Week 4 Reading Pope (2005): Conducting Ethnography in medical settings

Question 1

Issues that arise when undertaking ethnographic work

(Pope, 2005) 4

Answer 1

• gaining access
• recording data
• research roles
• researching elite groups

Question 2

How long have ethnographic research methods been used to study medical education (Pugsley and Atkinson)

Answer 2

50 years

Question 3

4 Questions addressed in paper

(Pope, 2005)

Answer 3

• 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?

Question 4

Purpose of Paper by Pope (2005)

Answer 4

personal account of conducting ethnography in medical environments

Question 5

What is known on the subject (identified by Pope, 2005)

(ethnography)

Answer 5

Ethnography involves lengthy participation or immersion in a setting

Question 6

What the study adds to knowledge of ethnography (Pope, 2005) (5)

Answer 6

• 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

Question 7

Suggestions for further research (Pope, 2005)

Answer 7

systematic observational methods employed in ethnographic research used in clinical training to examine and refine practice

Question 8

who oversees gaining ethical approval in the UK

Answer 8

a system of research ethics committees (RECs)

Question 9

RECs

Answer 9

= Research Ethics Committees, oversee ethical approval in UK, prmarily a mechanism for governing quantitative research

Question 10

issues with RECs

Answer 10

• 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

Question 11

issues with gaining access (health context)

Answer 11

• 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)

Question 12

how did Pope (2005) gain access to 3 studies

Answer 12

• 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

Question 13

Access in study of anaesthetists

Answer 13

facilitated by consultant anaesthetist who was part of the research team

Question 14

Access in study of waiting list management

Answer 14

permission of senior managers (who instigated research project) to hang around admissions office
office staff bemused, did not object

Question 15

impact of routes of entry into organisation or group

Answer 15

point of entry + alliances with powerful gatekeepers influence how group members perceive research
–> reflect on power imbalances

Question 16

Hawthorne effect

Answer 16

changes to participant behaviour due to research being carried out

Question 17

solutions to research becoming ‘embedded’ (participants forget you are there, consent issues

Answer 17

• openly writing notes to signal tha research is happening
• reminding participants that research is happening

Question 18

Opportunity to write notes, especially if privacy required

Answer 18

toilet breaks

Question 19

Fieldnotes provide

Answer 19

raw material for analysis

Question 20

How does Pope (2005) classify her own notes?

Answer 20

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)

Question 21

Pope (2005)’s changing research role throughout studies

Answer 21

etic –> emic
initially outsider/complete observer –> moved toward participant end of continuum as relationship with surgeons progressed
identification with patient –> surgeon perspective

Question 22

‘Studying up’

Answer 22

= ethnographer is more ‘junior’ party in age, professional or occupational status or gender (minority)

Question 23

Public accounts by elite informants

Answer 23

= rehearsed presentations rather than in-depth, unofficial story needed
Hawthorne effect
- avoid with informal interview settings e.g. meals, coffee, cigarette breaks

Question 24

Reflexivity

Answer 24

= thinking critically about roles and relationships, about ethics and responsibilitie
- central to ethnography

Question 25

Pope’s 3 studies

Answer 25

• ‘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