Blurring the boundaries: using institutional ethnography to inquire into health professions education and practice

Abstract

CONTEXT Qualitative, social science approaches to research have surged in popularity within health professions education (HPE) over the past decade. Institutional ethnography (IE) offers the field another sociological approach to inquiry. Although widely used in nursing and health care research, IE remains relatively uncommon in the HPE research community. This article provides a brief introduction to IE and suggests why HPE researchers may wish to consider it for future studies.METHODS Part 1 of this paper presents IE's conceptual grounding in: (i) the entry point to inquiry ('materiality'), (ii) a generous definition of 'work' and (iii) a focus on how 'texts' such as policies, forms and written protocols influence activity. Part 2 of this paper outlines the method's key features through exemplars from our own research. Part 3 discusses the ways in which research that blurs the lines between educational and clinical practice can be both generative for HPE and accomplished using IE. RESULTSThe authors demonstrate the usefulness of IE for studying complex social issues in HPE. It is posited that a key added value of IE is that it goes beyond individual-level explanations of problems and phenomena, yet also closely studies individuals' activities, rather than remaining at an abstract or distant level of analysis. Thereby, IE can result in feasible and meaningful social change at the nexus of health professions education and other social systems such as clinical practice.CONCLUSIONS IE adds to the growing qualitative research toolkit for HPE researchers. It is worth considering because it may enable change through the study of HPE in relation to other social processes, structures and systems, including the clinical practice world. A particular benefit may be found in blending HPE research with research on clinical practice, toward changing practice and policy through IE, given the interrelated nature of these fields.

Critically reflective practice and its sources: A qualitative exploration

“…Following the tradition of institutional ethnography, 21,22 the loosely structured interviews focused on encouraging participants to articulate the work they did at the clinic-school interface in relation to supporting children with disabilities. 23,24 Participants were explicitly probed about how they learned to practise in this context and how certain views or approaches described during their interviews were derived. Although the original institutional ethnography study included observation and document data, these were not included in the secondary analysis presented in this current paper.…”

Why institutional ethnography? Why now? Institutional ethnography in health professions education

“…Ng et al. propose a further benefit of institutional ethnography; they advocate that as a research modality, it offers the opportunity to combine research into the education of health professionals with research into the practice of these health professionals, championing their undoubtable interlinkage instead of separating them [ 3 ]. Both this potential for transformation and this connection of the education/practice divide is likely to appeal to the pragmatic side of health professionals, both as educators and clinicians.…”

“…Webster and colleagues looked at the effect of a new policy that mandated a reduction in waiting times for patients in emergency departments, finding that the clinicians working there ‘perceived that efficiency was more important than education and was in fact the new definition of ‘good’ patient care’ [ 30 ]. This work is cited as an example where by a change in policy (activated through a text) organizes and regularizes practice [ 3 ] but with ‘hidden dangers’ [ 1 ]. The consequences of this appeared to be the emphasis on speedy rather than compassionate care where patients were perceived as obstructing this efficiency [ 3 ].…”

“…We do not intend this article to be an institutional ethnography ‘how to’ per se ; for this, readers are directed to Ng et al. [ 3 ], Campbell and Gregor [ 4 ], Smith [ 5 ] and Smith [ 6 ]. Rather, we aim here to make this innovative approach to inquiry more accessible in HPE, by laying the foundations to enable readers to consider it and to further the use of institutional ethnography in the field of HPE research.…”

Institutional Ethnography as a Method of Inquiry for Criminal Justice and Socio-Legal Studies

“…Although IE has been predominately used by academics and practitioners in Canada and the United States (see Malachowski, Stasiulis and Skorobohacz 2017)-specifically in social work, health care (Ng, Bisaillon and Webster 2017), sociology (Smith 2006) and education (Griffith 2006)-in recent years IE has been attracting some socio-legal and criminal justice scholars. Notably, Marsden (2012) used IE to research migration law, Matulewicz (2015) to research workplace harassment, and Doll (2016Doll ( , 2017 to research mental health law.…”