Week 4 Reading Pope (2005): Conducting Ethnography in medical settings Flashcards
Issues that arise when undertaking ethnographic work
(Pope, 2005) 4
- gaining access
- recording data
- research roles
- researching elite groups
How long have ethnographic research methods been used to study medical education (Pugsley and Atkinson)
50 years
4 Questions addressed in paper
(Pope, 2005)
- How do ethnographers gain access to the setting?
- How is data recorded?
- Is there a fixed role for the researcher?
- Are there special issues involved in researching elite groups?
Purpose of Paper by Pope (2005)
personal account of conducting ethnography in medical environments
What is known on the subject (identified by Pope, 2005)
(ethnography)
Ethnography involves lengthy participation or immersion in a setting
What the study adds to knowledge of ethnography (Pope, 2005) (5)
- degree of participation in life of setting varies
- research roles are not fixed and move along a continuum from observer to participant
- consent may need to be negotiated as research becomes embedded
- important to consider impact of routes into setting
- typically, ethnographer occupies more powerful position than subjects, but medical ethnography often reverses this hierarchy
Suggestions for further research (Pope, 2005)
systematic observational methods employed in ethnographic research used in clinical training to examine and refine practice
who oversees gaining ethical approval in the UK
a system of research ethics committees (RECs)
RECs
= Research Ethics Committees, oversee ethical approval in UK, prmarily a mechanism for governing quantitative research
issues with RECs
- lengthy and bureaucratic process of approval (32 applications)
- don’t understand ethnographic research
- REC members may not have expertise to judge a qualitative research protocol
issues with gaining access (health context)
- REC incompetence/lengthy process
- new research governance requirements (all research approved by particular healthcare organisation involved)
- hard for non-NHS researcher to identify individuals to grant permissions
- long negotiations, form-filling, honorary contracts
- being briefed on risks, however minimal (e.g. occupational health and safety guidelines about blood/bodily fluids in US)
how did Pope (2005) gain access to 3 studies
- existing network of contacts in UK–> access to organisations + suggest other contacts in USA
- only 1 UK surgeon said no (busy) but let watch, no USA surgeons said no
Access in study of anaesthetists
facilitated by consultant anaesthetist who was part of the research team
Access in study of waiting list management
permission of senior managers (who instigated research project) to hang around admissions office
office staff bemused, did not object
impact of routes of entry into organisation or group
point of entry + alliances with powerful gatekeepers influence how group members perceive research
–> reflect on power imbalances
Hawthorne effect
changes to participant behaviour due to research being carried out
solutions to research becoming ‘embedded’ (participants forget you are there, consent issues
- openly writing notes to signal tha research is happening
- reminding participants that research is happening
Opportunity to write notes, especially if privacy required
toilet breaks
Fieldnotes provide
raw material for analysis
How does Pope (2005) classify her own notes?
Realist: document every minutiae of life in the setting and offer single reading or version of events
- style developed over time, comes most comfortably
- transferable to other ppl (they can follow along)
Pope (2005)’s changing research role throughout studies
etic –> emic
initially outsider/complete observer –> moved toward participant end of continuum as relationship with surgeons progressed
identification with patient –> surgeon perspective
‘Studying up’
= ethnographer is more ‘junior’ party in age, professional or occupational status or gender (minority)
Public accounts by elite informants
= rehearsed presentations rather than in-depth, unofficial story needed
Hawthorne effect
- avoid with informal interview settings e.g. meals, coffee, cigarette breaks
Reflexivity
= thinking critically about roles and relationships, about ethics and responsibilitie
- central to ethnography
Pope’s 3 studies
- ‘Waiting lists for elective surgery’: focus on people-processing activities of ‘lower order participants’ (in this case, medical clerks and secretaries who managed elective care waiting lists) Research question: How do waiting lists really work?
- ‘Surgical practice’: understand how surgeons accomplish surgery and how the acquire new skills and knowledge
- ‘Anaesthetics expertise’: examine routes to acquisition of expertise, notably, the importance of the apprenticeship model of training and role of tacit knowledge, use of personal routiens and communication
