Why is qualitative interdisciplinary research so difficult to take seriously?

I was recently corresponding with a professor discussing one of the “Big Five” medical journals. My research is primarily qualitative and he remarked that the particular editor he was talking to, “doesn’t believe that qualitative research is research.” It is unfortunate that this perception exists in academic medicine and in particular with journal editors, the gatekeepers of scientific knowledge. I’d like to address the arguably widespread perception in academia that interdisciplinary research is generally of poor quality and more specifically, challenges that qualitative research faces in academic medicine. In order to answer this question, I thought it was necessary to address a more fundamental question: What is the definition of quality and who defines it?

Any scientific exploration must include an understanding of the research’s epistemological framework. Those with a realist ontology seek an objective truth that exists independently of an individual’s understanding of the world, whereas qualitative researchers tend towards a more interpretive lens.

The challenge with interdisciplinary research is that it operates at the intersection of these different theoretical frameworks. Researchers are thus confronted by the debates between these diverse worldviews in ways that disciplinarily focused researchers are not. Due to unequal funding streams and leadership structures, dominant frameworks emerge within interdisciplinary departments, which dictate definitions of quality.

Because publication counts factor so highly in evaluation metrics such as the REF, the academic publishing industry has a tremendous influence on this interdisciplinary research agenda. A drive to publish in high impact journals incentivises researchers to conform to these journal’s definitions of quality, even if their definition reflects a framework that is different from their researcher’s mode of inquiry.

Traditional quantitative medical sciences for example, judge research quality by its generalizability and validity. Because of this, they are less accepting of approaches such as phenomenology, which focus instead on understanding the subjective experiences of individuals in a specific setting. Checklists have emerged to conform qualitative research to positivist understandings of validity and generalizability. Standards such as double coding to ensure objectivity and consistency, are required for publication in reputable medical journals. One checklist even recommends that “interpretation must be grounded in ‘accounts’ and semi-quantified if possible or appropriate.”

I have spoken to social scientists working in medical based departments, who felt that the need to adapt to the principal discipline posed challenges to their intellectual self-identity. They expressed angst over their inability to produce research true to their home discipline’s definition of quality. This might affect their own employment prospects if they decide to move back into their native discipline. In my own research, I have realized that manuscripts I will submit to medical journals will need to written through a more objectivist mindset, rather than through an interpretive framework that seems more appropriate for my project.

This perception of poor quality reflects not only intrinsic prejudices against interdisciplinary research, but also systematically ingrained biases in the publication process. A recent study elucidated factors that contribute to this perception by showing that journal rankings inherently disadvantaged this type of research. They found that top journals “span a less diverse set of disciplines than lower ranked journals,” resulting in systematic bias against interdisciplinary research. Because publications in high impact journals are a proxy for quality and determine REF evaluation and financing, this becomes a disincentive against engaging in interdisciplinary research.

Many have warned me that it is difficult to publish qualitative research in the best medical journals. Particularly discouraging is a study which showed that over a span of ten years, only 0-0.6% of articles in the top ten medical journals were qualitative. As an early career researcher, this means that I will have a more difficult time distinguishing myself amongst my quantitative colleagues, since evaluation for jobs, promotions, and funding, are primarily based upon where we have published.

This is also disheartening if one thinks about the real world impact of requiring interdisciplinary research to conform to sweeping definitions of quality (impact is after all a REF priority!). These overwhelming structural incentives promote further siloing into individual disciplinary camps. As a medic transitioning into the social sciences, I have been thoroughly impressed by the ability of social scientists to provide a deeper understanding into key problems in health care. Social scientific inquiry in medicine has the potential to apply alternative insights towards positively informing health care practice. Cross-fertilization of ideas will remain limited unless we redefine quality to include all relevant modes of inquiry, and lower the barriers to publishing interdisciplinary research.


How to Truly Inspire Interdisciplinarity: Lessons From a Cambridge College

Studying at Cambridge, I have had the privilege of drawing inspiration from the familiar and routine. I am fortunate that my workspace is across from the breathtaking King’s College Chapel. Just looking up and seeing the calmness and majesty of this architectural masterpiece washes away any momentary PhD setback. My walk to lectures takes me by the pub where Watson and Crick celebrated their discovery of DNA and J.J. Thompson discovered the electron. My bike ride home runs through the field where the rules of football were invented.

But what makes Cambridge an incredible place is the casual and natural interdisciplinarity that is unavoidable and fully ingrained into its social fabric. Student life is focused around the colleges; the dining hall, bar, and common areas are the nexus of the Cambridge experience. This is unique amongst post-graduate experiences in higher education. In most universities, social interactions are centred around one’s academic department.

In Cambridge, students hang out with people from every discipline from scientists to the social sciences to artists. Graduates and faculty at Cambridge colleges live, eat, and work together. They have offices in both their department as well as in their college, and they work with colleagues in other disciplines in college committees and councils. This creates a community that fully embodies the notion of working together as academics and intellectuals, rather than as a biologist, an architect or a historian. When disciplines mix organically, you develop new ideas and perspectives, as well as a flexibility and acceptance for other ways of thinking.

Looking back over the past few years, my most profound and influential educational moments occurred not in the classroom, but over meals, casual conversations, and at the pub. It was here in Cambridge that a good friend with opposing political views, but a ready willingness to engage in thought provoking debates, taught me how to hold my own in casual conversational debates on current affairs. It was in the King’s College bar where I first understood the fundamentals of Marxism over a pint with an anthropologist friend. Random discussions with a friend studying architecture resulted in our creation of a medical hypothesis to explain stigmata in Christianity. The most engaging discussion I’ve ever had about my PhD project on Do-Not-Resuscitate decision-making was with my philosopher and historian friends debating the moral philosophical aspects of autonomy and suffering. And a central influence in my desire to engage the public with my academic research developed through conversations with a friend who studies the Sociology of intellectuals.

These defining moments left me unsatisfied with a purely clinical career path. Residency training following my MPhil was at times a frustrating experience, as I could not help but think about all the structural problems that hindered my ability to properly care for patients. It was infuriating to only be able to put plasters on the acute issues that only temporised deeper pathologies that could only be fixed if we addressed the underlying problem such as lack of insurance, poverty, and skewed economic incentives in medicine.

I found it repressive to be so inspired by events such as the Arab Spring, only to go to work in the hospital and not hear a single mention of these events. I yearned to be back in Cambridge, where I could discuss the implications of the day’s events with my friends in Middle Eastern Studies and International Relations. It also reminded me of how far I had come. I recalled walking into work one day during medical school and someone telling me, “Al Zarqawi is dead.” I looked up at the patient census and asked, “What?! Which patient was he? What did he die of?” I was so immersed in medicine at the time that I had no conception of what was going on in the outside world.

Interdisciplinarity is the new buzzword in academic research and education. But few universities are able to pay more than just lip service to this concept. Indeed, the very nature of academia resists interdisciplinarity. We are trained to become experts on the most minute aspects of our subject, and are chastised for being too broadly focused or having too many interests. As Simon Goldhill, Director of the Cambridge Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) states, “We have people who know more and more about less and less. That’s the definition of a PhD, isn’t it?” This intense specialisation prevents us from seeing the forest amongst the trees. It is thus completely unsurprising that cross-disciplinary efforts and inter-departmental initiatives often fail and do not go beyond initial superficial connections. I have heard gripes at more than one prestigious institution about the impenetrable silos that separate departments and communities within the university.

A common reminisce about college is the spontaneous philosophical conversations that occur in dorm hallways until 3 am. It is unfortunate that in most institutions of higher learning, we stop talking to each other after undergrad. Instead, we compartmentalise ourselves off in our departments, talking to people who think the same way we do. We begin preaching to the choir and feel affirmed that our style of thought is the only right way. The way in which we are trained and specialise shapes our identity and how we process the world beyond our academic disciplines.

Not only do we develop specialised knowledge, but we also become inculcated in a particular way of examining and talking about the world that breeds distrust against other approaches and a belief that our methodology is the best. I have felt for example, that some academic physicians on the surface embrace the concept of applying social sciences to medicine, but are unable to accept non-positivist ways of understanding the world and dismiss it as insufficiently rigorous. Joe Henrich, an anthropologist, used game theory rather than the more traditional ethnography to elucidate cross-cultural differences in gift giving and human behavior. Rather than embracing the capacity for other fields to enhance understanding, many anthropologists felt threatened by this methodological promiscuity, finding it “unethical,” “heavy-handed and invasive.”

I think a key aspect to achieving substantive interdisciplinarity is through the intentioned design of physical and social spaces. Creating spaces where people continuously come into contact with people outside their discipline in natural, casual social settings over and over again, helps develop social networks that eventually become the source of intellectual inspiration and creativity. Here is where “nudge” can be applied, where calculated use of space have the power to change human behavior and promote unconventional social interactions and networks.

Stanford has been a pioneer in designing physical spaces to foster mixing of ideas and philosophies. The Center for Clinical Sciences Research (CCSR) building has few walls. Instead of lab bench space being allocated by research group, where all members of a lab are grouped together, scientists are interspersed around the entire building, promoting collegiality and discussion amongst members of different labs and disciplines. Its intentions were clear from the start, “its design responds to emerging trends for interdisciplinary biomedical research, [where] interaction between disciplines and individuals is encouraged.” Bio-X’s Clark Center is another example of interdisciplinary spaces, where “warehouse like lab spaces and shared facilities” foster collaboration between engineers, scientists, doctors and others to develop technologies and solutions to a common problem.

At Stanford, I participated in a program called the Biodesign Innovation Program, which brought together engineers, business students, and medical students into small teams to come up with solutions to medical problems. My team invented a device, which we’ve since patented to minimally invasively cool the heart during a heart attack. The experience emphasised the ability of different perspectives to develop innovative solutions to existing problems. The Stanford d.school (Institute of Design) is the latest example of innovation in interdisciplinarity, where students from any department are able to take classes in applying concepts of design to their specific areas of research.

Michael Bloomberg recently announced a $350 million donation to the Johns Hopkins University, the largest donation of its kind to a university. He stipulated that a portion of this donation go towards endowing professorships focused on collaborative interdisciplinarity. I would urge Mr. Bloomberg to also encourage Johns Hopkins to think about new ways to nudge scholars out of their comfortable silos through design strategies that bring researchers of different subjects together. It would be amazing if new developments on campus grouped people in innovative ways, perhaps by problems to be solved or themes to explore, rather than by discipline. Programs similar to Stanford’s Biodesign Innovation Program would further bring together researchers, but perhaps more importantly, social spaces should be created which foster collegiality, trust and personal connections.

Many medical school campuses, including Johns Hopkins, are miles away from the main campus, preventing easy interactions between these campuses. Obviously it would be unfeasible to change this, but future buildings could be strategically located in ways that foster cross-disciplinary interactions. The Hopkins Bio Park is currently under development. Why not introduce buildings that house academics in medicine, humanities and social science who work together and research together as equals the intersection between medicine and the social science?

Princeton and Yale have collegiate systems modeled on those of Oxford and Cambridge colleges, where undergraduates live and socialize together in colleges. Neither graduate students nor faculty members are integrated into the college system. The colleges primarily provide residential and social support, rather than academic enrichment. I believe that these institutions have missed out on a critical aspect of the “Oxbridge” college system. Integrating the remainder of the university population into the college structure would enhance interdisciplinary interactions at the graduate and potentially faculty level. This is key because it is at the graduate level where we start becoming specialised and indoctrinated into the academic mindset.

I am leading a conference in Cambridge called the Global Scholars Symposium, which brings together students for three days of cross-disciplinary discussion with leaders in the field to discuss global problems, and how we can apply creative solutions to these issues. Participation in this conference in past years inspired me to continue looking outwards beyond my field to think about what we as young individuals can do to make the world a better place. Creating more opportunities that bring together scholars from different fields would hopefully inspire academics to look outwards beyond publication counts and grant writing to see how their research can be applied to solving real world problems.

Taking the interdisciplinary path has not been easy. Residency would have been far easier if I wasn’t always frustrated by the social and political problems which got my patients in the hospital in the first place, and hospital financing practices which at times seemed to prioritize the bottom line over patient care. I sometimes envied my colleagues who were singularly focused on becoming cardiologists so that they could focus on repairing valves. In my PhD research, I am constantly admonished for being too unfocused, and the desire to meld divergent discourses and epistemological stances has been fraught with challenges and misunderstandings. Hopefully in the end, I will be able to say that it was worth it and there will be a role for someone like me when I’m done with this chapter in my intellectual development.

A version of this essay was published in the Guardian on 15 March, 2013