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Canadian Family Physician•Le Médecin de famille canadien|
Vol 57: MARCH • MARS 2011Hypothesis | Section of Researchers
•Section des chercheurs
Ethnography: traditional and criticalist
conceptions of a qualitative research method
Shafik Dharamsi
PhDGrant Charles
PhDT
eaching family medicine residents how to conduct research is increasingly being seen as a crucial component of their training, in part as a means of strengthening the discipline and in part to improve their practices. Whereas quantitative methods once domi- nated approaches to medical research, the application of qualitative methods is seen as an effective way to study issues in primary care.1-3 Ethnography is one such quali- tative approach that offers residents a useful tool for conducting research. This article presents an overview of ethnography as a research method that is used to gain a deeper understanding of human behaviour, moti- vation, and social interaction within specific and com- plex cultural contexts.Ethnographic research has long played an impor- tant role in medicine.4-6 Becker and colleagues’ land- mark ethnographic study, Boys in White: Student Culture in Medical School,7 used qualitative interviews and par- ticipant observation to learn how medical students are acculturated into the medical profession; how they learn to negotiate the social complexities within the hospi- tal; and their anxieties, doubts, and idealism as they go through medical training. The study also provides use- ful insight into students’ evolving and shifting concep- tions of the medical profession. Ethnographies such as this one provide an in-depth perspective on a range of health-related issues, such as the professional8 and cor- porate culture,9 social determinants,10 the illness experi- ences of patients,11 moral problems in health care,12 the family’s role in patient care,13 patient attitudes toward delivery of care,14 and other factors that influence health care and health outcomes.15-17 In essence, ethnographies provide a deeper insight into a culture. In this sense cul- ture is defined as the collective assumptions and beliefs that influence the practices of a particular group of peo- ple who share a social space.
The term ethnography is thought to have first been introduced in 1922 by Bronsilaw Malinowski (1884- 1942).18 It has its roots in the descriptive science19 of social anthropology, central to which is the study of culture and cultural behaviour.20 Ethnographies, how- ever, are not limited to studies of ethnic rituals and practices. They include studies that describe and explain a range of social phenomena within various culture-sharing groups. These ethnographies pro- vide an in-depth description and analysis, and paint a portrait of the ways in which culture-sharing groups interpret their experiences and create meaning from
their interactions. Surgeons, for example, have a par- ticular professional culture influenced by attitudes and behaviour that are characteristic of that group and transmitted across generations through learning.21
Divergent approaches
Traditional approaches to ethnographic research endeavoured to collect facts and evidence through detached observations about the culture being studied, with the researcher attempting to operate in the back- ground as an objective bystander in order to develop an impartial understanding of observable phenomena.
This positivist* aim of impartiality, criticalists† will argue, is not tenable, as it depends upon the unlikely ability of the researcher to be once-removed from the culture under observation.22 Criticalists maintain that researchers are mistaken if they believe they are able to provide a neutral account of others’ experiences.
Unlike Malinowski, the next generation of researchers finds that ethnographers are influenced by a “culturally mediated world, caught up in ‘webs of significance’
they themselves have spun [where] there is no privi- leged position, no absolute perspective, and no valid way to eliminate consciousness from our activities or those of others.”23
Positivists defer to the transcribed interview over the lived experience of a face-to-face conversation. As a result, knowledge becomes a derivative of the captured, transcribed voice; the known, originally of flesh and blood, is transformed into an amorphous entity, only to be reincarnated and solidified in text. Both the cap- tured voice and the fixed subject can now be manipu- lated without fear of losing data to the continuity of life and time. A transcribed text can be seen as containing a set of meanings that remain frozen for all time, and is thus more reliable. Yet criticalists would argue that such texts are read and reread, interpreted and rein- terpreted with every new reading, through which the reader as researcher creates newer meanings and rei- fications. What goes unrealized is that each encounter
*Positivists subscribe to the theory that empirical experience is the most legitimate source of knowledge, and that knowl- edge begins and ends with a sensory experience free of sub- jective interpretation.19
†Criticalism presupposes that knowledge is conjectural, socially constructed, and ephemeral—always open to critical analysis and re-analysis.19
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with the text is a new experience. To believe that each reading is still an encounter with the original experience ignores the contextual, historical moments that pro- duced it.24 The text is given a life of its own with a cor- responding belief that it presents the “truth” about the situation being studied.
Criticalists believe, therefore, that the new ethnog- rapher must be careful not to be entrapped by a par- ticular form and version of truth. The social world is governed by multiple truths, which are contextually sit- uated.25 The researcher’s credibility and legitimacy are gained by acknowledging the representation of mul- tiple versions of truth, showing how each version can impinge on and shape the phenomenon being studied.
No single version is given authoritative privilege, for each has its own strengths and limitations—for exam- ple, at the scene of an accident, a range of perspectives is obtained to help illuminate the situation in order to arrive at the best possible explanation of what hap- pened. Meanings are not inherent in observation alone, but rather must be elucidated through the interpreta- tion of the range of perspectives offered to illuminate the phenomenon under study.
Constructing realism
Although it might seem as if this movement toward
“multiple truths” means that it is impossible to ever know anything, the opposite might in fact be the case.
Instead of looking for a single truth when using an eth- nographic approach, researchers are encouraged to try to understand the cultural environment from mul- tiple points of view. Hence, in qualitative research, the term experience is more commonly used than truth.
Researchers will need to broaden their perspectives while taking into account diverse perceptions of what is occurring in the social environment. Rather than developing single-person interpretations and gener- alizations, the aim is to collect thick, extensive, and detailed descriptions and interpretations of the area being studied.26 We can speculate that if a study like Boys in White,7 for example, were being conducted today it would be a much richer work, as it would not only be looking at the socialization of medical students from the “detached” perspective of the researchers but also examining in more detail the views of patients and other professionals, as well as the diversity within the student group. The experiences embedded in each of these perspectives would help us develop a much richer understanding of medical students within their social context.
Qualitative research is not a monolithic concept like statistics. It draws upon a rich variety of strategies and theoretical frameworks from different disciplines and traditions. Ethnography is but one qualitative research method for studying social phenomena.
Dr Dharamsi is Assistant Professor in the Department of Family Practice and Faculty Lead of the Global Health Network at the Liu Institute for Global Issues at the University of British Columbia in Vancouver. Dr Charles is Associate Professor in the School of Social Work at the University of British Columbia.
Competing interests None declared Correspondence
Dr Shafik Dharamsi, Department of Family Practice, University of British Columbia, 300-5950 University Blvd, Vancouver, BC V6T 1Z3; telephone 604 827-4397; e-mail shafikd@interchange.ubc.ca
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