Ethnography in qualitative educational research: AMEE Guide No. 80

Abstract

Ethnography is a type of qualitative research that gathers observations, interviews and documentary data to produce detailed and comprehensive accounts of different social phenomena. The use of ethnographic research in medical education has produced a number of insightful accounts into its role, functions and difficulties in the preparation of medical students for clinical practice. This AMEE Guide offers an introduction to ethnography – its history, its differing forms, its role in medical education and its practical application. Specifically, the Guide initially outlines the main characteristics of ethnography: describing its origins, outlining its varying forms and discussing its use of theory. It also explores the role, contribution and limitations of ethnographic work undertaken in a medical education context. In addition, the Guide goes on to offer a range of ideas, methods, tools and techniques needed to undertake an ethnographic study. In doing so it discusses its conceptual, methodological, ethical and practice challenges (e.g. demands of recording the complexity of social action, the unpredictability of data collection activities). Finally, the Guide provides a series of final thoughts and ideas for future engagement with ethnography in medical education. This Guide is aimed for those interested in understanding ethnography to develop their evaluative skills when reading such work. It is also aimed at those interested in considering the use of ethnographic methods in their own research work.

Introduction

Over the past decade or so, we have witnessed a sustained growth in the use of qualitative methods in health professions education and health services research. This expansion of qualitative research has provided a range of insightful accounts of the factors that influence the development and delivery of medical education across the globe. However, as much of this qualitative work has focused on the collection of interviews (individual interviews, focus groups) to generate evidence, the result has been the creation of a largely perceptional account of what students, faculty and administrators think about medical education, rather than data of what actually happens in this domain.

Ethnography offers a way forward here, to help overcome these limitations of relying solely on interview data. Through the collection of observations, interviews and documentary data, which are triangulated (i.e. compared and contrasted with one another) ethnographic research offers a qualitative approach with the potential to yield detailed and comprehensive accounts of different social phenomenon (actions, behaviour, interactions, beliefs). Through its use of in situ observations ethnographers can ‘immerse’ themselves in a social setting, thereby generating a rich understanding of social action. Participant observation also provides ethnographers an opportunity to gather empirical insights into social practices which are normally ‘hidden’ from the public gaze. Additionally, since it aims to generate holistic social accounts, ethnographic research can identify, explore and link social phenomena which, on the surface, have little connection with each other. As such, ethnographic research differs from other forms of qualitative research such as phenomenology (the analysis of interviews to understand individual's lived experiences) or discourse analysis (the analysis of talk and/or documents to understand the influence of embedded discourses).

Table

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

Due to this complexity, unlike many other forms of qualitative research, ethnographic research is more difficult to undertake. For example, due to the need to spend relatively long periods of time gathering data that offers a detailed account of a particular setting means it is resource-intensive. Recording the multifaceted nature of social action that occurs is a difficult task, as there are a range of temporal, spatial as well as behavioural elements which need to be documented. The unpredictability of everyday life often means that data collection activities can be disrupted or access withdrawn depending on ever-changing local circumstances and politics.

This Guide offers an introduction to ethnography – its history, its differing forms, its role in medical education, its practical application – which we hope will be of use to colleagues interested in understanding this approach when reading ethnographic work, or for colleagues interested in considering the use of ethnographic methods in their own research work.

Why the need for a Guide?

Given the increasing amount of ethnographic work published in medical education (also more broadly in the health professions education and health services research literature), it was felt an AMEE Guide introducing core ethnographic principles, approaches, tools and techniques would be of value to the medical education community. It will be helpful in providing key insights into understanding the essence of ethnography – its methodological roots and the methods employed to gather and analyse data, its contribution to medical education research, as well as insights to the tools and techniques which generate good quality ethnographic work.

Who should read this Guide?

As noted above, this Guide provides an introduction for colleagues based in medical education settings who are interested in understanding ethnographic principles, approaches, methods and techniques. As such, this Guide will be of most use to those readers who: (a) want an initial outline of ethnographic research: its origins, its varieties, its role in medical education, (b) require basic details of how to undertake this form of research and (c) have an interest in beginning to employ an ethnographic approach in their personal research.

What will be covered in this Guide?

As noted above, this Guide offers an introduction and outline to understanding ethnography in medical education. In doing this, the Guide is presented in the following way:

• Section “What is ethnography?” outlines the main characteristics of ethnography, describe its origins, its methods and its products.

• Section “Actioning ethnography: planning, undertaking and writing” offers a range of ideas, methods, tools and techniques for undertaking an ethnographic study.

• Section “Methodological and theoretical developments” discusses a range of methodological and theoretical developments that have occurred in ethnographic research.

• Section “Ethnography in medical education” discusses the role, contribution and limitations of ethnographic work undertaken in a medical education context.

• Section “Final thoughts” provides a series of final thoughts and ideas for future engagement with ethnography in medical education.

Mindful of the various backgrounds and levels of development in medical education research of readers of this Guide, we have also included the following:

• A number of boxes, tables and figures to help illuminate key points about the nature and use of ethnography

• A set of two appendices: a range of web-based resources aimed to offer a wide variety of ethnographic insights and a selection of key texts, chapters and papers we have used in our ethnographic work.

What is ethnography?

Overview

In this is section we initially outline the key defining attributes of ethnography, before providing an overview of its anthropological and sociological origins. We then describe the essences of ethnography as a research approach that consists of a number of methods and techniques.

Defining ethnography

Ethnography is the study of social interaction and culture groups, whether these groups are defined as societies, communities, organizations or teams. The term ethnography comes from the Greek words ethnos (people) and graphei (to write). The central aim of ethnography is to provide rich, holistic insights into peoples’ world views and actions, as well as the nature of the location they inhabit (Hughes 1992). As Hammersley (1985) stated, “the task [of ethnographers] is to document the culture, the perspectives and practices of the people in these settings. The aim is to ‘get inside’ the way each group of people sees the world” (p152).

Since its conception in the early twentieth century, ethnography has evolved into a diverse set of methodological practices used across many academic disciplines, including anthropology, sociology and education. The diversity of ethnographic approaches across multiple disciplines has contributed to the growing challenge in defining ethnography without reducing its complexity or bounding its multitude of conceptualisations. However, as outlined by Hammersley and Atkinson (2007), there are several key features that set ethnographic research apart from other qualitative research methodologies (Box 1).

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.

To begin to understand what ethnography encompasses, further we go on explore the origins of this approach before discussing its use as a research approach, a toolbox of methods and a product.

Origins of ethnography

Ethnography can be traced back to anthropological studies of small societies undertaken in the early 1900s, wherein researchers such as Bronislaw Malinowski, Alfred Radcliffe-Brown and Franz Boas participated in these societies over long periods of time and documented their social arrangements and belief systems (Atkinson & Hammersley 1994). The early ethnographies from this discipline were closely linked with colonialism and therefore characteristically involved studies of the ‘other’, or foreign and exotic social groups. The ethnographic text was initially produced at this time and involved the writing up of fieldwork when an ethnographer returned home. This thick, naturalist description became a rite of passage for students and scholars wanting to study anthropology.

The ethnographic approach was later adopted by members of the Chicago School of Sociology in the 1920–1930s (e.g. Everett Hughes, Robert Park, Louis Wirth) to a variety of contemporary social problems (e.g. homelessness, immigration) linked to the urbanization of Chicago. In the 1940s, the second wave of Chicago School of Sociology focused on the ethnographic study of professional groups, occupations work and education (Reeves et al. 2008).

Subsequently, the use of ethnography as a research methodology has proliferated across the social sciences and within different academic fields such as education, healthcare sciences and business. There was also increasing interest in connecting cases studied ethnographically across space and time (Eisenhart 2001). In health services literature, the focus on the professions, occupations and clinical work has continued, and produced some illuminating studies such as Strauss et al.'s (1963) study of achieving and maintaining order between managers, clinicians and patients within psychiatric hospital settings and Allen's (1997) study of boundary-work between nurses and doctors. In the Section “Methodological and theoretical developments”, we provide information about the growing use of ethnographic work in medical education.

Ethnography as a methodology

Ethnography is a research methodology and as such it has a strong foundation in empiricism and naturalism (Hammersley & Atkinson 2007) – collectively these approaches emphasize the collection of data in naturalistic social settings. Like other forms of qualitative research, ethnography differs from positivistic inquiry, as ethnographers neither hypothesize about their research, nor does the ethnographic method set out to test hypotheses. Instead, ethnographic research is exploratory in nature. This approach means that the ethnographer goes into the field to explore a cultural group and/or explore certain social interactions. The research questions are therefore not necessarily specified at the beginning of this endeavour, instead this approach facilitates an inductive and iterative approach whereby thick description leads to the development of research questions as the social phenomenon is being studied.

Moreover, ethnography is defined by fieldwork or the active and prolonged involvement of the ethnographer with the local context being studied. Traditionally, this context was a discrete and distant location. However, with the proliferation of ethnography across academic disciplines, fieldwork is now done on a variety of settings with different boundaries, and different proximities to the researcher (Atkinson 1994). An example of this is provided who discusses the use of online communication and how ethnography can be applied to the study of online relationships which overcome the usual time-space restrictions associated with traditional ethnographic work (i.e. the need for the ethnographer to be in the same location at the same time as the study participants).

A ‘toolbox of methods’

Ethnography can also be seen as a toolbox of methods, which are integrated into a multifaceted methodological approach. Particularly characteristic of ethnographic methods is participant observation whereby the ethnographer not only observes a social group, setting or subject matter, but engages in the participation actively with a general commitment to observing everyday social life. This is in contrast to observational methods, which look to make systematic observations about behaviour in situ.

As outlined by Hammersley and Atkinson (2007) in Box 1, the collection of unstructured qualitative data contributes significantly to the toolbox of methods used in the ethnographic methodology. Specifically, the toolbox incorporates the collection of observational data, in-depth interviews, life histories or documents (e.g. texts, photographs, videos and other mediums). The triangulation of these qualitative methods substantively contributes to this approach.

The use of these methods to gather rich, contextually detailed data has a direct influence on the number of cases (e.g. physical locations) one can study ethnographically. As outlined in Box 1, the focus on one (or a small number) of cases is typical in ethnography. This is the direct result of gathering detailed data over extended lengths of time. Section “Actioning ethnography: Planning, undertaking and writing” offers further details on the toolbox of methods one can use when undertaking an ethnographic study.

A ‘product’ of the research process

Ethnography also refers to the written product of the research process. A key focus of ethnography is upon the writing and reporting of experiences from the field (e.g. Flick 2009). Two main products are the fieldnotes (Section “Actioning ethnography: planning, undertaking and writing”) and the final product(s) (e.g. reports, papers, photographs, videos) that disseminate findings.

Ethnography, through the written word, provides richly described accounts of the social phenomenon being studied. As well as recounting of the methods used, these accounts also offer detailed ‘thick’ descriptions of the people, places, actions and reactions being studied, which are presented in the form of study findings. The production of these textual reports often entails a theoretical component that helps frame, illuminate and explain phenomenon under study. See the Section “Ethnography in medical education” for more details about the use of theory in ethnographic work.

Increasingly ethnographers are also producing work that uses different types of audio-visual media such as photography and film. The products generated by these methods include the use of images and audiovisual media in the socio-cultural practices as well as the visual dimension of objects, bodies, places and environments (e.g. Pink 2006).

Concluding comments

As outlined above, ethnographic research, as an approach which emerged from anthropological and sociological study, is based upon a set of specific attributes which define its nature. Ethnography is a methodology with an associated toolbox of methods – primarily participant observation – and a range of products (e.g. reports, videos).

Actioning ethnography: Planning, undertaking and writing

Overview

In this section we provide an overview of the practices and processes associated in actioning or doing ethnographic work in a medical education context. In doing this we provide a range of ethical, methodological and practical factors that underpin the ethnographic enterprise. Specifically, we discuss five sets of inter-related activities: planning, sampling, data collection, data analysis and writing up. Embedded in each of these activities, we discuss a variety of associated techniques and issues to be considered when undertaking this type of work.

Planning issues: Access and ethics

Attaining approval from the appropriate decision makers for access to a research setting is an essential first step in planning an ethnography. Attaining access may be challenging. For example, some people are often reluctant at the thought of being ‘scrutinised’ by researchers. In addition, access is a practical issue, which involves the negotiation of resources and strategies.

Although there are different ways to gain entry into the field (e.g. through a formal sponsor, by use of informal networks), a major component of such work is effective impression management – ensuring that interactions when negotiating access are done in a positive, open and constructive fashion. This will help the ethnographer gain creditability with the initial gatekeepers to a particular community, and then also begin to build a rapport with study participants, and identify gatekeepers or people who will facilitate one's entry into closed or formal organisations. However, as Hammersley and Atkinson (2007) note, access into the research setting cannot be considered a ‘one-off’ event. Often access will need to be re-negotiated with the different individuals (e.g. deans, vice deans, faculty members) at different stages of a study (initial contact, entry into different research sites) as the work proceeds over time.

Ethnographic research, like all social research needs to be undertaken in an ethical way, with due care and attention to safeguarding the interests of research participants. Punch (1994) outlines the main ethical issues researchers need to consider – “the avoidance of harm, fully informed consent and the need for privacy and confidentiality” (p89). To ensure that proposed research work addresses each of these issues, all ethnographies need prior ethical approval from the local research ethics committee which covers the institution in which the study is due to be undertaken. Helpfully, there are now a number of published guidelines to help prepare a submission for formal ethical approval (e.g. Egan-Lee et al. 2011).

Of course, once ethical approval is obtained, it is then the responsibility of the ethnographer to ensure it is effectively practiced – undertaking informed consent before data collection activities, ensuring anonymity of participants, and maintaining confidentiality and privacy of all data gathered.

Sampling

Sampling is an important aspect to framing data collection and analysis activities. In ethnography, sampling of the research setting is an important component of data collection, which frames the overall methodology. Indeed, the importance of setting can be inferred when reading titles of ethnographic pieces which often refer more directly to the group of people or place of research than to the substantive subject or research problem (Mackenzie 2006).

In general, the central issue of sampling is the ‘trade off’ between number of cases (e.g. settings, individuals, actions, activities) selected – the breadth of the study, as opposed to the depth of study – or the time of the ethnographer to go generate a detailed, thickly described account of the phenomenon under investigation. Often in ethnographic work, a single study site is selected, but multiple individuals, actions and activities embedded within this setting are selected to develop an insightful account of daily life.

Participants, activities and interactions are either sampled on an opportunistic or purposeful basis – the latter is more preferable in generating a more comprehensive picture of studied phenomena as obviously more thought has gone into the selection process (Atkinson & Pugsley, 2005). It is usual for ethnographers to allocate periods of time for observation in order to sample common activities (e.g. ward rounds) that occur at a research setting. However, the sampling of less frequent activities is also sought after – to identify, for example, outlying behaviour which also contributes to daily life. In doing so, a more sophisticated description of the social setting can be generated.

Data collection – Using the ethnographic toolbox

There are a number of possible data sources that can be collected during fieldwork. Data collection is most often affiliated with a heavy use of resources, and so is an important aspect of research to plan and execute. There are a range of different but complementary methods which can be utilized in ethnography. Outlined below are the major methods used to collect data.

Participant observation

Participant observation is the key methodological approach involved in ethnography. Denzin (1989) defines participant observation as “a field strategy that simultaneously combines document analysis, interviewing of respondents and informants, direct participation and observation, and introspection” (pp 157–158). As such, participant observation is a more active engagement with research participants, requiring the ethnographer to balance the insider versus outside continuum. The ethnographer through participation begins to act and behave like an insider, but always carries a sense of objectivity towards participant observation whereby one can separate oneself from the group being studied. In contrast, non-participant observation is characterized as a method where the researcher ‘follows[s] the flow of events. Behaviour and interaction [of research participants] continue as they would without the presence of a researcher, uninterrupted by intrusion” (Adler & Adler 1994, p. 81).

Practically, there is a spectrum of different levels of participation, which lies between the two poles. Gold created a typology of participant roles to begin to define levels of participation (Figure 1).

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

The level of participation depends on the research site and includes both formal and informal interactions with study participants. Other components of participant observation include the use of additional qualitative and quantitative methods. Several methods are commonly used as a component of participant observation and include in-depth interviews, life histories and document analysis.

In-depth interviews

In-depth interviews are also referred to as focused, unstructured or ethnographic interviews. This method of interviewing “does not use fixed questions, but aims to engage the interviewee in conversation to elicit their understandings and interpretations” (Liamputtong & Ezzy 2005, p.332). These interviews are characterised by active involvement in engaging the participant to converse about a particular topic or discussion relevant to the research questions or topic being explored. Often, in-depth interviews are complimentary to participant observation in that the observation provides insight into everyday life and interviews provide insight into articulating and explaining social everyday life.

Life histories

Life histories are a type of interview that concentrates on “individual life and its told history with a view to understanding social processes determined by class, culture and gender” (Bornat 2004, p.28). This method considers the individual as an active participant in the research process. Life histories provide the ethnographer with the opportunity to extend their understanding beyond the time they spend in the field. Also it facilitates the ethnographer to collect more examples of everyday life that may be observed or recounted in participant observation and in-depth interviews.

Documentary data

Document analysis is the analysis of textual documents such as media reports, legislation and/or graphic documents such as photographs and maps. The document analysis provides insights into how messages, language and discourses are represented by participants being studied. Document analysis can provide useful background information to the study while also providing insight into how participants view themselves. This analysis, in triangulation with the other methods above, can provide insight into how participants represent themselves.

Triangulation

Triangulation is an analytical technique that incorporates and compares multiple methods with the intent of providing a more in-depth and holistic understanding of a phenomenon. The use of multiple methods during the course of ethnography establishes unique concerns around data analysis and synthesis. Not only is triangulation an important way for ethnographers to establish methodological rigor/quality, the use of triangulation is an important aspect of data synthesis to establish contextually rich and representative articulation of what is being studied. Denzin (1970) defines triangulation as “a term linked to navigation or surveying whereby people discover their position on a map by taking bearing on landmarks; where the lines intersect a person's position is indicated”. There are four types of triangulation – methodological, data, investigator and theoretical – they are outlined in Table 1.

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

Reflexivity in ethnography

Reflexivity refers to the representation, recognition and placement of the self in ethnographic inquiry. In classical ethnographic inquiry, ethnographers saw the collection of data as natural, wherein ethnographers were watching the social phenomenon in its natural order. As a result, there was little or no consideration on how ethnographer's presence impacted upon the people being studied or the recording and reporting of data. Reflexivity is a technique which involves the consideration of oneself (the researcher) while planning and conducting ethnographic research. It refers to the self-reflection of one's background, values and history, as it impacts how to view and report social phenomenon. Within research reports, reflexivity is presented in the form of a description of the ethnographer's ideas and experiences, which can be used by readers to judge the possible impact of these influences on a study.

Analysing data

The data analysis in the ethnographic methodology is iterative and unstructured. There are three aspects of data analysis: description, analysis and interpretation. Description refers to the recounting and describing of data, inevitably treating the data as fact. Analysis refers to the process of examining relationships, factors and linkages across the data points. Finally, the interpretation of data builds an understanding or explanation of the data beyond the data points and analysis. Although these three components are not always easily teased apart, they can be important for the ethnographer and reader to understand, because it can in part reflect the further data collection and rhetorical devices used during writing.

The process of writing fieldnotes is a unique feature of ethnography that connects the data collection and analysis through iterative reporting and interpretation of findings from all methods utilised. In the data collection, fieldnotes provide space for jotting down observations, stories, descriptions and interpretations which are observed during participant observation. Table 2 looks at the nine types of observations which can be explored in fieldnotes.

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

Also, field notes can entail notes from other methods used during the time in the field, while documenting the ethnographers methodological, ethical and theoretical considerations and struggles. It is important that observations, descriptions and interpretations are clearly indicated throughout writing field notes because the field notes become a record and a data point during the data analysis and writing process. The clearer the differentiation becomes, the better position the ethnographer is in to report both the phenomenon they record and the interpretations they add during the research process. Table 3 illustrates how fieldnotes can be analyzed iteratively throughout the research process.

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.

Using technology in data analysis

Although the breadth of ethnography topics and genres has grown over the last 20 years and the “rules” of ethnography have become fuzzier; there has been a trend in ethnographic literature to become more reliant on software programmes for data analysis. The range of capabilities available in software packages varies greatly and provides new ways for ethnographers to organize and manage their data. Some qualitative data analysis software include:

• Ethnograph (http://www.qualisresearch.com/default.htm)

• Nvivo (http://www.qsrinternational.com/products_nvivo.aspx).

Although there is a range of capabilities across the different software programmes, there are several common features which have changed the nature of qualitative analysis (John & Johnson 2000). These features and their impacts will be discussed below.

Multiple advantages of software programmes have been widely recognised in the literature. Jon and Johnson note several major benefits to utilising such programmes as “an ability to deal with large amounts of qualitative data, reducing the amount of time needed for manual handling tasks, increased flexibility and thoroughness in handling data, providing for more rigorous analysis of data, and providing a more visible audit trail in data analysis” (John & Johnson 2000, 394). Generally, these advantages enhance the convenience and efficiency of data analysis throughout the research process. Codes, notes and data can be re-organised, searched and re-linked at anytime. Also, proponents of using software systems discuss the ways that they can enhance the validity and rigor of the data analysis process. They state that larger collections of data can be searched systematically, that such capabilities reduce human error and makes more “visible” the choices and strategies in the data analysis process. Finally, some data analysis software packages have theory-building and complex relationship analysing capabilities, which can transform unstructured data into structured codes and analytic themes (Coffey & Atkinson 1996).

Conversely, with the widespread use of software technologies, ethnographers are becoming more aware of disadvantages of such programmes. The most cited concerns include the fact that because the software packages are created to analyse large quantities of data, there is an emphasis on quality and breadth over meaning and depth. Importantly, the focus on ethnography in creating a thick description of a phenomenon may mean that software programmes are in contradiction to the purpose and defining features of ethnography. Also, the software programmes can ‘homogenise’ data analysis and make the process more rigid and structured. Although proponents argue that this facilitates greater interconnection between other social sciences, ethnographers must be wary that this also makes the data more inflexible, especially when programmes assume that all data points are textual. Moreover, the emphasis on codes engages ethnographers to reduce data points whereas a major component of data analysis can be more focused to find relationships and connections, as contextualised understanding of the data (Coffey & Atkinson 1996; John & Jonson 2000).

Writing up

The writing of an ethnography has traditionally been seen as a distinct separate activity from the fieldwork. However, while in the field, the ethnographer is actually engaged in writing a thick description of their experiences and interactions. Therefore, one needs to regard the writing activity as a continued part of an ethnography – from the production of field notes, field journals or diaries to the final thickly described research report, paper, chapter or textbook.

The writing of ethnography is often described as a dualistic process of separating oneself (the ethnographer) from the other (the research participants) or a dialogue between the self and the other (Hegelund 2005). Indeed, the importance of the self and the other in ethnography has brought growing attention to the issue of reflexivity in ethnographic writing (Cant & Sharma 1998). This issue has grown to some importance in anthropological and sociological literature as ethnographers redress the issue of not presenting themselves in their writing. In doing so, modern ethnographers are producing work which contrasts with traditional ethnography texts, which separated researcher and research participants, often to mimic the ‘objective’ reports produced in positivistic research.

The rhetoric of ethnography refers to its aesthetics or style. The study of rhetoric has been categorised into several themes including “the conventionality of ethnographic texts, the representation of ‘self’ and ‘other’ in such texts, the character of ethnographies as a textual genre, the nature of ethnographic argumentation and the rhetoric of evidence” (Atkinson & Hammersley 1994, p. 254). The study of rhetoric in ethnography has led to the categorisation and exploration of ethnographic styles and genres and how the text gained authority and legitimacy to the reader (Burawoy 2003).

Representation refers to how others are presented in ethnographic texts. It reflects the relationship between the ethnographer and the subject. Representation refers to the depiction of the “other” in ethnography (Atkinson & Hammersley 1994). Importantly, through the methodology of ethnography, the ethnographer often comes to view the study population as other, distinct from the self. Moreover, the consolidation of narratives in ethnographic writing gives voice to certain social actors while taking away the voice of other social actors (Fabian 1990).

Evaluating the quality of ethnographic work

An important consideration for conducting and embracing ethnographic work in medical education is making sure the medical education audience is equipped to interpret, evaluate and utilise findings from such work. However, many review articles on ethnography in this context have not discussed evaluating such work in detail (Atkinson & Pugsley 2005; Pope 2005; Savage 2006).

A challenge with evaluating ethnographic work is that the process and product use both scientific and artistic approaches in the collection and interpretation of data. It is therefore difficult to apply both scientific and subjective notions to the evaluation of a single complex piece of work. Nevertheless, to facilitate engagement with ethnography it is important not only to discuss the value of this type of work, but also to discuss potential ways to evaluate it. Table 4 provides a useful approach to evaluate an ethnography.

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”?

It is anticipated that attention to factors such as merit, reflexivity and impact outlined in Table 4 will strengthen the quality of ethnographic work. Indeed, good quality ethnographic work needs to ensure it explicitly incorporates such factors in its design and implementation. This table also provides a useful way for readers of ethnographic work to begin to evaluate its methodological quality.

Concluding comments

As discussed above, there are a range of practical, ethical and methodological factors involved in undertaking an ethnographic study. Associated which each are a number of inter-related activities – planning, sampling, data collection, data analysis and writing up – each of which were outlined and their varying issues and techniques discussed. In this section we also explored the need for work which can evaluate the quality of the ethnographic studies – an important, but challenging process given the complexity of this type of inquiry.

Methodological and theoretical developments

Overview

In this section we outline a number of methodological and theoretical developments that have occurred in ethnographic research. First, we outline the varyingly different forms of ethnography which have emerged and are commonly used in educational and health services contexts. Second, we discuss the emergence of different form and uses of theory within ethnographic research.

Types of ethnography

Over the last 20 years, multiple categorizations and ethnographic genres have emerged in the social science literature. This categorization has led to debates amongst proponents of different ethnographic approaches and styles about their respective merits and limitations, which we will not review here. Rather, we have outlined a few types of ethnography used in medical education.

Classic/traditional/realist ethnography

The classical form of ethnography originated in the anthropology field in the early twentieth century (Denzin 1997), and in the sociology field in the 1930s. It is also referred to as a “case-study” methodology (Hogan et al. 2009). Its approach was that of in-depth and holistic empirical description, based on the positivist notion of ‘detached researcher’ attempting to ‘objectively’ describe their ethnographic experiences. Often this resulted in text that was written in the third person, whereby phenomena are described as existing in a natural form, without any acknowledgement of the role of the ethnographer in the social setting (Hogan et al. 2009). This approach to ethnography is now widely rejected as failing to acknowledge the ethnographer and the relationships they build with the individuals engaged in their work (Atkinson et al. 2001).

Genre ethnography

Genre is a literary term that denotes the discourse or rhetoric of different texts. In literary studies, ethnography is a genre onto itself, which became increasingly studied from 1960s to 1980s (Van Maanen 2011). Within the field of social sciences, multiple types of ethnography have emerged through reflection and discussion on methodological, ethical and theoretical components of this literary genre. Although genres are closely linked to methodological, ethical and theoretical aspects of fieldwork, the writing of ethnography is considered something to be studied in its own right. Unique to writing ethnography is the importance of building the identity of the author and delivering information that is considered reliable and valid to the reader (Behar 2008). Language and text form play an important role in shaping and reflecting an author's intentions and claims, and examples of ethnographic style which invoke a particular authoritative rhetoric include putting forth evidence and many examples, providing and elaborating analogies, and offering interpretations (Van Maanen 2006). This rhetorical devise used in ethnography has become increasingly studied as a proliferation of writing styles emerged and methodological “self-consciousness” became central to conducting ethnography, in part, grown out of the fact that other social-biological disciplines have not engaged in evaluating ethnographic writing (Van Maanen 2011).

Rapid ethnography

Rapid ethnographic research is an approach whereby fieldwork is undertaken in a short and well-defined timeline. Typically, anthropological fieldwork took place over many months or years. Similarly, sociological fieldwork is also undertaken over multiple months. In a rapid ethnography, however, the time period for fieldwork is often limited to a few weeks or 1–2 months. Rapid ethnography is often conducted in settings where allowances for time and resources are not always available to conduct the research. Particularly in healthcare, ethnographic approaches have been considered especially appropriate to study the organisation of healthcare, professional groups and the delivery of healthcare (Savage 2000). The approach of rapid ethnography dictates that ethnographers enter the field with a more well-defined and narrow research question and study case. Often rapid ethnographies access the engagement of further work in the field, or specifically try to problematise a specific issue in a study case or setting (Harris et al. 1997). Therefore, production of rapid ethnographies usually do not take the form of monographs; instead, more direct and short reports are produced which do not always provide a thick description in a traditional sense, but provide insight on the narrow range of research questions or focus which was put forward at the beginning of the research.

Feminist ethnography

Feminist ethnography is a textual form, which came to prominence in the 1970s. The decree of this type of ethnography is to redress the sexist imbalance in ethnographic research. Often in this type of ethnography there is a focus more centrally on ethical and methodological issues over the substantive topic (Stacey 1988). Moreover, it centrally rejects positivism, naturalism and the use of dualism (the abstraction and separation between the subject and object). The feminist ethnographers seek to achieve an egalitarian research process, depicted by authenticity reciprocity and intersubjectivity, rather than embrace hierarchical and exploitative relationships associated with conventional research.

Critical ethnography

During 1960–70 s critical ethnography emerged as a type of ethnographic text onto its own. Like feminist ethnography, it critiqued the traditional and natural research approach and identified a political nature of ethnographic research and of the substantive subject matter (Hogan et al. 2009). Three conditions of the critical ethnography are that the ethnographer must engage in the political aspects conducting research, the work must be a starting point for social critique and transformation, and the inquiry engages in reflexivity to identify the research's own limits (Foley 2002). Unlike classic ethnography, there is not a pursuit of the ethnographer to stay detached and scientifically objective.

Online ethnography

This form of ethnography, sometimes referred to as virtual ethnography or netnography, uses the internet to gather and analyse data such as online texts, interviews and discussions from interactive chat rooms, forums and virtual communities. In many respects, this form of ethnography maintains the traditional approach of ethnography through the generation of ‘thick description’ from an immersion into the life of the online culture or community (Hine 2000).

Duoethnography

This form of ethnography is a collaborative research methodology in which two or more researchers juxtapose their life histories in order to provide multiple understandings of a social phenomenon. In particular, researchers use their own biographies as sites of inquiry to create dialogic narratives (Norris et al., 2012).

Autoethnography

This type of ethnography focuses more centrally on the writer's subjective experience and perspective as the object of study (Chang 2008). Autoethnography embraces the self as a narrator and part of the story unlike the naturalist and positivist approaches to traditional ethnographic work. Authoethnography accounts move towards an autobiographic narration style of writing (Denzin 2003).

Theory and ethnography

While traditional anthropological accounts were conducted from a positivist theoretical position designed to gather descriptive accounts of ‘distant’ and ‘new’ (non-western) cultures, increasingly, ethnography has been influenced by a range of theoretical perspectives, including symbolic interactionism, phenomenology, feminism, constructionism and postmodernism.

Theoretical development as defined by Snow et al. (2003) has been described as having four basic elements:

• A set of logically interrelated propositions;

• Openness to subjecting propositions to empirical assessment and falsification;

• A focus on making empirical events meaningful via conceptualization and

• Discourse that facilitates explanation of empirical events.

In general, theories are used in ethnographies to explain and provide a deeper understanding of findings. Theories are useful for making inferences from data collected at a single site for wider application to other settings. Ethnographic works can be classified as engaging with theory in three ways: theoretical discovery, theoretical extension, and theoretical refinement. An explanation and example of each of these approaches is provided below.

Theoretical discovery

Here, an ethnography generates new theoretical concepts or frameworks rather than linking theory from previous work. An example of this approach is Seabrook's (2004) ethnographic study of medical teachers’ everyday concerns about their teaching role and environment (Box 2).

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.

Theoretical extension

This type of ethnography broadens the relevance of a particular concept or framework to other empirical contexts. Lincoln and Guba (1985) refer to this type of theory engagement as “transferability” of theory between multiple contexts. This type of theoretical development often examines patterns that appear across contexts, such as social processes or developmental phases. An example of this approach is Lewin and Reeves’ (2011) ethnography of interprofessional collaboration on general medicine wards of a large UK teaching hospital (Box 3).

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.

Theoretical refinement

Theoretical refinement is the modification of existing theoretical perspectives through the examination of new material. Theoretical refinement can be conducted alone or alongside theoretical extension. An example of this approach is Waring's (2009) use of a constructionist and narrative approach in his ethnography on the creation of knowledge in patient safety (Box 1).

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.

While ethnographies can engage with theory in all three ways listed above, most often studies either engage theory through extension and refinement.

Concluding comments

As discussed above, through methodological development and innovation, over the past few decades a range of different forms of ethnography have emerged (e.g. feminist, critical, rapid ethnographies), each of which is a slightly contrasting theoretical orientation and/or differing approach to sampling, data collection and interpretation. Similarly, increasing use of theories in ethnography, as discussed above, has resulted in a range of different ways to generate more insightful ethnographic work.

Ethnography in medical education

Overview

In this section we initially look back at the emergence of the use of ethnography in medical education before presenting the findings from a scoping review of how ethnography has been defined and employed in medical education to generate a more informed picture of its role and contribution to the field.

Looking back

As noted in the Section “What is ethnography?”, ethnography has had a long tradition in and across the social sciences and within different academic fields such as healthcare, and organisational and business sciences. Similarly, ethnography has informed a number of medical education studies for a number of years.

While the emergence of ethnography in medical education can be traced back to the late 1950s in the publication of two landmark studies: The Student Physician (Merton et al. 1957), and Training for Uncertainty (Fox 1957), most notably, the work by Becker and colleagues’ Boys in White remains a classic in this field (Box 5).

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.

Collectively, these studies, as well as a number of more recent works (e.g. Bloom 1973; Atkinson 1984; Good & Vecchio Good 1993; Sinclair 1997) have employed ethnographic methods to reveal a range of insights into the nature of student behaviours and perceptions in medical schools while addressing student culture and the hidden curriculum through their prolonged engagement in the profession. Arguably, findings from this ethnographic work have affected medical education – in initially recognising the impact of factors such as the hidden curricula, as well as generating responses to attempt to ameliorate their impact through policy reform and curriculum modernisation.

Scoping review

To elicit a more comprehensive understanding of how ethnography has been defined and explore how it has been employed in medical education, we undertook a small scoping review. We restricted our searches to the four major medical education journals in the field (Academic Medicine, Advances in Health Sciences Education, Medical Education, and Medical Teacher) and retrieved any articles published by these journals from their inception to 2011. The search terms we used included ‘ethnography’, ‘ethnographic research’, ‘participant observation’ and ‘non-participant observation’.

Findings

Initially 40 articles were retrieved in this scoping review from the following sources: Medical Education (n = 22); Academic Medicine (n = 9); Medical Teacher (n = 7); Advances in Health Science Education (n = 2). During the review of these texts, 9 studies were excluded; the majority (n = 8) because the papers were not ethnographic works, in that they did not have an ethnographic approach, utilise ethnographic methods or produce an ethnographic study. Instead, these works were often qualitative in nature utilising one qualitative method that was not triangulated with other methods. While these excluded studies often cited that the analysis was ‘ethnographic’ in nature (theoretically informed, sensitive to local context and perceptions of participants) it was not conducted in terms of typical ethnographic research. As a result, although it is important to note that these studies are qualitative in nature, they cannot be considered ethnographic work.

Analysis of the final 32 included papers generated a number of themes. These included:

• The use of critical evaluation of medical education (Walker 1989; Bonny 2005; Balmer 2010)

• An exploration of socialization of students into the medical profession (Pope et al. 2003; Seabrook 2004),

• The examination of students’ perceptions of professionalism (McClenon 1996; Donetto 2010)

• The investigation of the role of the hidden curriculum within medical education (Varpio 2009).

In addition, we found that often ‘thick description’ was a key goal of the ethnographic research (Reeves 2008). Ethnographic methods were also found to provide a useful perspective to study organisational context and culture (Kuper et al 2010). In addition, a key issue discussed in many papers reporting on ethnography in medical education was that ethnography is time and labour intensive. Moreover, several articles provided discussion about the strengths of using an ethnographic approach to medical education activities, as the in-depth analysis of day-to-day activities, it was often argued, facilitated comprehensive understandings of functions of medical education for students, teachers and administrators (Walker 1989; Leung 2002; Atkinson & Pugsley 2005).

The analysis also indicated several similar characteristics. First, the included studies refer to ethnography as the use of a set of methods (or tools) to investigate phenomena, rather than using it as a methodology (see Section “Introduction” for the distinction between these two terms). Second, while triangulation of methods was performed, it was not always clear how this achieved. Third, as often encountered in clinical settings, it was difficult for the ethnographer (typically not a trained clinician) to fully participate in the social setting being studied. Therefore, ethnographies often included the collection of non-participant or sometime marginal participant observations, which were engaging and interactive but without direct participation in central activities of the community under investigation. Finally, most ethnographies in medical education have depended upon relatively brief engagement (i.e. days or weeks) in the field gathering observational work – an issue which reflects the poor resources available for this type of work. This limitation with the use of ethnography is not confined to medical education; it has become realised with the proliferation of ethnography across different applied disciplines. In response to these limitations, new types of ethnography (e.g. rapid ethnography – see Section “Introduction”) have been developed in an attempt to address the temporal elements and/or mitigate some of the intensive resources needed.

Discussion

As presented above, ethnographic studies within medical education have generated some very helpful illuminations of a range of teaching and learning phenomena, which have contributed to a greater understanding for this field. However, as the scoping review indicated, despite making some useful advances in knowledge, there are a number of limitations within this body of work.

While attention to methodological issues, such as providing more details when triangulating data or methods, are easy to fix by researchers; the limited funding for ethnographic work is clearly not. Though, encouragingly, the empirical insights generated by ethnographic work are increasingly being valued by a widening range of medical education stakeholders (teachers, policymakers, researchers and administrators).

Concluding comments

As we discussed above, the use of ethnography in medical education has a relatively long and impactful history. For example, ethnographic work has provided important insights into the how medicine, through a complex array of implicit and explicit socialisation processes continues to reproduce its common values, attitudes and beliefs. As previously noted in this section, the findings from this ethnographic work have had an impact for medical education – both in recognising the potency of these socialisation processes, as well as beginning to address their detrimental effects. Nevertheless, as the scoping review of ethnography in medical education revealed there are also a number of limitations to this work, which require methodological refinement to enhance the quality of future ethnographic work in the field.

Glossary

Authenticity is a technique for judging the processes and outcomes of a qualitative study. It has a number of criteria, including representation of a range of different realities, enabling people to develop more sophisticated understandings of the phenomenon being studied, helping people appreciate the viewpoints of people other than themselves, stimulating some form of action, and empowering people to act.

Constructionism (also called social constructionism) is an epistemology that posits that there is no objective truth waiting for us to discover it. Rather, meaning comes into existence in and out of our engagement with the realities in our world. Meaning is therefore not discovered but constructed.

Discourses are forms of representation that typically consist of multiple modes including language, visual images, symbols, nonhuman things/material cultural objects and other modes of communication. Discourse theory has many roots including social constructionism and ethnography.

Empiricism is an epistemology that asserts that knowledge comes only or primarily from sensory experience. Empiricism emphasizes the role of experience and evidence, especially sensory experience, in the formation of ideas.

Epistemology is the study of knowledge to help understand and explain how we know what we know. Its goal is focused on questioning what knowledge is, how it is acquired, and the possible extent a given subject can be known.

Feminism is a theoretical framework that is driven by an interest in women's experiences, often focusing on power differentials, with the goal of resolving gendered inequities. This approach is based on notions of authenticity, reciprocity and intersubjectivity, which aims to overcome hierarchical and exploitative relationships associated with traditional forms of research involving women.

Hermeneutics is an approach which aims to interpret the nature of verbal and nonverbal forms of communication as well as the underlying aspects that affect these forms of communication (e.g. presuppositions, assumptions)

Inductive reasoning begins with a problem or idea and through a process of exploration individuals arrive at some theoretical understanding of that problem or phenomenon.

Intersubjectivity is the tendency for individuals to arrive at common constructions and shared interpretations of reality. Intersubjectivity is the core concern of the interpretive traditions in qualitative research.

Iteration in qualitative research is a process whereby data gathered at one point informs data subsequently gathered. Researchers use what they learn from day to day to guide subsequent decisions about what to observe, who to interview, what to look for, and what to ask about.

Naturalism proposes that the social world should be studied in its ‘natural’ state and that research should be sensitive to the nature of the setting and the phenomena being investigated. Naturalistic approaches limit the use of preconceived theory and conceptual categories, focusing on descriptions of the details of everyday life.

Narratives are ways in which individuals and groups make sense of and interpret their experiences through a process of storytelling

Phenomenology is a philosophy that assumes that the experience of any reality is possible only through interpretation. Phenomenology has stimulated the growth of major interpretive traditions in qualitative research, such as symbolic interaction and hermeneutics.

Positivism is a philosophy that contains a belief in the existence of a single objective reality. A positivist approach is defined by the logic of the experiment, universal or statistical laws, and directly observable phenomena.

Postmodernism is a theoretical framework that encompasses the concept of a fragmented, ever changing reality; also, the abandonment of the modernist ideals of progress and rationality

Reciprocity is the give and take of social interactions and may be used to gain access to a setting and to obtain thick, rich, description and in-depth interviews. Feminist and critical analyses have examined the politics of reciprocity and its possibility for exploitation.

Symbolic interactionism is concerned with the study of human meaning that is seen to emerge out of symbolic realms and related meaningful action.

Thick description is a term used to describe the detailed, context-sensitive and locally informed fieldnotes that an ethnographer is able to produce from deep immersion in a particular culture.

Triangulation is a technique in which a researcher compares the findings of different methods, theories and/or perspectives of different people or groups to help produce a more comprehensive and nuanced set of findings.

Final thoughts

In this Guide we have aimed to offer an introduction to ethnography and its use in medical education. As we have discussed above the use of ethnography in medical education presents a number of opportunities: its use of participant observation enables ethnographers to ‘immerse’ themselves in a setting, enabling them to generate a rich understanding of social action and its subtleties. This method also allows ethnographers the opportunity to gather empirical insights into social practices which are normally ‘hidden’ from the public awareness. Indeed, through the collection and triangulation of multiple forms of data (observations, interviews and documents), ethnography has the potential to yield comprehensive accounts of different phenomenon in a medical education context. However, as previously noted, given the complexity of a number of conceptual, methodological, ethical and practical issues, this type of research endeavour can be difficult to successfully complete.

Nevertheless, by acknowledging and discussing this complexity it is hoped that this Guide has provided some helpful insights for those interested in understanding the ‘good, the bad and the ugly’ when reading ethnographic work. It is also anticipated that this Guide has provided some useful insights for those interested in using ethnographic methods in their own research work. The two appendices that follow provide further resources and readings to deepen and build upon the content presented in this Guide. However, for those interested in undertaking ethnographic work, we would recommend that advice and guidance is obtained from experienced researchers.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Appendices

In this section we have provided two appendices for additional ethnographic resources to provide readers with some additional sources to read and use in their own work:

Appendix 1 – A range of web-based resources aimed to offer a wide variety of ethnographic insights

Appendix 2 – A selection of key texts, chapters and papers we have used in our ethnographic work.

Appendix 1: Web resources

Below are a range of useful web-based resources – journals and websites – which offer a rich array of ethnographic insights:

Qualitative Health Research is a journal that provides an international, interdisciplinary forum to enhance health care and further the development and understanding of qualitative research in health-care settings.

Website: qhr.sagepub.com

Qualitative Inquiry is a journal that provides an interdisciplinary forum for qualitative methodology and related issues in the human sciences. The journal focuses on methodological issues raised by qualitative research rather than the content or results of the research and addresses advances in specific methodological strategies or techniques.

Website: qix.sagepub.com

Qualitative Research is an international, interdisciplinary journal that publishes on the methodological diversity and multi-disciplinary focus of qualitative research. It accepts contributions from within sociology, social anthropology, health and nursing, education, human geography, social and discursive psychology and discourse studies.

Website: http://www.qrj.sagepub.com

Qualitative Sociology is a journal dedicated to the qualitative interpretation and analysis of social life. The journal offers both theoretical and analytical research, and publishes manuscripts based on research methods such as interviewing, participant observation, ethnography, historical analysis, content analysis.

Website: http://www.springer.com/social+sciences/journal/11133

Qualitative Sociology Review publishes empirical, theoretical and methodological articles applicable to all fields and specializations within sociology, and covers a range of different methodologies, including ethnographic work.

Website: http://www.qualitativesociologyreview.org

The Qualitative Report is an on-line bi-monthly journal devoted to writing and discussion of and about qualitative, critical, action, and collaborative inquiry and research. The Qualitative Report serves as a forum and sounding board for researchers, scholars, practitioners, and other reflective-minded individuals who are passionate about ideas, methods, and analyses permeating qualitative, action, collaborative, and critical study.

Website: http://www.nova.edu/ssss/QR/index.html

Visual Ethnography is an online peer-reviewed journal dedicated to researches on the following topics – the production and the use of images and audio-visual media in the socio-cultural practices, the ethnographic representation through audio-visual media and devices (film, photography, multimedia, etc.); the gaze and the practices where vision is an important item for the construction of the meaning in the social relationships and practices; on the visual dimension of objects, bodies, places and environments.

Website: http://www.vejournal.org/?journal=vejournal

Appendix 2: Selected reading

In this appendix with have included a selection of texts, chapters and journal papers which we have found helpful in our ethnographic work:

Books

Atkinson P, Coffey A, Delamont S, Lofland J, Lofland L (editors). 2001. Handbook of Ethnography. London: Sage.

Emerson RM, Fretz RI, Shaw LL. 1995. Writing ethnographic fieldnotes. Chicago: University of Chicago Press.

Fetterman D. 1988. Ethnography: Step by step (2nd edn). London: Sage.

Green J, Thorogood N. 2004. Qualitative methods for health research. London: Sage.

Hammersley M. 1992. What's wrong with ethnography? Methodological explorations. London: Routledge.

Spradley J. 1979. The ethnographic interview. New York: Holt.

Chapters

Bogdewic SP. 1999. Participant observation. In: Crabtree BF, Miller WL, editors. Doing qualitative research. Thousand Oaks: Sage. pp 47–69.

Fielding N. 1993. Ethnography. In: Gilbert N, editor. Researching social life. London: Sage. pp 154–171.

Geertz C (editor). 1973. Thick description: Toward an interpretive theory of culture. In: The interpretation of cultures. New York: Basic Books. pp. 3–30.

Prasad P. 2005. Ethnography: Cultural understandings of natives. In: Randall L, editor. Crafting qualitative research. New York: M.E. Sharpe. pp. 75–90.

Journal Papers

Atkinson P. 1992. The ethnography of a medical setting: Reading, writing, and rhetoric. Qual Health Res 2(4):451–474.

Atkinson P, Pugsley L. 2005. Making sense of ethnographic research in medical education. Med Educ 39:228–234.

Castañeda QE. 2006. The invisible theatre of ethnography: Performative principles of fieldwork. Anthropol Quart 79(1):75–104.

Charmaz K, Oleson V. 1997. Ethnographic research in medical sociology: Its foci and distinctive contributions. Sociol Methods Res 25:452–494.

Dixon-Woods M. 2003. What can ethnography do for quality and safety in health care? Qual Safety Health Care 12:326–327.

Fine G. 1993. Ten lies of ethnography. J Contemp Ethnogr 22:267–294.

Finlay L. 2002. Negotiating the swamp: The opportunity and challenge of reflexivity in research practice. Qual Res 2(2):209–230.

Geertz C. 1973. Thick description: Toward an interpretive theory of culture. Culture: Critical Concepts Sociol 1:173–196.

Hammersley M. 2006. Ethnography: Problems and prospects. Ethnogr Educ 1(1):3–14.

Jeffrey B, Troman G. 2005. Time for ethnography. Brit Educ Res J 30:535–548.

Lecompte M. 2002. The transformation of ethnographic practice: Past and current challenges. Qual Res 2(3):283–299.

McDonald S. 2005. Studying actions in context: A qualitative shadowing method for organizational research. Qual Res 5(4):455–473.

Pope C. 2005. Conducting ethnography in medical settings. Med Educ 39:1180–1187.

Reeves S, Kuper A, Hodges BD. 2008. Qualitative research methodologies: Ethnography. BMJ 337:512–514.

Savage J. 2000. Ethnography and health care. BMJ 321:1400–1402.

Watson J. 2012. Making organizational ethnography. J Organ Ethnogr 1(1):15–22.

Webb C. 2001. Analysing qualitative data: computerized and other approaches. J Advan Nurs 29(2):323–330.

Wilson WJ, Chaddha A. 2009. The role of theory in ethnographic research. Ethnography 10(4):549–564.

Wind G. 2008. Negotiated interactive observation: Doing fieldwork in hospital settings. Anthropol Med, 15(2):79–89.