are the culprits. If you find that your manuscript far exceeds the suggested word count, we recommend revising for clarity and brevity, with particular attention to the Introduction and Discussion. A presubmission peer review from a colleague who is an excellent writer can be helpful in determining content that does not enhance clear communication. Finally, consider whether information in long blocks of text may be more clearly conveyed in a table or figure, as these are not counted in the total word count. However, manuscripts that require more words for clear communication can be submitted with a cover letter that describes the rationale for exceeding the word limit recommendation (see online supplementary data for a writing checklist).

We greatly value qualitative studies of complex problems in GME, as evidenced by the increasing number of qualitative research studies published in JGME. We believe that qualitative methods, applied rigorously, are pivotal to answering some of the most pressing questions in GME. We need this work to ensure effective, humane training of trainees for high-quality care of patients. Let us know how we can help in smoothing the submission path for qualitative manuscripts by emailing [email protected].

The online version of this article contains a writing checklist.