A practical guide to reflexivity in qualitative research: AMEE Guide No. 149

Figures & data

Table 1. Commonly cited definitions of reflexivity from the field of qualitative research.

Reference	Definition
(Walsh 2003)	“That which turns back upon (or takes account of) itself or the person’s self”
(Dowling 2006)	“The analytic attention to the researcher’s role in qualitative research. A continuous self-critique and self-appraisal where the researcher explains how his or her own experience has or has not influenced the stages of the research process.”
(Gentles et al. 2014)	“The generalized practice in which researchers strive to make their influence on the research explicit -to themselves and to their audience.”
(Finefter-Rosenbluh 2017)	“A continual internal dialogue and critical self-evaluation of the researcher's positionality (Pillow 2003), which leaves the researcher changed in its wake (Mauthner and Doucet 2003).”
(Russell and Kelly 2002)	“A process of honoring oneself and others in our work through an awareness of the relational and reflective nature of the task.”
(Finlay 2002b)	“A thoughtful, conscious self-awareness that encompasses continual evaluation of subjective responses, intersubjective dynamics and the research process itself”
(Kuehner et al. 2016)	“A strategy of using subjectivity to examine social and psychosocial phenomena, assuming that social discourses are inscribed in and social practices are embodied by the researcher.”
(Malterud 2001)	“Attending systematically to the context of knowledge construction, especially to the effect of the researcher at every step of the research process.”

Box 1. Summary of and reflexivity orientations applied in Unravelling residents’ and supervisors’ workplace interactions: an intersubjectivity study Olmos‐Vega, F. M., Dolmans, D. H. J. M., Guzmán‐Quintero, C., Stalmeijer, R. E., & Teunissen, P. W. (2018).

Case Summary

A constructivist grounded theory study, conducted by the first author of this Guide (FOV), explored how residents and supervisors came to a shared understanding of how to provide patient care jointly. The study took place in an anesthesiology department in Bogotá, Colombia. 11 residents from different training levels and 18 clinical supervisors with varying years of teaching experience participated. We conducted the study under a constructivist paradigm while using a sociocultural theoretical framework to understand learning. The interdisciplinary research team consisted of an anaesthesiologist pursuing a PhD in HPE (FOV), an anthropologist, two educationalists, and an obstetrician with expertise in workplace learning. The principal investigator was a clinical supervisor in the anesthesiology department during data generation and analysis and, as such, had previous working relationships with all the participants. The rest of the team were outsiders to the research context; they had no prior contact with the participants or the research field. We generated data first through focus groups with residents and supervisors and then through field observation. Focus groups with supervisors were held independently from those with residents. The first author moderated the focus groups with an observer (the anthropologist). Then, the anthropologist conducted five months of non-participant observation in the Operating Room, the outpatient clinic, various hospital wards, and the labour ward.

Box 2. Personal reflexivity

Personal Reflexivity Ask yourself: how are our unique perspectives influencing the research?

I (FOV) was the primary investigator in this study, conducted as part of my PhD research in Health Professions Education. All of my colleagues and residents were aware of this aspect of the study context. Being an insider researcher, many of my research ideas stemmed from personal experiences and observations as a clinical supervisor. As a supervisor, I often work closely with residents from across the graduate medical education continuum. Based on these experiences and informal conversations with my colleagues, I noticed the complexities involved in arriving at a mutual understanding about how to work with residents. I was disappointed by the lack of information available in the literature to help guide my thinking. My supervisors' experiences enabled me to appreciate the importance of looking at the supervisor-resident dyad as a unit of analysis. While many care providers are working with residents, the construction of a shared understanding of how to offer care to a specific patient was deeply enmeshed in the dynamics of these dyads. By using this personal insight, I shaped my study to focus on supervisory dyads. The first crucial step in my personal reflexivity involved reflecting on how I usually work with my residents and managing my assumptions around how my peers think about and experience supervision. During data generation and analysis, I started to uncover many nuances involved in working with residents in supervisory dyads through the experiences of my colleagues. I saw myself trying out new ways to supervise my residents and adapt to their uniqueness. As a result, I gained new supervisory tools and approaches that allowed me to adapt to each resident's needs and preferences in each situation.

Box 3. Interpersonal reflexivity

Interpersonal Reflexivity: Power Ask yourself: what relationships exist and how are they influencing the research and the people involved? What power dynamics are at play?

I was an insider during my study of clinical supervision. But I was not just any insider: I was a clinical supervisor in the department in which we conducted the study. In other words, the participants were colleagues I worked with and residents I supervised. I also did my residency training in the same department, which meant that most of my colleagues had been my supervisors at some point. Consequently, my interactions in the research space were influenced by experiences as a supervisor and as a (former) resident. I had to carefully think through and document how these existing relationships and my position in the context impacted my data and the context itself. For example, being known in the context gave me access to many participants; however, I had to mediate any pre-existing differences of opinion with or feelings about the supervisors and/or residents to uncover their clinical supervision experiences. In addition, I had to consider how existing power dynamics were shaping my interactions with residents—e.g. would they highlight the more positive experiences they had with me as a supervisor, or would those who did not like my supervisory style avoid participating in the study as a result of our previous encounters? Different dynamics shaped my interactions with supervisors—e.g. some of my former supervisors could have felt pressure to ascribe to my views on supervision or may have felt that they were being evaluated.

Box 4. Methodological reflexivity

Methodological Reflexivity Ask yourself: How are we making methodological decisions and what are their implications?

We conducted our study from a constructivist paradigm, using a sociocultural theory (Billett’s Co-participation Theory) to inform our theoretical framework and constructivist grounded theory as methodology. This approach allowed us to explore a social process through the participants' and researchers’ voices, capitalizing on my role as an insider co-constructing data. Although we believe this was the best methodological approach, it was certainly not the only option. I remember that one of the authors suggested using Actor-Network Theory (ANT) to explore our findings. Although they had agreed with the initial theoretical framework, they felt we were missing essential elements in our analysis of field observations. By choosing ANT, a socio-material framework, this author argued, we could investigate how different material artefacts (physical spaces, objects, or organizational protocols) influence supervisory dyads. After considerable group discussion, we decided to stick with our initial theoretical framework since co-participation theory would also allow us to focus on essential aspects of the interpersonal relationship between resident and supervisor. Being methodological reflexive entailed understanding both the affordances and shortcomings of our choices and making these implications explicit in the manuscript. This example also demonstrates the need to evaluating continously the alignment of our paradigm and theoretical framework when making methodological decisions in data generation and analysis.

Box 5. Contextual reflexivity

Contextual Reflexivity Ask yourself: How are aspects of context influencing the research and people involved?

Being contextually reflexive in our study entailed understanding the unique setting of the study—an anesthesiology department in a high-complexity, urban, academic hospital. Supervisor-resident relationships in this context tend to be intense and continuous, often in a 1:1 ratio. This meant that supervisory dyads worked together closely while caring for patients, which could be different from other disciplines, types of hospitals, or areas with fewer resources. The specific department we studied also encouraged a less hierarchical workplace structure and culture. Therefore, it was necessary to reflect on and report on how this context uniquely shaped interactions between supervisors and residents. In addition to reflecting on how the context impacted the research, I reflected on how my research impacted the context. I held informal conversations with some of my colleagues during non-participant observation. We discussed the feeling of being observed by a stranger and how observation could feel like an evaluation. Through these trust-building discussions, my colleagues often exchanged impressions about how they usually worked with the residents. People repeatedly questioned their decisions and practices while asking me the right way to do it. It was evident that this study caused participants to reflect on their supervisory choices and those of their peers.

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