Realist Case Study Research: A Methodological Guide

Much of what happens in health professions education (HPE) is intervention work in complex systems, and researchers now expect methodologies that go beyond whether a programme worked to explain how and why it worked and for whom. Realist evaluation and case study research each speak to that need, and they have developed alongside one another. Their purposeful integration, however, has not been articulated as a methodology in its own right. We draw on realist evaluation theory and on case study methodology informed by our own realist programme in supervised workplace learning, to describe the integration. We call it realist case study research. What follows describes what makes the pairing more than the sum of its parts and works through the phases of the approach using a single running study. We discuss where the approach is useful and where it is not. Realist case study research uses realist evaluation logic, expressed through programme theory and context-mechanism-outcome (CMO) configurations, to drive bounded case inquiry. Case study methodology gives the realist project the disciplined boundaries and thick within-case description it needs. Realist logic gives case study research an explanatory spine and a systematic way of comparing across cases that moves past thematic reading. The result is a refined programme theory, tested against the messy particulars of practice and portable to new settings.