By Eve Purdy (@purdy_eve)
Participant observation is “the description of events, behaviours, and artifacts in a social setting”- it is the cornerstone of data collection in anthropology. Historically, anthropologists ventured to exotic locales and immersed themselves in a foreign culture for years at a time. To learn about the group, they watched carefully, gradually participated in more culturally significant events, and documented their experiences in a “thick description” –written field notes that made an effort to capture the essence of what they witnessed. They later used these field notes to inform the written ethnography. In addition to providing rich data for analysis, participant observation is used to help the researcher gain a general sense of the structure and organization of the group, to build relationships with those in the community, and to guide the research questions and agenda. Though anthropology has changed dramatically in the last century, participant observation remains one of the most important tools available to study groups of people in their natural settings. The types of cultures that anthropologists examine through participant observation is no longer limited to foreign civilizations; it also includes businesses, governments, healthcare, education, and community organizations.
During participant observation studies, the researcher is embedded in the day-to-day existence of the group over a period of time. He or she engages in all activities ranging the spectrum from mundane to significant. The role of the participant-observer usually includes creating field notes on experiences and collecting data in a number of forms. Often anthropologists conduct many informal interviews with a gamut of informants to support a broader, more representative cultural interpretation. Anthropologists are trained to tune all five senses to intake the world around them. Throughout these experiences their engagement ranges the spectrum from observer to participant depending on the particular situation or event (figure 1). The expert anthropologist learns how to navigate this spectrum fluidly, taking clues as to when their presence and participation is allowed and when it may not be appropriate. It is rare for the anthropologist to be entirely on the participant end of the spectrum, meaning that they are in a fluctuating state of mindfulness about the culture and behaviours of the group around them.
The translation of participant observation data to meaningful ethnography relies heavily on reflexivity – the ability of the researcher to understand and reflect on how his or her own lens affects interpretation of the group they are studying. Anthropologists are trained to be reflexive and moments of pause are often built in to studies. In the publication of their work, anthropologists overtly acknowledge their positioning and share their reflections with readers. Fostering reflexivity is again achieved through mindfulness of one’s own perspective and deliberate reflection on the role it plays in the research process.
So how might concepts from participant-observation be useful to medical learners? At the beginning of medical training, when present in the clinical setting, medical students are almost exclusively observers. As they graduate they move quite quickly from observer to participant. Little time is spent in the middle phases. This evolution is natural and it is beneficial. There certainly is much to be learned from doing. Though somewhat outdated the familiar adage “see one, do one, teach one” is not entirely far off from reality. When medical students or residents are forced to observe a procedure, or interaction, or surgery they have previously performed independently it is often perceived by the learner quite negatively. I have heard this experience referred to as belittling and infantilizing by some of my colleagues. However, by starting to think a bit more like anthropologists, this opportunity to observe can be turned into a valuable learning experience too. I suggest that once learners start to feel themselves slipping down the participant-observer spectrum, instead of getting frustrated, begin activating observational senses. Some considerations are:
- Is there something unique about this situation (stability of the patient, complexity of the procedure, timing considerations for your supervisor or team) that may explain your relative participation?
- What micro-procedural or communication skills do your staff employ in the more dominant participatory role? How do they arrange their equipment? What exact words do they use when asking a patient about angina? How do these micro-skills differ from yours? Which ones will you adapt? Which ones will you reject?
- How is the patient reacting? What is their experience like?
Beyond honing observational senses around technical skills and patient interactions, the benefits of mindfulness about environment and culture also have the ability to help medical learners adapt to their ever changing circumstances. This is particularly true for residents who participate in off-service rotations. As one begins on a new ward, or new team, there are social rules of engagement that go well beyond the introductory emails and lectures. Anthropologists use participant observation to gain understanding of social hierarchy, use key informants to gather socially important information, and eventually begin to blend in. Medical learners can do the same. I encourage learners to be particularly observant in the first days of a new rotation. This can lead to a quicker transition to the team, and as such, a potentially more fruitful learning experience.
The reflexivity practiced by anthropologists involved in participant observation also offers potential benefit. Being outwardly observant of the people you work with, patients you care for, and groups you belong to can be valuable but the dedicated practice of inward reflection can also be profound. One way to be reflexive is to consider moments of disagreement. When two consulting services disagree you might consider how your lens (reality, pressures, training) affects the way they you see the problem. How is this different than the person you are speaking with? Acknowledging and reflecting on strong emotions is another way to start. Why do you get frustrated with certain patient presentations? Why did you just snap at someone on the phone? The root of these emotions can often be a starting point for growing into the best possible physician. This can be a mental practice or written. Alternatively, collaborative reflexivity is an option. Find a close professional friend or mentor and reflect together on such situations and circumstances.
In addition to reading textbooks, attending rounds, reading articles, and listening to podcasts, participant observation is yet another tool that medical learners can use to grow professionally. We can apply the tools of anthropology to increase the understanding of our medical world and of ourselves.
- Kawulich, B. 2005. Participant observation as a data collection method. Qualitative social research; 6(2):43.
Feature photo provided by author