Using Q methodology in health sciences education to study subjectivity.

Q methodology is a unique, yet underutilized methodology designed specifically to scientifically study subjectivity. Q, as it is most often referred to, is an appropriate methodology whenever a researcher is interested in uncovering and describing the multiple divergent viewpoints on any topic. Such discovery of viewpoints provides insight into the subjectivities related to policies, values, priorities, judgements, opinions, and decisions. The disciplines where Q has been used for research are many, and include health sciences, education, and other social science / behavioral science fields. Because of its rather idiosyncratic place in research, however, many Q methodologists are self-taught or seek education through a few select universities that offer graduate level Q courses. The key to successfully approaching a Q study is to embrace its unique approach to studying subjectivity such that it is a powerful tool in health science education and other fields. It is common to find inconsistencies related to Q terminology, analyses, and decision making across studies. There is often an over reliance on concepts that come from purely quantitative methodologies such as R factor analysis rather than embracing the qualitative-quantitative hybridity of Q. This article is written as a primer with a focus on understanding Q at a deeper level rather than a step-by-step guide.

Universities and the COVID-19 Pandemic: Comparing Views about How to Address the Financial Impact.

Universities were forced to move instruction online and send residential students home due to the pandemic, resulting in financial shortfalls. Governing boards, administrators, and governments made decisions including eliminating faculty and staff, and programs yet these decisions were rarely inclusive of university stakeholders or innovative. This study's purpose is to examine and compare viewpoints of stakeholders in relation to addressing the financial impact of the pandemic in hopes of capturing innovative and effective pathways for universities. Because the purpose involved describing and comparing these viewpoints, the researcher selected a unique mixed method, Q methodology [Q] for this study. In Q, participants sort statements related to the topic into a grid such that their Q-sort provides a snapshot of their subjectivity. Participants' sorts are grouped empirically into factors, each representing unique viewpoints. Three distinct viewpoints emerged: 1) Focus on teaching mission and students, 2) University as a business, and 3) University as community. Views 1 and 3 were dominated by university faculty while View 2 was dominated by non-faculty including administrators and staff. Q's determination of distinguishing statements within each view provides the ability to compare these views' uniqueness. The three views and consensus among the views represent rejection of decisions to lay off faculty or close programs, among others, in order to balance university finances. The importance of tenured faculty in relationship to shared governance and academic freedom is especially stressed by two of the viewpoints. Implications for higher education policy, innovation, democratic problem-solving, and governance are discussed.

Inter-rater variability as mutual disagreement: identifying raters' divergent points of view.

Whenever multiple observers provide ratings, even of the same performance, inter-rater variation is prevalent. The resulting 'idiosyncratic rater variance' is considered to be unusable error of measurement in psychometric models and is a threat to the defensibility of our assessments. Prior studies of inter-rater variation in clinical assessments have used open response formats to gather raters' comments and justifications. This design choice allows participants to use idiosyncratic response styles that could result in a distorted representation of the underlying rater cognition and skew subsequent analyses. In this study we explored rater variability using the structured response format of Q methodology. Physician raters viewed video-recorded clinical performances and provided Mini Clinical Evaluation Exercise (Mini-CEX) assessment ratings through a web-based system. They then shared their assessment impressions by sorting statements that described the most salient aspects of the clinical performance onto a forced quasi-normal distribution ranging from "most consistent with my impression" to "most contrary to my impression". Analysis of the resulting Q-sorts revealed distinct points of view for each performance shared by multiple physicians. The points of view corresponded with the ratings physicians assigned to the performance. Each point of view emphasized different aspects of the performance with either rapport-building and/or medical expertise skills being most salient. It was rare for the points of view to diverge based on disagreements regarding the interpretation of a specific aspect of the performance. As a result, physicians' divergent points of view on a given clinical performance cannot be easily reconciled into a single coherent assessment judgment that is impacted by measurement error. If inter-rater variability does not wholly reflect error of measurement, it is problematic for our current measurement models and poses challenges for how we are to adequately analyze performance assessment ratings.

Effect of an exercise and weight control curriculum: views of obesity among exercise science students.

Awareness of effective weight management strategies is necessary to prepare exercise science students for future work with obesity. Exercise science faculty members developed a course related to exercise as a therapeutic tool and options available for weight loss. The purpose of the present study was to investigate student views of weight management and obesity, which can be a difficult task using traditional methods such as Likert scale surveys. To investigate student views relative to the course content, Q methodology, which is a mixed-method research approach, was used at the beginning and end of the course. Students completed a Q sort, ranking 44 statements related to obesity in accordance to their own points of view. The pretest/posttest design enabled an opportunity to determine if course goals were accomplished and if student perceptions related to obesity were transformed. Factor analysis of precourse sorts revealed that students possessed a naïve singular view of weight-related concepts. Analysis of sorts at course completion resulted in a two-factor solution revealing changes in perspective; some students took on a health professional type of view, whereas others demonstrated antifat views. In conclusion, the findings revealed key variables that should be addressed in curricula involving therapeutic obesity interventions. An improved curriculum based on these results should better encourage students to develop a broad comprehension of multifactorial causes and treatment for weight management and obesity. Implementing the use of Q methodology may serve as a valuable asset to measure and evaluate subjectivity of obesity discrimination. Antifat attitudes among exercise science students may influence future clients' potential achievements.