Dawn Goodwin

Ethics and Ethnography: An Experiential Account

In this article, the authors discuss an ethical dilemma faced by the first author during the fieldwork of an ethnographic study of expertise in anesthesia. The example, written from the perspective of the first author, addresses a number of ethical issues commonly faced, namely, the researcher-researched relationship, anonymity and confidentiality, privacy, and exploitation. She deliberates on the influences that guided her decision and in doing so highlights some of the elements that combine to shape the data. The authors argue that this process of shaping the data is a symbiotic one in which the researcher and the community being studied construct the data together.

Making monitoring ‘work’: human–machine interaction and patient safety in anaesthesia

This study aimed to explore the use of electronic monitoring within the context of anaesthetic practice. We conducted workplace observation of, and interviews with, anaesthetists and other anaesthetic staff in two UK hospitals. Transcripts were analysed inductively for recurrent themes. Whilst formal sources of knowledge in anaesthesia deal with the issue of monitoring in terms of theoretical principles and performance specifications of devices, anaesthetists in practice often ‘disbelieve’ monitoring information. They call on and integrate other sources of knowledge about the patient, especially from their clinical assessment. The ability to distinguish ‘normal’ and ‘abnormal’ findings is vital. Confidence in electronic information varies with experience, as does the degree to which electronic information may be considered ‘redundant’. We conclude that electronic monitoring brings new dimensions of understanding but also the potential for new ways of misunderstanding. The tacit knowledge underlying the safe use of monitoring deserves greater acknowledgement in training and practice.

Passing on tacit knowledge in anaesthesia: a qualitative study

Objective  To explore the acquisition of knowledge in anaesthetic practice using qualitative methods.

Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence.

PurposeAlthough the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia.MethodsWe adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts.ResultsWe noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake.ConclusionCommunication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.RésuméObjectifĽimportance de la communication est de plus en plus reconnue en anesthésie, mais la formation structurée sur le sujet n’a porté jusqu’ici que sur des aspects limités. Nous voulions documenter et analyser la communication apprise de façon informelle et qui a cours entre le personnel ďanesthésie et les patients au moment de ľinduction et du retour à la conscience lors ďune anesthésie générale.MéthodeNotre approche, ethnographique, était fondée sur ľobservation du personnel au travail dans les blocs opératoires et sur ľanalyse subséquente des observations transcrites.RésultatsLors de ľinduction, nous avons noté trois principaux styles ďinformations ordinairement combinés. En ordre de fréquences, la communication était : (1) descriptive, oò les anesthésiologistes expliquaient au patient ce qu’il pouvait s’attendre à ressentir ; (2) fonctionnelle, elle semblait organisée pour aider les anesthésiologistes à maintenir la stabilité physiologique ou à éva luer la différence de profondeur de ľanesthésie et (3) évocatrice, elle faisait appel à des images et à des métaphores. La conversation décrite était en principe dirigée vers le patient, mais elle indiquait aussi aux autres membres de ľéquipe comment ľinduction se déroulait. Dans certains contextes, ľéquipe pouvait aussi participer à la communication. Au réveil, la communication visait habituellement à démontrer que le patient était éveillé.ConclusionLa communication lors de ľinduction et du retour à la conscience tend vers des modèles spécifiques comportant des aspects dominants qui ont toutefois des fonctions similaires. Ce travail de communication est partagé par les membres de ľéquipe ďanesthésie. Il reste à explorer la relation entre les styles de communication et la performance de ľéquipe ou les indicateurs de la sécurité ou du bien-être du patient.Objectif Ľimportance de la communication est de plus en plus reconnue en anesthesie, mais la formation structuree sur le sujet n’a porte jusqu’ici que sur des aspects limites. Nous voulions documenter et analyser la communication apprise de facon informelle et qui a cours entre le personnel ďanesthesie et les patients au moment de ľinduction et du retour a la conscience lors ďune anesthesie generale.

Communication entre anesthésiologistes, patients et équipe ďanesthésie : une étude descriptive de ľinduction et du retour à la conscience

PurposeAlthough the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia.MethodsWe adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts.ResultsWe noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake.ConclusionCommunication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.RésuméObjectifĽimportance de la communication est de plus en plus reconnue en anesthésie, mais la formation structurée sur le sujet n’a porté jusqu’ici que sur des aspects limités. Nous voulions documenter et analyser la communication apprise de façon informelle et qui a cours entre le personnel ďanesthésie et les patients au moment de ľinduction et du retour à la conscience lors ďune anesthésie générale.MéthodeNotre approche, ethnographique, était fondée sur ľobservation du personnel au travail dans les blocs opératoires et sur ľanalyse subséquente des observations transcrites.RésultatsLors de ľinduction, nous avons noté trois principaux styles ďinformations ordinairement combinés. En ordre de fréquences, la communication était : (1) descriptive, oò les anesthésiologistes expliquaient au patient ce qu’il pouvait s’attendre à ressentir ; (2) fonctionnelle, elle semblait organisée pour aider les anesthésiologistes à maintenir la stabilité physiologique ou à éva luer la différence de profondeur de ľanesthésie et (3) évocatrice, elle faisait appel à des images et à des métaphores. La conversation décrite était en principe dirigée vers le patient, mais elle indiquait aussi aux autres membres de ľéquipe comment ľinduction se déroulait. Dans certains contextes, ľéquipe pouvait aussi participer à la communication. Au réveil, la communication visait habituellement à démontrer que le patient était éveillé.ConclusionLa communication lors de ľinduction et du retour à la conscience tend vers des modèles spécifiques comportant des aspects dominants qui ont toutefois des fonctions similaires. Ce travail de communication est partagé par les membres de ľéquipe ďanesthésie. Il reste à explorer la relation entre les styles de communication et la performance de ľéquipe ou les indicateurs de la sécurité ou du bien-être du patient.Objectif Ľimportance de la communication est de plus en plus reconnue en anesthesie, mais la formation structuree sur le sujet n’a porte jusqu’ici que sur des aspects limites. Nous voulions documenter et analyser la communication apprise de facon informelle et qui a cours entre le personnel ďanesthesie et les patients au moment de ľinduction et du retour a la conscience lors ďune anesthesie generale.

Refashioning Bodies, Reshaping Agency

Poovey has argued that the anesthetized “unresisting body” can offer no impediment to a doctors interpretation of its conduct. In contrast, drawing on ethnographic data of anesthetic practice, this article suggests that the technological augmentation of the body required by present-day anesthesia enhances the ability of an unconscious body to convey its needs and shape the course of the anesthetic. In analyzing the expressions of anesthesias cyborgs, the author draws on Haraway, Latour, and Suchman to reconsider the characteristics of agency and how an unconscious body might “resist” or inform a doctors interpretation. This attempt to explore the nature and distribution of agency within a collective is intended as a contribution to the debates surrounding medical dominance and those theorizing the role of technology in health care.

Ethnographies of diagnostic work : introduction

Doctors, mechanics, technicians, helpline operators do it, as do the police, prison officers, therapists, designers and many other professionals. Diagnostic activity — aimed at identifying and categorising problems (or opportunities) and defining scope for action — is crucial in many different contexts; aviation (Dekker, 2005), the chemical industry (Reason, 1997), healthcare (Kohn et al., 2000), business (Weick and Sutcliffe, 2001), as well as engineering and design, are just some of domains within socity that rely on it. The product — ‘the diagnosis’ — can be mundane (sometimes a cough is just a cough), or hugely consequential, such as the confirmation ‘you are well clear of friendlies’ in a 2003 friendly-fire incident in Iraq that killed one soldier and injured four others (Nevile, 2009). Diagnoses are important for a number of reasons: through diagnoses, understanding of underlying facts and causes can be measured or expressed quantitatively; diagnoses can be transformative, reflexively shaping the material and experiential reality of people’s lives; they can provide access to resources or treatment, and they can be a meeting-ground for different perspectives (those of patients and healthcare professionals, users and designers, or pilots and ground controllers, for example). Visions of alternative futures and the ‘mapping out’ of paths towards them are built on diagnoses of the status quo.

Acting in anaesthesia : ethnographic encounters with patients, practitioners and medical technologies

1. Understanding anaesthesia: theory and practice 2. Refashioning bodies, reshaping agency 3. Accounting for incoherent bodies 4. Teamwork, participation, and boundaries 5. Embodied knowledge: coordinating spaces, bodies, and tools 6. Recognising agency, legitimating participation, and acting accountably in anaesthesia.

Socialization, Indifference, and Convenience: Exploring the Uptake of Influenza Vaccine Among Medical Students and Early Career Doctors

The Chief Medical Officer recommends that all health care workers receive an influenza vaccination annually. High vaccination coverage is believed to be the best protection against the spread of influenza within a hospital, although uptake by health care workers remains low. We conducted semistructured interviews with seven medical students and nine early career doctors, to explore the factors informing their influenza vaccination decision making. Data collection and analysis took place iteratively, until theoretical saturation was achieved, and a thematic analysis was performed. Socialization was important although its effects were attenuated by participants’ previous experiences and a lack of clarity around the risks and benefits of vaccination. Many participants did not have strong intentions regarding vaccination. There was considerable disparity between an individual’s opinion of the vaccine, their intentions, and their vaccination status. The indifference demonstrated here suggests few are strongly opposed to the vaccination—there is potential to increase vaccination coverage.

How we tackled the problem of assessing humanities, social and behavioural sciences in medical education

Abstract Background: Assessment serves as an important motivation for learning. However, multiple choice and short answer question formats are often considered unsatisfactory for assessment of medical humanities, and the social and behavioural sciences. Little consensus exists as to what might constitute ‘best’ assessment practice. What we did: We designed an assessment format closely aligned to the curricular approach of problem-based learning which allows for greater assessment of students’ understanding, depth of knowledge and interpretation, rather than recall of rote learning. Conclusion: The educational impact of scenario-based assessment has been profound. Students reported changing their approach to PBL, independent learning and exam preparation by taking a less reductionist, more interpretative approach to the topics studied.