Ethnography in qualitative educational research : AMEE Guide No. 80

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

The disconnections between space, place and learning in interprofessional education : an overview of key issues

This article explores and discusses current conceptual and empirical dimensions of the study of space, place, education and interprofessional education (IPE) within a health professions context. This article addresses defining elements of the concepts, their use in nursing and medical literature and their positioning within educational theories. It outlines a series of ideas and approaches for future research aimed at investigating the intersections and relationships amongst these concepts. Importantly, this article argues that the conceptualization of space and place in IPE can potentially impact how educational space, places and curricular are (re)conducted and utilized

Positioning continuing education : boundaries and intersections between the domains continuing education, knowledge translation, patient safety and quality improvement

Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the similarities and differences amongst the four domains in relation to their missions, stakeholders, methods, and limitations. This paper highlights the potential for a more integrated and collaborative partnership to promote networking and information sharing amongst the four domains. This potential rests on the premise that an integrated approach may result in the development and implementation of more holistic and effective interdisciplinary interventions. In conclusion, an outline of current research that is informed by the preliminary findings in this paper is also briefly discussed. The research concerns a comprehensive mapping of the relationships between the domains to gain an understanding of potential dissonances between how the domains represent themselves, their work and the work of their 'partner' domains

(Mis)perceptions of continuing education : insights from knowledge translation, quality improvement, and patient safety leaders

INTRODUCTION: Minimal attention has been given to the intersection and potential collaboration among the domains of continuing education (CE), knowledge translation (KT), quality improvement (QI), and patient safety (PS), despite their overlapping objectives. A study was undertaken to examine leaders' perspectives of these 4 domains and their relationships to each other. In this article, we report on a subset of the data that focuses on how leaders in KT, PS, and QI define and view the domain of CE and opportunities for collaboration. METHODS: This study is based on a qualitative interpretivist framework to guide the collection and analysis of data in semistructured interviews. Criterion-based, maximum variation, and snowball sampling were used to identify key opinion leaders in each domain. The sample consisted of 15 individuals from the domains KT, QI, and PS. The transcripts were coded using a directed content analysis approach. RESULTS: The findings are organized into 3 thematic subsections: (1) definition and interpretation of CE, (2) concerns about relevance and effectiveness of CE, and (3) opportunities for collaboration among CE and the other domains. While there were slight differences among the data from the leaders of each domain, common themes were generally reported. DISCUSSION: The findings provide CE leaders with information about KT, QI, and PS leaders' (mis)perceptions about CE that can inform future strategic planning and activities. CE leaders can play an important role in building upon initial collaborations among the domains to enable their strengths to complement each other

Quality improvement, patient safety, and continuing education : a qualitative study of the current boundaries and opportunities for collaboration between these domains

PURPOSE: Quality improvement/patient safety (QI/PS) and continuing education (CE) efforts have a common aim to improve health care outcomes. Yet, minimal collaboration occurs between them. This lack of integration can be problematic given the finite resources available and the potential value of approaching health care challenges from different perspectives. The authors conducted an exploratory study to understand Canadian leaders' perceptions and experiences with both their own and the other domain, with the aim of increasing their understanding of the boundaries and opportunities for collaborative approaches to improving health care. METHOD: The authors conducted this study in 2011-2012 using a qualitative interpretivist framework to guide the collection and analysis of data from semistructured interviews. They used criterion-based, maximum variation, and snowball sampling to select 15 leaders from the domains of QI/PS and CE to interview. They transcribed verbatim the interviews and coded the transcripts using a directed content analysis approach. RESULTS: Participants described the relationship between QI/PS and CE in four ways: (1) the separation of QI/PS and CE as distinct interventions, (2) (re)positioning CE in QI/PS activities, (3) (re)positioning QI/PS in CE activities, and (4) further integrating QI/PS and CE. CONCLUSIONS: These findings have important implications for how leaders in QI/PS and CE should mindfully and strategically negotiate their relationship to ensure the relevance and effectiveness of their domain's activities

Interpreting secondary cardiac disease variants in an exome cohort

BACKGROUND: Massively parallel sequencing to identify rare variants is widely practiced in medical research and in the clinic. Genome and exome sequencing can identify the genetic cause of a disease (primary results), but can also identify pathogenic variants underlying diseases that are not being sought (secondary or incidental results). A major controversy has developed surrounding the return of secondary results to research participants. We have piloted a method to analyze exomes to identify participants at-risk for cardiac arrhythmias, cardiomyopathies or sudden death. METHODS AND RESULTS: Exome sequencing was performed on 870 participants not selected for arrhythmia, cardiomyopathy, or a family history of sudden death. Exome data from 22 cardiac arrhythmia and 41 cardiomyopathy-associated genes were analyzed using an algorithm that filtered results on genotype quality, frequency, and database information. We identified 1367 variants in the cardiomyopathy genes and 360 variants in the arrhythmia genes. Six participants had pathogenic variants associated with dilated cardiomyopathy (n=1), hypertrophic cardiomyopathy (n=2), left ventricular noncompaction (n=1) or long QT syndrome (n=2). Two of these participants had evidence of cardiomyopathy and one had left ventricular noncompaction on ECHO. Three participants with likely pathogenic variants had prolonged QTc. Family history included unexplained sudden death among relatives. CONCLUSIONS: Approximately 0.5% of participants in this study had pathogenic variants in known cardiomyopathy or arrhythmia genes. This high frequency may be due to self-selection, false positives, or underestimation of the prevalence of these conditions. We conclude that clinically important cardiomyopathy and dysrhythmia secondary variants can be identified in unselected exomes

Interpreting Secondary Cardiac Disease Variants in an Exome Cohort

BACKGROUND: Massively parallel sequencing to identify rare variants is widely practiced in medical research and in the clinic. Genome and exome sequencing can identify the genetic cause of a disease (primary results), but can also identify pathogenic variants underlying diseases that are not being sought (secondary or incidental results). A major controversy has developed surrounding the return of secondary results to research participants. We have piloted a method to analyze exomes to identify participants at-risk for cardiac arrhythmias, cardiomyopathies or sudden death. METHODS AND RESULTS: Exome sequencing was performed on 870 participants not selected for arrhythmia, cardiomyopathy, or a family history of sudden death. Exome data from 22 cardiac arrhythmia and 41 cardiomyopathy-associated genes were analyzed using an algorithm that filtered results on genotype quality, frequency, and database information. We identified 1367 variants in the cardiomyopathy genes and 360 variants in the arrhythmia genes. Six participants had pathogenic variants associated with dilated cardiomyopathy (n=1), hypertrophic cardiomyopathy (n=2), left ventricular noncompaction (n=1) or long QT syndrome (n=2). Two of these participants had evidence of cardiomyopathy and one had left ventricular noncompaction on ECHO. Three participants with likely pathogenic variants had prolonged QTc. Family history included unexplained sudden death among relatives. CONCLUSIONS: Approximately 0.5% of participants in this study had pathogenic variants in known cardiomyopathy or arrhythmia genes. This high frequency may be due to self-selection, false positives, or underestimation of the prevalence of these conditions. We conclude that clinically important cardiomyopathy and dysrhythmia secondary variants can be identified in unselected exomes