Focused ethnography as an approach in medical education research

Abstract

Context Over recent decades, the use of qualitative methodologies has increased in medical education research. These include ethnographic approaches, which have been used to explore complex cultural norms and phenomena by way of long‐term engagement in the field of research. Often, however, medical education consists of short‐term episodes that are not bound to single sites, but take place in a myriad of locations and contexts such as classrooms, examination stations, clinical settings and online. This calls for methodologies that allow us to grasp what is at stake in an increasingly multifaceted and diverse field. Methods In this article, we direct attention to focused ethnography, which has emerged as a useful, suitable and feasible applied qualitative research approach, and which uses adapted classic ethnographic methods, such as direct observation, to gain new insights and nuanced understandings of distinct phenomena, themes and interactions in specific settings in medical education (eg the learning potential of ward rounds, or how hierarchical positions affect learning situations). We introduce methodological key features of focused ethnography to give insights into how the approach can be used, and we offer examples of how the method has been used in medical education research to show how it has contributed in different ways to the field of medical education research. Furthermore, we address and discuss some of the main challenges and limitations of the approach. Conclusions Focused ethnography offers a methodological approach that sheds light over limited and well‐defined social episodes and interactions. Precisely because the field of medical education consists to a large degree of such fragmented interactions, focused ethnography can be seen as a methodology tailored to these characteristics and should become an integrated part of the toolkit of medical education research.

Chances for learning intraprofessional collaboration between residents in hospitals

“…21 Particularly in health care and medical education research, ethnographic approaches have been considered appropriate to study professional groups, sociocultural aspects and the organisation of health care and medical education. 22,23 Lingard et al 24 describe how ethnographic research is well suited for capturing the complexity of the daily practice of interprofessional education and collaboration. Compared to classic ethnographic research, which focuses on understanding a cultural phenomenon, a rapid ethnographic research approach prescribes that researchers enter the field with a more well-defined and focused research question and scope.…”

“…Compared to classic ethnographic research, which focuses on understanding a cultural phenomenon, a rapid ethnographic research approach prescribes that researchers enter the field with a more well-defined and focused research question and scope. 21,23,25,26 Rapid ethnography-based methods provide a means of collecting data within a short, well-defined timeline by using triangulation of observations, in-depth interviews and theory. 21 In this study, we collected data by observations within daily practice and in-depth interviews to gain insight into what is already being done and to explore opportunities for and barriers to learning intraPC between PC and MS residents within hospital placements.…”

“…46 We think we minimised participants' reactivity by being embedded in the environment and checking our observations during the in-depth interviews with the participants. 23,46 Observers were dressed in a hospital uniform and we undertook at least four observations in every hospital department. We noticed that people did interact with us as if we were new colleagues and continued their actions seemingly uninterrupted, especially when we revisited departments.…”

Ethnography, methodology: Striving for clarity

“…As they do so, they aim to clarify 'methodological confusion' around the different types of ethnographic approaches, and foster 'methodological clarity in future medical education research.' 2 We are grateful to these authors 2 for opening up the discussion around ethnographic methodologies, although we wonder to what extent focused ethnography is truly ethnography in the sense that it unveils the social and cultural processes in medical education settings. Rather, by questioning the terminology used, we hope to bring forth a more nuanced understanding of what it means to categorise our research approach, and to what extent this categorisation is a rhetorical device for legitimisation.…”

“…8 Focused ethnography, in a similar way to other abbreviated forms (eg, rapid ethnography, quick ethnography), differs from traditional ethnography by virtue of its 'short and intense' fieldwork. 2,7 However, when time in the field is truncated, a core feature of what it is to undertake ethnographic research is compromised. As Woods articulates: 'Processes, for example, of cultural induction, labelling, identity formation, differentiation and polarisation, curriculum modification, friendship formation, all require lengthy involvement in the research field, otherwise only part of the process will be sampled, leading to misleading analyses.'…”