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Cited by 1,028Qualitative Research Methods and ApplicationsInnovations in Medical EducationQualitative Research Methods and Ethics

Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking

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Varpio, Lara, Ajjawi, Rola, Monrouxe, Lynn V, O'Brien, Bridget C, Rees, Charlotte E·2017·Medical Education
DOI 10.1111/medu.13124
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Abstract

Context: Qualitative research is widely accepted as a legitimate approach to inquiry in health professions education ( HPE ). To secure this status, qualitative researchers have developed a variety of strategies (e.g. reliance on post‐positivist qualitative methodologies, use of different rhetorical techniques, etc.) to facilitate the acceptance of their research methodologies and methods by the HPE community. Although these strategies have supported the acceptance of qualitative research in HPE , they have also brought about some unintended consequences. One of these consequences is that some HPE scholars have begun to use terms in qualitative publications without critically reflecting on: (i) their ontological and epistemological roots; (ii) their definitions, or (iii) their implications. Objectives: In this paper, we share our critical reflections on four qualitative terms popularly used in the HPE literature: thematic emergence; triangulation; saturation, and member checking. Methods: We discuss the methodological origins of these terms and the applications supported by these origins. We reflect critically on how these four terms became expected of qualitative research in HPE , and we reconsider their meanings and use by drawing on the broader qualitative methodology literature. Conclusions: Through this examination, we hope to encourage qualitative scholars in HPE to avoid using qualitative terms uncritically and non‐reflexively.

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  • In the reviewed articles, authors made reference to concepts, concerns and practices that reflect (post) positivist concerns, such as small samples or lack of generalisability as limitations, saturation as a criterion for stopping data generation, triangulation, participant validation, and concern about researcher bias.

    “In the reviewed articles, for example, authors made reference to concepts, concerns and practices that reflect (post) positivist concerns – and ones which are often entirely normalised within disciplinary contexts.”

    From Supporting best practice in reflexive thematic analysis reporting in <i>Palliative Medicine</i> : A review of published research and introduction to the <i>Reflexive Thematic Analysis Reporting Guidelines</i> (RTARG) (2024) · cites this paper as [29]

  • Qualitative methodologists have already presented thoughtful considerations of what is assumed and at stake in various supposedly universal criteria.

    “Luckily, qualitative methodologists have already done a lot of the heavy lifting here (e.g., Braun & Clarke, 2021b;Smith & McGannon, 2018;Varpio et al., 2017Varpio et al., , 2021)), presenting thoughtful considerations of what's assumed and at stake in various supposedly universal criteria.”

    From Toward good practice in thematic analysis: Avoiding common problems and be(com)ing a <i>knowing</i> researcher (2023) · cites this paper as Varpio et al., 2017

  • The concept of saturation is widely debated, and information power might be a better concept.

    “This concept is widely debated, however, and Varpio et al. provides a great description of why information power might be a better concept.6”

    From How to … assess the quality of qualitative research (2020) · cites this paper as [6]

  • The concepts of triangulation or crystallisation are used as quality markers in somewhat different ways depending on the paradigm.

    “Varpio et al. further explain how the concepts of triangulation or crystallisation are used as a quality marker in somewhat different ways, depending on the paradigm.6”

    From How to … assess the quality of qualitative research (2020) · cites this paper as [6]

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Authors
Varpio, L., Ajjawi, R., Monrouxe, L. V., O'Brien, B. C., & Rees, C. E.
Affiliations
  • Uniformed Services University of the Health Sciences (US)
  • Deakin University (AU)
  • Chang Gung Memorial Hospital (TW)
  • Department of Medicine University of California San Francisco San Francisco California USA
  • Monash University (AU)
Corresponding author
Varpio, Lara
ORCID
Venue
Medical Education
Publisher
Wiley
Published
2016-12-16
Volume
51
Issue
1
Pages
40-50
ISSN
  • 0308-0110 (ISSN-L)
  • 1365-2923
DOI
10.1111/medu.13124
OpenAlex
W2562778769
Semantic Scholar
f6cc49a0d5ae5b26dadfdbc5c52c7ebf8dea5908
Cited by
1,028
References
64
Citations by year
2026: 146 · 2025: 169 · 2024: 167 · 2023: 138 · 2022: 137 · 2021: 108 · 2020: 59 · 2019: 44 · 2018: 41 · 2017: 16 · 2016: 2
FWCI
152.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Medical Education (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Topics
  • Social Sciences › Education › Qualitative Research Methods and Applications
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Social Sciences › Sociology and Political Science › Qualitative Research Methods and Ethics
Keywords
qualitative research methodology, health professions education, triangulation, saturation, member checking, reflexivity, ontological and epistemological assumptions, research legitimacy
MeSH terms
Health Occupations, Humans, Research Design, Qualitative Research

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