#8 Methods Consult – Paradigms

Host: Lara Varpio

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Methods Consult – Paradigms is an inaugural episode where Lara Varpio dig a bit deeper into the some of the science methods and theory in Health professions education.

When you need a little help, or a second opinion, or just some advice from an expert colleague, you might call for a consult. These methods consults are precisely that: a little insight from a colleague who has medical education research experience and (some) expertise.  

The philosophies of science and research paradigms.

Today’s consult covers a topic that is the foundation of any research: the philosophies of science and research paradigms. Whether you’re explicitly aware of it or not, you have ideas and assumptions about how to conduct research. These ideas and assumptions are the groundwork for all the decisions you make when you conduct your research. But, when you work in an interdisciplinary field of research like health professions education, you realize that not everyone shares the same ideas and assumptions. This is why, to be a savvy researcher in our field, you need to know your way around the philosophy of science and (at least some of) the paradigms that live therein. 

The word PARDIGM is a label we give to a world view, to the way a researcher thinks and reasons about the work of developing new knowledge. A paradigm shapes how someone thinks about reality, about knowledge, and about rigorous research. It acts as the foundation of your research and scaffolds all the things that you will do in your research efforts: from writing the research question, to all the decisions about data collection and analysis, to your expectations of rigor, to the arguments you will present in a published evidence-based manuscript. Therefore, it is important to know what your assumptions are. It is important to be explicitly aware of the PARADIGM with which you align.  

In this episode, we address two of the most common paradigms in our field. This is a simplification. When it comes to philosophy, there are a lot of details and arguments. This podcast will only delve into some of those details. For a more fulsome review, please look at the references offered below.   

To begin, I’ll ask you to imagine our field of health professions education. Visualize what that means to you. Who are the people there? What are the physical spaces involved? What topics do we grapple with? Which policies are particularly important? Think about the breadth, depth and diversity of what is involved in HPE.  

How do we go about studying this environment? Where do we start?  

Well, let’s push our thought experiment a little further. I’ll ask you to imagine organizing all HPE-related things into two columns: social reality and physical reality. (Note: This is an artificial separation. In reality, all these things are intertwined and are not solely within one column of our table, but for now, imagine how you might divide them) 

Social reality Physical reality
People working in HPE (e.g., faculty, learners, etc) 
Spaces where learning happens (e.g., lecture halls, clinical workspaces) 
Influential groups in HPE (e.g., accrediting organizations, promotion & tenure committees, etc)Patient care interventions and equipment (e.g., pharmaceuticals, surgical tools)
Policies (e.g., accreditation standards, exam pass/fail structures)Objects used in learning and in patient care (e.g., electronic health record, podcast recordings) 
Some competencies (e.g., communication skills, collaboration skills)Some competencies (e.g., technical skills) 

Physical reality

How are we going to examine the things and topics of the physical reality? The foundational premises for a lot of research, the scientific method, was originally developed to examine topics that we might place on this side of our table. Research conducted here will usually strive for objectivity. We don’t want to influence the physical world we are studying; instead, we want to see how it works, try to develop cause and effect explanations. To do that, we need to be controlled, to do everything we can to study ONE variable without changing others. We can then observe that variable, build knowledge about it through objective observation and calibrated measurements. Ideally, my findings will be replicable and generalizable. The knowledge we develop describes the unchanging regularities in the physical world.  

Example: Simulation for teaching suturing skills.  

Social reality

In this reality it is harder to be objective. People are interacting with each other in ways we can’t control. In social reality cultures exists, and groups, and group dynamics where for some people, some actions are permissible, and for others the same actions are not. And it is in these social spaces a lot of HPE happens. Think about professionalism for example, in the social reality, professionalism is not the same thing for all people, groups, cultures or organization that is a part of all HPE space.

A question I ask myself if I’m in doubt if the study belongs in the social space or physical: Would this phenomenon be the same, 50 years ago, or 500 miles away? If it belongs in the social space it most probably not be the same, because it is not consistent.

The tools I had for studying reality in the physical side, objectively some of the same techniques will not work here in the social side.

How to differentiate between realities 

HINT: I’m in doubt if the phenomenon I’m studying is one that I want to study as part of a social reality or as part of a physical reality, I ask myself this question: Would this phenomenon be the same today as it was 50 years ago or 500 miles away? If I think this phenomenon changes over time and over contexts (i.e., if my answer yes to my question), then I’m thinking of it in terms of a social reality.

Why are we engaging in this thought experiment 

ask you to entertain this thought experiment because it highlights that the goals for doing research on different phenomena are different depending on how you conceptualize the phenomenon. Rigor looks very different in these different spaces. The tools used for studying reality are very different in these different spaces. Therefore, do to research on different phenomena requires that you start by being very clear about how you are thinking about your object of study.  

But it is just a thought experiment 

Remember, we teased apart the phenomena involved in HPE artificially and theoretically. As you know, all of these pieces link together. They are all intertwined and influencing each other. No single topic rests solely in one reality or the other. But when we are thinking about research, we need to be very clear about how I am conceptualizing the phenomenon I’m studying. What kind of reality am I assuming to be the foundational scaffold of my study? 

  • Am I studying a reality that is external to me and that is has unchanging regularities? Am I looking for cause and effect relationships between different factors? If yes, then you are likely working from a post-positivist orientation. 
  • Am I studying a reality that changes over time and across contexts? Is the phenomenon one that exists within and/or between people? If yes, then you are likely working from a constructivist orientation. 

Why are these orientations important to consider?

In each of these orientations—in each of these paradigms—research practices and outcomes are very different.   

Post-positivist paradigm: Rigorous research and the knowledge developed through that research is objective and unbiased. The object of study is reality: it is unchanging, and it is consistent. Others should be able to replicate my study and generate similar findings. My findings will be generalizable across time and contexts—because, if my research is rigorous, I have developed insights into the reality that is permanent and predictable.  

Constructivist paradigm: Rigorous research and the knowledge developed through that research is subjectively shaped and informed. The object of research is a social and personal reality that is contextually and socially connected. To understand that reality, I need insights from people. I need to find out how they think and how they relate to each other. I will likely ask a variety of open ended questions to elicit reflections from people, to glean more information about their experiences and their communities. This means that the reasearch is not objective. I’m building an understanding of the social reality in collaboration with the people I speak to. So the goal of research in this paradigm is not objectivity. But this doesn’t mean that “anything goes” or that I can “make up” what I want from the data. Instead, as a researcher, I need to explain my context, my participants, and my orientations so you, as the reader, can decide if your situations is sufficiently similar that the findings of my research would resonate with your reality. I also rely heavily on theory for other transferability arguments.  

NB: Paradigms should not be considered as hierarchial. No one paradigm is better or worse than another. Instead, they simply offer different foundations for thinking about and for conducting research. 


Good research in HPE is being carried out from many different paradigms. This is important because it means that we hold different conceptualizations of what reality is and what knowledge is. We hold different expectations of rigor. I need you to tell me the paradigm from within which you are conducting your research so that I know which standards of rigor you’re aiming for and what foundations are scaffolding your investigations.  


Academic Medicine’s Philosophy of Science Series

Contains several articles in the theme, among them this overview:

Varpio, L., & MacLeod, A. (2020). Philosophy of Science Series: Harnessing the Multidisciplinary Edge Effect by Exploring Paradigms, Ontologies, Epistemologies, Axiologies, and Methodologies. Academic Medicine, 95(5), 686. https://doi.org/10.1097/ACM.0000000000003142

Labonte, R., & Robertson, A. (1996). Delivering the Goods, Showing Our Stuff: The Case for a Constructivist Paradigm for Health Promotion Research and Practice. Health Education Quarterly, 23(4), 431–447. https://doi.org/10.1177/109019819602300404

Young, M. E., & Ryan, A. (2020). Postpositivism in Health Professions Education Scholarship. Academic Medicine, 95(5), 695. https://doi.org/10.1097/ACM.0000000000003089

Bergman, E., de Feijter, J., Frambach, J., Godefrooij, M., Slootweg, I., Stalmeijer, R., & van der Zwet, J. (2012). AM Last Page: A Guide to Research Paradigms Relevant to Medical Education. Academic Medicine, 87(4), 545. https://doi.org/10.1097/ACM.0b013e31824fbc8a




I love these methods consults so much that I made them the materials for my microteaching for my MedEd PgCert!

Teresa Sörö

Teresa Sörö

So lovely to hear! We are looking forward to more of those during the fall as well. Stay tuned!

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