Ethnography in qualitative educational research: AMEE Guide No. 80

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Practice points

With its origins in anthropology, ethnography is the study of social interactions, behaviours and perceptions that occur within groups, organisations and communities Ethnography has an underlying research methodology and an associated toolbox of methods (participant observations, interviews, documents) which shape both and generate detailed understanding of the social action Ethnographers employ a number of key techniques (e.g. thick description, reflexivity, triangulation) to enhance the quality of their work Ethnographic research has generated a number of insightful accounts into the development and delivery of medical education

Box 1 Features of ethnographic research (Hammersley & Atkinson 2007)

1. People's actions and accounts are studied in everyday contexts, rather than under conditions created by the researcher – such as in experimental setups or in highly structured interview situations. In other words, research takes place ‘in the field’.

2. Data are gathered from a range of sources, including documentary evidence of various kinds, but participant observation and/or relatively informal conversations are usually the main ones.

3. Data collection is, for the most part, relatively ‘unstructured’, in two senses. First, it does not involve following through a fixed and detailed research design specified at the start. Second, the categories that are used for interpreting what people say or do are not built into the data collection process through the use of observation schedules or questionnaires. Instead, they are generated out of the process of data analysis.

4. The focus is usually on a few cases, generally fairly small-scale, perhaps a single setting or group of people. This is to facilitate in-depth study.

5. The analysis of data involves interpretation of the meanings, functions, and consequences of human actions and institutional practices, and how these are implicated in local, and perhaps also wider, contexts. What are produced, for the most part, are verbal descriptions, explanations, and theories; quantification and statistical analysis play a subordinate role at most.

Figure 1. Gold's typology of research roles (from Pope 2005, p. 1183).

Table 1  Types of triangulation used in ethnography (Denzin 1970)

Type	Descriptor
Data triangulation	Involves the use of different sources of data to examine phenomenon across settings and at different points in time
Method triangulation	Entails the use of multiple research methods to compare and contrast different insights each method may provide
Investigator triangulation	Involves different investigators gathering data to produce more complex empirical accounts by understanding possible differences
Theory triangulation	Where different concepts and theoretical perspectives are used to see how each illuminates the data in different ways

Table 2  Nine observational dimensions (Spradley 1979)

Dimension	Descriptor
Space	Physical layout of the place(s)
Actor	Range of people involved
Activity	A set of related activities that occur
Object	The physical things that are present
Act	Single actions people undertake
Event	Activities that people carry out
Time	The sequencing of events that occur
Goal	Things that people are trying to accomplish
Feeling	Emotions felt and expressed

Table 3  How to analyze field notes (Wadsworth 1998, p55)

Issues to consider	Description
1	Diligently record your observations as soon as possible after you have finished them, remembering to describe not only what you have seen and experienced but also recording your feelings and perceptions of the events.
2	Work out themes as they emerge.
3	Record your reflections about primary observation but keep them separate by using a separate column alongside.
4	Work out how to check these interpretations. What questions will you need to ask to make sure that you are hearing or seeing what you think you are? Who will you need to ask?
5	Arrange a series of more formal ‘feedback’ sessions with the informants.

Table 4  Evaluating ethnographies – five considerations (Richardson 2000)

Consideration	Descriptor
Substantive contribution	Does this piece contribute to our understanding of social-life? Does the writer demonstrate a deeply grounded (if embedded) human-world understanding and perspective? How has this perspective informed the construction of the text?
Aesthetic merit	Does this piece succeed aesthetically? Does the use of creative analytical practices open up the text, invite interpretive responses? Is the text artistically shaped, satisfying, complex, and not boring?
Reflexivity	How did the author come to write this text? How was the information gathered? Ethical issues? How has the author's subjectivity been both a producer and a product of this text? Is there adequate self-awareness and self exposure for the reader to make judgments about the point of view? Do authors hold themselves accountable to the standards of knowing and telling of the people they have studied?
Impact	Does this affect me? Emotionally? Intellectually? Generate new questions? Move me to write? Move me to try new research practices? Move me to action?
Expresses a reality	Does this text embody a fleshed out, embodied sense of lived-experience? Does it seem “true” – a credible account of a cultural, social, individual, or communal sense of the “real”?

Box 2 Ethnography and theoretical discovery

Seabrook's (2004) work was part of a longitudinal ethnographic study of a single UK medical school between 1995 and 2000. The author notes that, “in order to avoid predetermining what might come out of the study, a grounded approach was taken [which involved] attempting to approach the research with an open agenda and allowing themes and theories to ‘emerge’ from the data” (p. 214).

Seabrook observed curriculum committees, teaching, assessment and evaluation activities; conducted in-depth semi-structured interviews with doctors and students; and participated in informal discussions with staff and students. The major themes reported included teachers’ concerns about the students, the infrastructure for teaching and their relationship with the medical school.

Box 3 Ethnography and theoretical extension

Lewin and Reeves (2011) examined how Goffman's theory of impression management could be used to explain how professionals ‘present’ themselves when interacting on hospital wards and also how they employ front stage and backstage settings in their collaborative work. The study findings suggest that doctor-nurse relationships were characterised by ‘parallel working', with limited information sharing or effective joint working. Interprofessional working was based less on planned, ‘front stage' activities, such as wards rounds, than on ad hoc backstage opportunistic strategies. These backstage interactions, including corridor conversations, allowed the appearance of collaborative ‘teamwork' to be maintained as a form of impression management. These interactions also helped to overcome the limitations of planned front stage work. The data also highlighted the shifting ‘ownership' of space by different professional groups and the ways in which front and backstage activities are structured by physical space.

Box 4 Ethnography and theoretical refinement

Waring (2009) examined how knowledge about safety is constructed and re-constructed through inter-subjective storytelling and through interaction with hospital systems. The study occurred in a teaching hospital and data collection consisted of over 300 hours of direct observations of management processes, clinical interactions, surgical procedures; informal conversations; semi-structured interviews; and hospital documents. Waring illuminates how knowledge about safety changes, in terms of its form, meaning and content, as it moves from narratives of staff through the routines and systems of risk management. Clinicians’ accounts of risk in terms of localised concerns and issues and collective beliefs about professional responsibility and jurisdiction change as they become de-authored and re-constructed to reflect managerial assumptions about learning. The author discusses the implications in relation to service improvement and organisational power.

Box 5 Boys in white – student culture in medical education (Becker et al. 1961)

A team of sociologists from the Chicago school of sociology conducted an ethnography of a medical school in Kansas, stemming from a general interest in studying professional groups and education. Although the study was intended to be for social scientists, the study had great insight into and impact on medical education. It focused on student experiences and perceptions of faculty, their enrolled programme and on their future medical practice. Data were gathered by the use of participant observation and in-depth interviews. Importantly it produced a number of insightful findings: students’ efforts to find out what professors wanted from them in tests and exercises, their ‘latent culture’ (i.e. the division into alphas/betas and fraternity/non-fraternity groupings); their slow assimilation of medical values through peer pressure; their learning how to negotiate the complexities of a hospital or clinic; and their increasingly cynical perspectives on their futures in the profession.

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