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Table of Contents
MINI-REVIEW
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 109-111

Employment of ethnography research to ensure effective delivery of medical education and clinical training


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission28-Nov-2020
Date of Decision14-Dec-2020
Date of Acceptance26-Dec-2020
Date of Web Publication13-Apr-2021

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_149_20

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  Abstract 


Ethnography is one of the qualitative approaches, wherein the researcher gets submerged into the study setting that has to be explored. An extensive search of all materials related to the topic was carried out in PubMed and a total of five articles were selected based upon the suitability with the current review objectives. The ethnography approach gives a sense of freedom to the researchers to understand in depth the multiple variables in clinical settings or in the delivery of medical education, as the approach remains open ended. In fact, the generated evidence helps the administrators or teachers to understand the dynamics and the root cause of the problem, which then can be effectively sorted out. In conclusion, the application of ethnography empowers the administrators to get a better understanding of the issues in the delivery of medical education and health care. The need of the hour is to encourage training of faculty members in qualitative research, as a trained ethnographer can utilize their skills for the better understanding and effective resolution of the issues impacting effective curriculum delivery.

Keywords: Ethnography, medical education, qualitative research


How to cite this article:
Shrivastava SR, Shrivastava PS. Employment of ethnography research to ensure effective delivery of medical education and clinical training. J Nat Sci Med 2021;4:109-11

How to cite this URL:
Shrivastava SR, Shrivastava PS. Employment of ethnography research to ensure effective delivery of medical education and clinical training. J Nat Sci Med [serial online] 2021 [cited 2021 Jun 13];4:109-11. Available from: https://www.jnsmonline.org/text.asp?2021/4/2/109/313646




  Introduction Top


Researchers from the field of medicine have been extensively using quantitative research traditionally and over the years, the use of qualitative approaches and mixed methods designs has also been sought.[1],[2] There has been a growing desire among the health professionals to gain deep insights into the varied issues of medical education, including improving the learning outcomes among the students and the problems which they face in routine clinical practice.[1] Most of these issues can be well understood and accordingly corrective strategies can be planned based on the research findings obtained from the different approaches of qualitative research.[2]


  Methods Top


An extensive search of all materials related to the topic was carried out in PubMed. Relevant research articles focusing on ethnography in medical education published in the period 2005-2019 were included in the review. A total of seven studies similar to current study objectives were identified initially, of which, two were excluded on account of irrelevance to the present study and due to the unavailability of the complete version of the articles. Overall, five articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include ethnography and medical education. The collected information is presented under following headings, namely scope of ethnography, ethnography in medical education & clinical training, Prerequisites for rich findings, Lessons from the field, Implications for practice and Implications for research.


  Scope of Ethnography Top


Ethnography is one of the qualitative approaches, wherein the researcher gets submerged into the study setting that has to be explored.[3] The ethnography approach gives a sense of freedom to the researchers to understand in depth the multiple variables in clinical settings or in the delivery of medical education, as the approach remains open ended.[4] These studies are generally done in a single normal setting and involve prolonged duration of fieldwork to get in-depth details from the study participants.[1]

The information is obtained through face-to-face interactions and is a clear reflection of the perspectives and behavior of study subjects. The researchers adopt an inductive approach and based on the responses obtained develop the hypothesis and also enable interpretation of the results of the study.[1],[2] Ethnography has been widely used in the sociobehavioral studies, health sector, and has immense scope in the field of medical education and improving medical training.[3],[4],[5] In fact, the generated evidence helps the administrators or teachers to understand the dynamics and the root cause of the problem, which then can be effectively sorted out.[1],[4]


  Ethnography in Medical Education and Clinical Training Top


In medical education, ethnography has been used to define the problem when it is complex in nature (namely understanding of students' behavior or teaching professionalism or hidden aspects of the medical curriculum to medical students in a continuum without compromising the packed medical training schedule), explore the potential factors attributed to a problem or scenario (like identification of the factors which led to the poor performance of the students in a specific subject), documentation of a particular process (namely protocol adopted for competency-based assessment of postgraduate medical students or doctor–patient/nurse–patient relationship), description of unanticipated outcomes (such as reduction in the outpatient department census), for the introduction of curricular reforms based on the feedback received from the previous batch of students, and to identify answers to those questions which cannot be answered by other methods (like perception of medical students or teachers about the curriculum).[1],[2],[3],[4],[5]


  Prerequisites for Rich Findings Top


To ensure in-depth findings, it is a must that the researcher should develop good rapport with the study participants even before the study starts and share the purpose of the study and how the findings will be useful for the benefit of them (mutually beneficial).[6] Moreover, the researcher has to formulate a robust research question, which should be in alignment with the adopted methodology and has to be supported by groundwork (like technical support or interviewing skills, time management, obtaining notes, etc.).[4],[6]

The researcher should practice being reflexive through introspection and reflection about the entire process of data collection and should ensure that it remains transparent and should not get affected by their own opinions.[5] Moreover, it is always a good approach to adopt different methods of data collection (namely participant observation, in-depth interviews, documents, etc.), which ensures both richness of the information and establishes trustworthiness through triangulation.[3],[4],[5] Finally, at the time of analysis, a thick description of the entire process needs to be done. Although ethnography has significant application in different domains of medical education, we have to be aware about the limitations of the same, namely time-consuming process, difficulty in the generalizability of study findings, subjectivity, less sample size, need of a skilled researcher, and lack of funding agencies.[5],[6]


  Lessons from the field Top


At Shri Sathya Sai Medical College and Research Institute, a constituent unit of Sri Balaji Vidyapeeth, Puducherry, in the process of exposing the first-year undergraduate medical students to community settings, ethnography research method has been employed. These students as a part of early clinical exposure are first exposed to theoretical sessions on qualitative research methods, including ethnography, and this is followed by field visits. Though, the exact definition of ethnography is not being met (viz. medical students staying with the local community), nevertheless the students interact with the members of the field practice area regarding various issues and accordingly develop significant understanding about the sociodemographic and livelihood pattern of the people. The exposure to emic perspective in the early stages of their medical training plays a significant role in the making of a better clinician and holistic healthcare professional.


  Implications for practice Top


Ethnography has immense scope in the making of a competent healthcare professional. As a part of the National Social Service initiative, interested undergraduate medical students gets an opportunity to live with the local people in their own settings for a period of 7-10 days. During this stay, the medical students get insight into the sociocultural practices, and the problems faced by the local residents. Such a posting satisfies the definition of ethnography and as an ethnographic researcher, the students can come out with local feasible and practical solutions to the given problems of the resident, by ensuring that the community is itself involved in the entire process. Similarly, ethnographic research can also be employed during the period of internship in the department of Community Medicine and both students & local people can be benefited.


  Implications for research Top


Ethnography has immense scope in research activities during the period of medical training and it can provide effective inputs on multiple complex issues that needs further exploration. For instance, ethnography can be employed to understand the behavior of students, identify effective strategies to teach professionalism, ascertain factors responsible for poor performance in academics, documentation of the process of competency based assessment, reasons for reduction in the outpatient department census, perception of medical students or teachers about the curriculum, etc. The results of such research work can be effectively used for better medical training.


  Conclusion Top


The application of ethnography empowers the administrators to get a better understanding of the issues in the delivery of medical education and health care. The need of the hour is to encourage training of faculty members in qualitative research, as a trained ethnographer can utilize their skills for the better understanding and effective resolution of the issues impacting effective curriculum delivery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Goodson L, Vassar M. An overview of ethnography in healthcare and medical education research. J Educ Eval Health Prof 2011;8:4.  Back to cited text no. 1
    
2.
Shrivastava SR, Shrivastava PS. Employing qualitative research in medical education research. Mustansiriya Med J 2018;17:104-5.  Back to cited text no. 2
  [Full text]  
3.
Atkinson P, Pugsley L. Making sense of ethnography and medical education. Med Educ 2005;39:228-34.  Back to cited text no. 3
    
4.
Andreassen P, Christensen MK, Møller JE. Focused ethnography as an approach in medical education research. Med Educ 2020;54:296-302.  Back to cited text no. 4
    
5.
Reeves S, Peller J, Goldman J, Kitto S. Ethnography in qualitative educational research: AMEE Guide No. 80. Med Teach 2013;35:e1365-79.  Back to cited text no. 5
    
6.
Rashid M, Hodgson CS, Luig T. Ten tips for conducting focused ethnography in medical education research. Med Educ Online 2019;24:1624133.  Back to cited text no. 6
    




 

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  In this article
Abstract
Introduction
Methods
Scope of Ethnography
Ethnography in M...
Prerequisites fo...
Lessons from the...
Implications for...
Implications for...
Conclusion
References

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