ethnography medical education research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Med Educ Online
• v.24(1); 2019

Ten tips for conducting focused ethnography in medical education research

Marghalara rashid.

a Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

Carol S. Hodgson

b Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

Background : Medical education researchers increasingly use qualitative methods, such as ethnography to understand shared practices and beliefs in groups. Focused ethnography (FE) is gaining popularity as a method that examines sub-cultures and familiar settings in a short time. However, the literature on how FE is conducted in medical education is limited.

Aim : This paper provides 10 practical tips for conducting FE in medical education research.

Methods : The tips were developed based on our expertise in ethnographic research and existing literature.

Results : The 10 tips include: (1) Know the difference, (2) Build relationships before you start, (3) Have shared purpose and knowledge translation strategies with your stakeholders (4) Practice being reflexive, (5) Align research question with methodology, (6) Prepare your fieldwork, (7) Use a variety of methods for data collection, (8) Consider context on micro, meso, and macro levels, (9) Use triangulation, and (10) Provide a ‘thick description’,

Conclusions : These 10 tips give practical guidance to medical educators in thinking about how and when to conduct FE.

Introduction

For many health professions education (HPE) researchers, there is an increasing desire for a richer and deeper understanding to the questions they find in their everyday clinical practice. The use of qualitative methods is trending in medical education, which was pointed out in recent medical education publications [ 1 , 2 ]. Qualitative methodologies have advanced our knowledge by providing insightful accounts of the socio-cultural factors that impact the development, delivery, and outcomes of medical education [ 3 ]. Ethnography, for example, has a history of more than 50 years in medical education [ 4 ]. Examples of ethnographic studies that impacted medical education include The Student Physician by Fox from 1957 [ 5 ], which explored uncertainty in medical knowledge, and the 1961 landmark ethnographic study entitled Boys in White that examined the culture of medical students, their every day lives, and interactions in medical school [ 6 ]. Ethnography as a research method has elicited a valuable body of literature in this area [ 4 ] by observing, inquiring, and understanding peoples’ experiences, interpretations, their interactions, and relationships surrounding a topic in a real-life context. In this paper our focus is to introduce a recent form of ethnography, commonly referred to as focused ethnography (FE), that is gaining popularity in medical education [ 7 ], health research [ 8 , 9 ], and nursing education [ 10 ].

Ethnography is the description of people and their way of life. As a key method of anthropology, ethnography is concerned with culture, shared practices and beliefs, and how the social context shapes, and is shaped by, individuals [ 11 ]. Historically, ethnographers have studied unfamiliar cultures and spent extended periods in the field. Ethnographers immersed themselves in culture by learning the language and taking part in day-to-day activities. Today, researchers still value ‘cultural immersion’ to achieve a deeper understanding of the insider’s perspective through long-term fieldwork [ 12 ]; however, the field can be anywhere in the world including contemporary societies and familiar settings. Field data are collected using multiple methods such as participant observation, interviewing, document reviews, visual methods, or studying cultural artefacts. Ethnography differs from other qualitative methods because of its use of participant observation to understand shared meanings and practices. People do not or cannot always describe what they actually do and think during an interview. Observation and participation in context, however, can provide insights about real-world social and cultural processes that shape outcomes of interventions in medical education. As such ethnography can be invaluable to answer emerging questions in health-care settings; however, it needs to adapt to the specific context of medical education research [ 10 ].

Over the years, ethnography as a methodology has changed and, in response to the specific needs and contexts of different fields of research, contemporary forms of ethnographic practices, such as focused ethnography, have been developed [ 13 ]. Focused ethnography (FE) emerged within research contexts where long-term fieldwork is less often feasible. There is consensus among researchers today that FE is a well-suited methodology to examine sub-cultures within modern complex societies [ 14 , 15 ], such as interprofessional ward teams, teams in the emergency room during a resuscitation, or nurses in the neonatal intensive care unit (NICU). As ‘the study of shared experiences of a more confined, predetermined phenomenon’ [ 16 ] p.3 FE collects context-sensitive and culturally appropriate data in an efficient, pragmatic, and rapid way.

While FE offers a more pragmatic and feasible method for the medical education research context, the field of medical education has largely had a positivist approach to research and training that is only recently moving towards more interpretivist approaches (naturalistic inquiry). Researchers have come to acknowledge the importance of investigating the ‘how’ and ‘why’ research questions [ 17 ] including aspects of workplace or education culture. As a result, there is a gap between research practise that increasingly uses qualitative approaches, including FE, and the availability of training and literature on how to conduct high-quality focused ethnographies. In this paper, we provide 10 practical tips to help educators and researchers in medical education to design a FE project. Furthermore, we have organised these tips in the order of how one might think about different aspects of a FE project. In reality, the aspects addressed in the tips will be important at various times during the project, and will need consideration iteratively or simultaneously with others.

Know the difference

Understanding the difference between traditional ethnography and focused ethnography (FE) will allow researchers to choose the appropriate form of ethnography in order to explore their research question rigorously. Traditional and focused ethnography share many common features and require similar techniques to ensure quality data and analysis. The main difference lies in pragmatic considerations and what is feasible for the context of a medical education research project. In traditional ethnography, there is an emphasis on continuous and long-term fieldwork. The scope is generally vast and requires a commitment to gain an insider’s perspective. Ethnographers aim to familiarize themselves with the culture by actively participating, learning the language, and living alongside local people.

In contrast to traditional ethnography, FE explores a specific problem within sub-cultures and among small groups of people [ 18 ]. In recent years, scholars have found FE to be valuable and effective for technologically intricate modern sub-cultures [ 19 ]. Because, the scope of FE is narrow, the researcher generally has greater knowledge about the topic under study and relies less on immersion in cultural practices and interpretations by engaging in long-term fieldwork. Thus, FE is more feasible for busy medical educators who are curious and notice interesting interactions or outcomes in their own setting or other relevant groups that they may be interested in exploring. Focused Ethnography applies to any small-scale research that is conducted in the everyday setting, explores shared practices and meanings from a cultural lens, and where the researcher may or may not have familiarity with the sub-culture under study. FE is problem focused and context specific [ 20 ].

Build relationships before you start

Focused ethnography is about understanding people. Understanding people requires relationships; building relationships takes time. Starting early, before the official beginning of data collection, and getting to know a community or population group in context is helpful in a number of ways. Implementing a FE project benefits from partnering with the people affected through all stages. Informal interactions and building relationships with leaders or representatives of a professional community or population group, can help researchers acquire some familiarity with the context of the population, which allows for ‘exploration, reflexivity, creativity, mutual exchange and interaction’ [ 21 ] before research design and ethics applications are completed. The purpose of this engagement is to refine the project and methods. It is not data collection, in fact, nothing learned during these informal encounters is data without an appropriate ethics approval from a relevant academic institution. Investing this time can provide invaluable information to design a relevant and useful project. Informal conversations can help understand whether the research builds on an appropriate grasp of the issue(s), whether research questions are relevant, and help identify key informants and potential interviewees [ 22 ]. Listening and observing can help find out what is polite to ask and what is not. It can give a sense of how acceptable certain methods may be. Relationship building before completing the study design is a form of stakeholder engagement, and recognizes that key stakeholders of medical education research include learners, practitioners, and patients.

Have shared purpose and knowledge translation strategies with your stakeholders

The definition of knowledge translation (KT) by the Canadian Institutes of Health Research (CIHR) [ 23 ] highlights the exchange and application of knowledge to improve the health of people. Important for this is bi-directional knowledge transfer is collaborative decision-making between the research team and stakeholders on a number of issues: (1) which questions to answer; (2) how to answer them; and (3) how to disseminate and implement recommended findings. Such partnerships provide a platform to share and discuss project progress, key findings, and to ensure recommendations are relevant to policy and systems issues. The goal of KT goes beyond academic publishing or presenting research; it emphasizes dissemination of the research results directly to the stakeholders and community partners. When developing a KT and dissemination plan before the start of a project, research team members and stakeholders anticipate together clear, practical steps to be used during and after project completion that can lead to improved services and policies. With an eye on implementation, the researchers should ask a number of questions. Why am I doing this? What is the ultimate goal of conducting this research project? Is this project transferable to the real world? For whom is the knowledge intended? How should the emerging knowledge be transferred? [ 24 ]. Exploring these questions in partnership with stakeholders fosters research that has the potential to change practice and polices with positive outcomes for teaching and care delivery.

Practice being reflexive

During the 1980s, ethnographic practice underwent a tremendous shift recognizing how the cultural, socio-economic, and historical position of researchers and their disciplines shapes encounters in the field, as well as the interpretation of data and representation of knowledge in ethnographic writing [ 25 ]. As a result, reflexivity became a key practice in ethnography that helps researchers become aware of, make transparent, and transcend personal perspectives and biases that impact research relationships, researcher perceptions on how data are collected and interpreted. Reflexivity is introspection and reflection about how and why we as researchers and participants think the way we think, what we pay attention to, what we overlook and take for granted, how we ask questions, interpret answers, and represent results in writing. It is about bringing awareness to how our perception, thinking, and perspective is dynamically shaped by our culture, age, gender, social status, personal history, language, values, and experiences [ 26 ]. This applies to both, FE researchers who are familiar with the group under study and researchers who enter a field unfamiliar to them. Reflexivity is essential and acknowledges that no researcher can take a totally objective stance in understanding and describing another or one’s own culture or human group.

To practice reflexivity, Patton suggests a triangulation of reflexive questions (Patton 2015, see Figure 1 ) [ 11 ]. As with every skill, reflexivity needs practicing. Ask yourself: Why and how did you become interested in your topic? How did you adopt your theoretical framework? What values and feelings do you associate with the topic and people you are working with? What do you want to achieve? Why do you think it has value and for whom? What do you take for granted, What do you pay attention to? What could you overlook because of your existing perception of the problem? The goal is to reflect critically on one’s own role and the role of others in shaping the knowledge created with research.

Reflexive Questions: Triangulated Inquiry.

Patton M, Qualitative Research and Evaluation Methods (4th edition) pp. 72. Copyright © [2015] (Sage Publications, Inc.). DOI: [DOI number 978–1-4129–7212-3].

Align research question with methodology

Just as in quantitative research and other qualitative research, FE research starts with a solid research question, which is the foundational building block of an entire research project. Your research question will guide the study design and methodological choices of your research team [ 27 ]. It is vital that a strong cohesion exists between the research question, methodology, data collection, and theoretical framework. Lack of alignment deteriorates the overall credibility and authenticity of a research study. Choosing a theoretical lens that explains constructs and relationships relevant to answering the research question is vital and helps novice researchers have a clear understanding of what to focus on during data collection and analysis. Making ones’ theoretical lens explicit helps others critically evaluate the research and provides a rational for the choices of research methods and strategies for data analysis. Further, a thorough review of the existing literature will determine if the research question is novel. In FE, research questions are about understanding experiences of individuals, shared practices and meanings within a sub-culture or specific population. For example, what are the shared values and beliefs of faculty members, medical students, and community members who sit on medical school admissions committees? How do cultural elements of the group affect individual and collective behaviours, decisions, and outcomes? As a foundation for and guide throughout the research process, the research question should be precise and specific, clearly outlining what is being investigated and who is the study population. In FE like in quantitative research, research questions should be FINER [ 28 ], that is feasible, interesting, novel, ethical, and relevant.

Prepare your fieldwork

Many ethnographers have stories to tell about once-in-a-lifetime events when their recording device failed. Accidents happen even with the best preparation; however, thoughtful organization of technologies, supplies, and logistics can help data collection succeed [ 29 ]. Below are some pragmatic tips usually not included in the published literature on methods.

Reflect on how much equipment is manageable to carry during your observations and activities. Invest in a quality digital audio or video recorder. Learn how to use your equipment beforehand. Test equipment before you go in the field. Bring extra batteries and memory cards; remember all cables and adapters. Make a checklist to help gather all pieces before leaving for an interview or field visit. Become knowledgeable about capturing sound and microphones for different environments and purposes. Find out if interviews can take place in a quiet space or if you need to capture voices in noisy surroundings where you may need different recoding devices. Practice recording until you achieve useable recordings.

Interviewing

Plan enough time before and after interviews to reflect, catch your breath, and gather your thoughts. Keep a binder that contains all documentation, such as consent forms, information letters, interview guides, and receipt booklets for honoraria. Reflect on how participants relate to different spaces. How does the space affect how people feel, speak, and, as a result, shape the data collected? Plan for unusual interviewing places. At the beginning of each interview, state the date, location, and participant ID on the recording. Double-check that your devices are indeed recording. Interviewees may take the conversation in unexpected, yet valuable directions, be prepared to interview about these on the fly. It is useful to practice with colleagues and friends. Try not to interrupt too soon and too much. Stay with silences, avoid pushing the conversation by taking over and talking. Silences are important.

Note taking

Think about if one or two notebooks for field notes, interview notes, and personal reflections suits you best. If you prefer a laptop or tablet consider whether the setting and activity will allow you to plug-in or re-charge a device, whether using technology will hinder you in following along with participants, and how it may affect conversations and relationships. If recording an interview, it may be better to stay present in the conversation, maintaining eye contact (if appropriate), rather than taking notes. After the interview is over, write down your observations, non-verbal cues, emotional dynamics, your immediate thoughts and interpretations. Back up your recordings as soon as you can. Back up. Back up!

Plan extra time: even if the question, context, and group of people is specified and bounded in FE, research with people in context often takes unexpected turns and requires more time.

Use a variety of methods for data collection

FE is conducted over a short period and fieldwork is often conducted in intervals. The researcher will only be in the field for specific times to observe certain events [ 13 ] whereas in traditional ethnography fieldwork is ongoing and conducted over a long period. Building on your early engagement in the field (Tip 2), field visits will allow researchers to develop trustable relationships with their participants, which is crucial to gain a deeper understanding of interactions and meanings with the particular sub-culture. In FE, it is important to use multiple data collection methods. Data collection is intense and includes interviews, short field visits conducted occasionally, observations, field notes, audiovisual recordings, document reviews, and archival research [ 13 ].The rational for using multiple data collection is to maintain rigour and to gather in-depth data about the topic under study.

Field notes consist of facts, such as the participants in attendance, time and date of the observation, detailed description of activities observed, who is present, and what is happening. Field notes also consists of researchers’ thoughts and feelings, interpretations, and reflections on biases.

During an interview, it is important to provide and promote an atmosphere where participants share their thoughts and feelings freely [ 30 ]. Using a variety of probes is encouraged to elicit more detailed answers; a nuanced understanding; and to capture higher quality data. The key is to ask open-ended and non-judgmental questions. The interviews will involve an in-depth exploration of how meanings are derived through interactions in a particular sub-culture. Usually, the interviews last 45–60 min and the data are collected at the location preferred by the participants.

Observations in FE are conducted in short intervals at a selected time frame as opposed to long term and continuous. Observation is significant for studying the day-to-day activities of study participants more closely. In FE field observation, the researcher does not actively participate, but merely observes participants, interactions, or events [ 31 ]. Field observation will give rich contextual data and enhance our understanding by getting first-hand information about the culture or sub-culture being studied.

In FE, as in any qualitative methodology, data collection and data analysis happen simultaneously. Recordings are transcribed verbatim, and data may be entered in software, such as N-Vivo, to facilitate data analysis. Researchers should immerse themselves into their data and be actively involved in taking analytical notes throughout their data analysis.

Consider context on micro, meso, and macro levels

Ethnography in healthcare is often used to understand the context of a specific problem, but what is context ? Where does it start and end? The three levels of analysis, micro (e.g. learners, patients, educators), meso (e.g. organizations, groups), and macro (e.g. historical, political-economic, societal), are a useful structure, for both quantitative and qualitative research [ 32 ]. To consider how the issue under investigation is shaped by and shapes individuals, collectives, organizations, and socio-economic structures [ 33 ]. Relationships are at the centre of the transmission of knowledge and practices. Individuals (micro) relate to others within a group or a team but also outside of it. Groups as a whole and members of a group individually are connected to other groups in multiple, overlapping ways (meso). These interactions happen within social and socio-economic structures (macro). Within this context, some individuals and groups have more power to shape what is normal, possible, valued, and known. The levels of analysis are nested within each other as each relates to the other. While data collection and analysis in FE may focus on the micro level, it is crucial to contextualize and interpret findings in light of their intersections with meso (e.g. how admissions processes favour or disadvantage applicants) and macro processes (e.g. how funding and policies contribute to health disparities). These intersections will begin to emerge during data collection and ongoing analysis; and the insights may shift data collection and analysis iteratively to further explore how processes and outcomes shape each other at all three levels. It is especially important, when FE aims to inform change in medical education, to consider interactions between the individual, collective, and structural, systemic levels and how they affect knowledge, values, and practice and their change.

Use triangulation

The most important method to establish trustworthiness and credibility in FE is triangulation. Triangulation allows researchers to examine the data from different viewpoints and to check their interpretations against potentially disconfirming information. There are different types of triangulation:

(1) Method triangulation is the combined use of different methods, in FE it will include interviews, participant observation, field notes collected during short field visits, and documents [ 34 ]. This helps researchers to compare and contrast across different sources of data to confirm findings [ 20 ].

(2) Data source triangulation involves collecting data from different participants in different settings and at different time points [ 30 ]. Further, it is recommended that the research team take their analysed data back to the participants to make sure that the data reflects their experiences [ 35 ]. Having a diverse set of data will increase the overall quality and rigour of the study outcomes.

(3) Investigator triangulation involves different researchers to crosscheck data, i.e. validating transcripts, and analysis, i.e. cross coding, and critically question interpretations. Investigator triangulation adds greater depth and breadth to the credibility and trustworthiness of the data [ 36 ].

(4) Theory triangulation means utilizing a number of relevant theories for exploring and interpreting the data. This helps in supporting, explaining, or questioning study findings.

Provide a ‘thick description’

One of the main principles of credibility in ethnography, including FE, is to provide a thick description. Thick description refers to a comprehensive description of the setting, events, relationships, physical environment, people, and phenomena encountered in field work. Geertz (1973) [ 33 ] who coined the word ‘thick description’ believed that comprehensive description of ethnographic research led to the thick interpretation of inquiry, which helps understand intricacies of cultures and possible alternative meanings [ 37 ]. It includes an interpretation of the meaning attached to what was observed through an understanding of culture, history, social relations, and participants’ feelings and emotions [ 38 ]. Thick description is a backbone for constructing knowledge and interpreting complex cultural symbols and human interactions. Thick description including participants’ voice and stories in verbatim quotes, mediated by the researchers’ interpretation and theoretical lens will allow other researchers to draw conclusions about the phenomenon being studied and enhance the overall credibility and authenticity of a research project [ 35 ].

We presented practical tips to prepare the reader to conduct FE in health profession education. Focused ethnography emphasizes fast and intense data collection, sometimes this means that the importance of fieldwork is neglected. Capturing complexities within a sub-culture is the core of FE. For that, being present in the field and building relationships, even for shorter periods and for selected events, is crucial. For a successful research project, field data cannot be compromised at the expense of swift data collection, which will impair the overall value of a research project. Although FE explores familiar sub-cultures and has a smaller scope, it should maintain the major feature of its parent methodology – ethnography – that is fieldwork. This will allow for a thicker, deeper and more accurate understanding of the complex and multilayered nature of relationships within a specific sub-culture and its context.

Acknowledgments

The authors would like to thank the reviewers as their feedback helped improve the quality and clarity of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

• Open access
• Published: 05 December 2021

Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review

• Georgia B. Black   ORCID: orcid.org/0000-0003-2676-5071 1 ,
• Sandra van Os   ORCID: orcid.org/0000-0003-0021-8758 1 ,
• Samantha Machen   ORCID: orcid.org/0000-0003-4727-4423 1 &
• Naomi J. Fulop   ORCID: orcid.org/0000-0001-5306-6140 1  

BMC Medical Research Methodology volume  21 , Article number:  274 ( 2021 ) Cite this article

21k Accesses

5 Citations

15 Altmetric

Metrics details

A Correction to this article was published on 11 April 2022

This article has been updated

The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement.

We used a scoping review methodology drawing on Arksey and O’Malley’s methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 – April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills.

We included 274 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking.

Conclusions

We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.

Peer Review reports

Research can help to support the practice of healthcare improvement, and identify ways to “improve improvement” [ 1 ]. Ethnography has been identified particularly as a research method that can show what happens routinely in healthcare, and reveal the ‘ what and how of improving patient care [ 2 ]. Ethnography is not one method, but a paradigm of mainly qualitative research involving direct observations of people and places, producing a written account of natural or everyday behaviours and ideas [ 3 ]. Ethnographic research can identify contextual barriers to healthcare improvement. For example, Waring and colleagues suggested that hospital discharge could be improved by allowing staff to have more opportunities for informal communication [ 4 ].

There have been advances in ethnographic methods that support its role in supporting healthcare improvement. Multi-site, collaborative modalities of ethnography have evolved that suit the networked nature of modern healthcare [ 5 ]. Similarly, rapid ethnographic approaches (e.g. Bentley et al. [ 6 ];) meet the needs of improvement activities to produce findings within short timeframes [ 7 ]. However, the production of sustained ethnographic fieldwork has waned in response to demands for rapid evidence [ 6 , 8 , 9 ]. Critics of rapid ethnographic methods worry that they are diluting ethnography within applied contexts more widely [ 5 , 10 ].

The relationship between ethnography and healthcare improvement has been the subject of methodological concern [ 8 ]. The first concern is that some research identified as ethnography does not fit within the ethnographic paradigm, merely collecting observational data without a theoretical analysis, interpretation or researcher reflexivity [ 11 ]. A second concern is whether the topics of ethnographic inquiry produce findings that are seen as useful for improvement [ 12 ], particularly if they do not make explicit recommendations or produce checklists [ 8 , 13 , 14 , 15 ]. Authors fear that ethnographic findings that capture complexity [ 16 ] and expose taken-for-granted behaviours and phenomena [ 14 , 17 ] may be too abstract to be relevant to healthcare improvement [ 8 ]. However, these critiques position ethnographic research as a product which may be taken up by healthcare improvers, rather than seeing ethnographic work itself as an improvement activity. We take the view that healthcare improvement aims to change human behaviour to improve patient care, and is therefore reliant on the development of particular skills and habits (such as good communication) [ 18 ]. We would consider that engaging in ethnographic research may support skill development and habit formation that serves healthcare improvement.

In the literature of ethnography in healthcare improvement, there is not much discussion of the close relationship between methodological features of ethnographic research, and their impact on improvement skills. The aim of this paper is twofold: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement [ 19 ].

This is a scoping review following the methods outlined by Arksey & O’Malley and later refined by Levac et al., [ 20 , 21 ] including a systematically conducted literature review and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR; see Additional file 1 for PRISMA checklist). No protocol was published for this review. Our literature search and analyses were conducted iteratively, searching reference lists and undertaking discussions with colleagues about key lines of argument. We also held a workshop at Health Services Research UK conference in 2018 on this topic to gain a wide range of stakeholder views.

Systematic retrieval of empirical papers and purposive sampling

Our search strategy was designed to capture a wide range of approaches to ethnography from different journals, healthcare settings and types of research environment. It was not our aim to capture every study using this methodology, but to map the current field. Thus we did not search grey literature, books or monographs. The search strategy was developed and piloted in consultation with a health librarian. Medline (on OVID platform), PsychINFO, CINAHL and EMBASE databases were searched, and six journals were hand-searched, including: BMJ Quality & Safety, Social Science and Medicine, Medical Anthropology, Cochrane library, Sociology of Health and Illness and Implementation Science. These databases were searched between dates April 2013 – April 2018 and an update was performed in September 2019 using the search terms outlined in Additional file 2 . We limited the search to these dates in order to capture the most recent methodological characteristics of ethnographic studies in this field.

We screened titles and then abstracts according to the inclusion and exclusion criteria detailed in Table 1 . We included studies which self-identified as using ethnography or ethnographic methods rather than using our own criteria. This is because ethnography can be hard to define, and use of criteria may risk excluding papers which exemplify the sorts of tensions and workarounds we are trying to capture.

The retrieved papers were screened by GB, SVO and SM based on inclusion and exclusion criteria (Table 1 ). The total number of papers after screening titles, abstracts and full texts was 274 (Fig. 1 ).

PRISMA statement of all references retrieved, screened and included in the scoping review

Numerical charting

Characteristics of each paper, such as title, authors, journal, year, country and healthcare subject area were extracted (see Table 2 ).

Thematic analysis and development

We coded all 274 papers using NVivo software for stated aims and recommendations. This included close reading, and retrieval of key ideas and quotations from the papers that exemplified key ideas in relation to healthcare improvement, methodology and the authors’ reflections on these. The coded extracts of aims and recommendation in conjunction with the closer reading of the sub-sample were used to inductively develop conceptual ideas, such as how the corpus of papers explicitly aimed to contribute to healthcare improvement, and if not, how this affected the types of conclusions drawn. Some papers were read in greater depth to understand how the authors’ methods related to their findings and conclusions. In order to consider how ethnography supports habits and skills associated with healthcare improvement, we drew on a framework which identifies five habits of ‘improvers’: creativity, learning, systems thinking, resilience and influencing [ 19 ]. Applying this model to our selected papers, we mapped traits or approaches to the ethnographic studies that exemplified these habits either in the authors, or as part of developing these habits in others (e.g. healthcare decision-makers and professionals). Thematic interpretations and lines of argument were generated and discussed by all the authors.

Overview of study characteristics

The included studies covered a wide range of ethnographic methodologies and healthcare subjects, published internationally (Table 2 ) in predominantly social science and clinical journals (see Additional file 3 ). The full list of the 274 included studies is available in Additional file 4 .

Most studies described themselves as an ‘ethnography’ or ‘ethnographic’, although some described their methodology as ‘mixed methods’ including ethnographic components. For example, Collet et al. conducted a mixed methods participatory action research study using observations to produce an “ethnographic description” [ 22 ].

Almost all studies relied on observation and interviews as the main data sources. It was not always specified whether researchers took a participant or non-participant approach to observation. There were some examples of other data sources e.g. video data, surveys, documents, field notes, diaries, and artefacts. A few examples contained a paucity of data, such as only video data [ 23 ], limited fieldwork [ 24 ], a small number of interviewees [ 25 ], or reliance on focus group data alone [ 26 ]. Methods associated with qualitative methodology (but not necessarily ethnographic) were also used, such as data ‘saturation’ to denote that additional data did not provide new insights into the topic [ 27 ].

There were a number of minority or unusual ethnographic variations:

Quantitative ethnography [ 23 ]: temporal coding of physicians' workflow and interaction with the electronic health record system, and their patient.

Cognitive ethnography [ 28 ]: “identifying and elaborating distributed cognitive processes that occur when an individual enacts purposeful improvements in a clinical context”.

Street-level organizational ethnography [ 29 ]: intensive case study methods to explore the implications of healthcare policy at a street level.

Phenomenological ethnographies [ 30 ]: focussing on the lived experience and meanings associated with a phenomenon.

Geo-mapping [ 31 ]: geomapping of selected service data to define Latino immigrant community before conducting interviews and observations.

Use of different types of ethnography to support healthcare improvement

We found that many studies used methods that could identify issues relating to power and vulnerability, with potential relevance to how healthcare improvement problems are defined and solved, and by whom [ 1 ]. For example we noted a significant minority of studies using institutional and critical ethnography, mostly in vulnerable populations (see Table 3 ). These studies were explicitly attentive to systems and power relations, rather than on individual practices. We suggest that the use of geographically-oriented methods such as geo-mapping and street-level organisational ethnography are also attentive to the power structures inherent in place and space, and could be relevant to other geographical healthcare improvement topics such as networked healthcare systems, care at home and patient travel for treatment.

The high prevalence of ethnographic studies with vulnerable populations (e.g. psychiatry, end of life care) suggests that ethnography is also being conceptualised as an emancipatory method, reversing healthcare power structures in its focus. This has been a traditional focus of ethnography since social changes in power and representation in the 1970s, incorporated into the development of healthcare research methodology [ 40 , 41 ]. Some methods used were calculated to maximise the potential for supporting vulnerable groups, for example, Nightingale et al. [ 42 ] used focused ethnography (prolonged fieldwork in a small number of settings) to look at patient-professional interactions in paediatric chronic illness settings. The authors suggested that focussed ethnography is particularly suited to settings where fostering trust is essential. We would also suggest that ethnography may be particularly suited to settings in which participants are less able to verbalise their experiences.

The reviewed studies suggested that video ethnography can support healthcare improvement at a team level. For example, Stevens et al. [ 43 ] promoted video ethnography as a way to capture in-depth data on intimate interactions, in their study of elective caesareans. The video data allowed them to make use of timing data (e.g. of certain actions), physical positioning of different actors and equipment, and verbatim dialogue recording. The video data also suited the technical nature of the procedure, which was relatively time-limited. This form of data collection may not suit environments where healthcare activities are more spread out.

The impact of healthcare practitioner involvement in ethnographic fieldwork and findings

We noted that the use of ethnography for healthcare improvement has led to healthcare practitioners’ widespread involvement in data collection or analysis. We suggest that this is a form of negotiation across the healthcare-academia boundary, translating from ‘real world’ to data and back again. This has potential to create rich and relevant ethnographic studies that are geared towards improvement. However, some studies were undermined by a lack of reflexivity about the dual practitioner-ethnographer role.

A significant number of papers involved healthcare practitioners in fieldwork (e.g. Abdulrehman, 2017, Hoare et al. 2013; [ 37 , 44 ]). For example in Hoare et al. the lead researcher was a nurse, and wrote that they hoped “to bring both an emic and etic perspective to the data collection by bracketing my emic sense of self as a nurse practitioner in order to become a participant observer within my own general practice ” [ 37 ]. In this study, the findings fed directly into local service improvement as the lead researcher felt compelled to “share new ‘best practice’ information and join in the conversation.” There was little discussion about how this affected the generalisability of the findings, and whether their recommendations were adopted.

Similarly, Bergenholz et al. [ 45 ] conducted a study where a nursing researcher completed the main fieldwork and “assisted the nurses with practical care .” They acknowledged that “This may have caused limitations with regards to ‘blind spots’ in the nursing practice, but that it also gave access to a field that might be difficult for ‘outside-outsiders’ to gain .” However, there was no commentary on where the blind spots or extra access occurred, and how this may have affected the relevance and dissemination of their findings.

How might ethnography support healthcare improvement habits?

In this section, we evaluate the studies included in the review in terms of how their methods relate to improvement. We draw on the idea that successful improvement is based on a set of habits and their related skills acquired through experience and practice [ 19 ]. This section is structured around Lucas’s five habits of ‘improvers’: creativity, learning, systems thinking, resilience and influencing [ 19 ]. Under those headings, we describe the mechanisms by which ethnographic studies can support healthcare improvement habits, using illustrative examples.

Resilience is defined as being adaptable, particularly tolerating calculated risks and uncertainty, and proceeding with optimism. Being able to recover from adverse events is core to improvement, reframing them as opportunities. Adaptation and the ability to bounce back from adverse events and variation are core to improvement.

Tolerating the uncertainty of ethnographic data collection

While we did not relate these traits to any particular ethnographic approach in our studies, we would consider that undertaking any ethnographic project requires resilience, as data collection is inherently exploratory and uncertain. For example, Belanger et al. wanted to know how health care providers and their patients approach patient participation in palliative care decisions. The authors explicitly eschewed the pull to create guidelines or other formalised knowledge, but aimed to explore the “unforeseen and somewhat unavoidable ways in which discursive practices prompt or impede patient participation during these interactions.” [ 46 ]

Creativity is defined as working together to encourage fresh thinking by generating ideas and thinking critically.

Using a theoretical lens

Researchers may consider healthcare through a particular theory or framework (e.g. private ordering [ 47 ], masculine discourse [ 48 ], compassion [ 49 ]). The restriction of the theoretical lens enables critical thinking, and keeps the ethnographer creatively engaged. For example, Mylopoulos & Farhat [ 28 ] used the concept of adaptive expertise in a cognitive ethnography to explore “the phenomenon of purposeful improvement” in a teaching hospital. This theoretical lens revealed that clinicians were engaging in “invisible” improvement in their daily work, in “specific activities such as scheduling, establishing patient relationships, designing physical space and building supporting resources”. The authors suggested that these practices were devalued in comparison to more formal improvement activities, justifying the utility of the ‘adaptive expertise’ theory in bringing the daily improvement practices to light.

Challenging current problems and perspectives

We identified studies that challenged or reframed existing improvement problems e.g. Mishra [ 50 ]. This role removes the ‘blinkers’ of improvement research [ 51 ], and can ‘dissolve’ previously intractable implementation problems. For example, Boonan et al. [ 52 ] studied the practice of bar-coded medication from the perspective of nurses using the intervention. In their discussion, the authors challenge the assumption that if you introduce technology, then you will mitigate human factor risks. They highlighted that external pressures on hospitals perpetuate this perspective, and that “nurses and patients are consequently drawn into this discourse and institutional ruling, to which they are not oblivious”. Their recommendation was to understand the skills of nurses in tailoring technology to meet individual patients’ needs rather than trusting in systems blindly.

Learning is defined as harnessing curiosity and using reflective processes to extract meaning from experience.

Inviting reflection

We noted that some studies did not make explicit recommendations for improvement, but wrote their findings in a manner that would invite reflection on its subject matter. For example, Thomas & Latimer [ 53 ] wrote that they view their role as provocateurs of new ideas, stating that their intention “is not to propose specific policies or discourses designed to change or improve practice. More modestly, we hope that by analysing the everyday and by theorising the mundane, this article will ignite reflexive, ethical and pluralistic dialogues – and so better communication between practitioners, parents and the wider lay public – around reproductive technologies and medical conditions” (authors’ underline; p.951-2) [ 53 ]. Others such as Mackintosh et al [ 54 ] used their discussion section to examine their results in the context of other theories and provide illumination: “Our focus on trajectories illuminates the physiological process of birth and the unfolding pathology of illness (and death). This frame provides a means for us to link the agency of those involved in organising the care of acutely ill patients with the wider socio-political factors beyond the clinic, such as governmentality and risk (Heyman 2010, Waring 2007), death brokering (Timmermans 2005) and the medicalisation of birth and death (De Vries 1981).” (p.264). These two examples show that ethnographic work can be offered as an opportunity for learning and reflection, without a translation to specific recommendations.

Supporting a more ethical, expansive, inclusive, and participatory mode of healthcare

Problem-finding is highlighted as an important part of learning in improvement [ 19 ]. Several studies paid attention to multivocality and power, using this to find problematic, unethical and exclusive practices in healthcare. For example, some studies reported previously unheard viewpoints [ 55 , 56 , 57 ], or identified restrictive organisational barriers and normative assumptions [ 58 , 59 ]. Others promoted ethnography as a way of exploring ethics and morality [ 47 , 60 , 61 ], such as criticising research that prioritizes the needs of individuals over the good of society [ 62 ]. Ross et al. [ 63 ] suggested that it is also more ethical to use critical ethnography than other evaluative methods in researching vulnerable populations (e.g. neurological illness), by being able to “explore perceived political and emancipatory implications, [clarify] existing power differentials and [maintain] an explicit focus on action” .

Some studies directly researched power within the healthcare setting. For example, Batch and Windsor’s study of nursing workforce suggested that senior nurse leaders should use their positions to advocate for better working conditions [ 35 ], “ Manageable nurse/patient ratios, flexible patient-centred work models, equal opportunity for advancement, skill development for all and unit teamwork promotion”. Challenging traditional cultural assumptions that have produced and reproduced stereotypes is problematic because they most often are, by their very nature, invisible. In a more critical approach, Gesbeck’s thesis [ 62 ] on diabetes care work challenges the very mechanism of achieving healthcare improvement through research, stating that “we need to change the social and political context in which health care policy is made. This requires social change that prioritizes the good of the society over the good of the individual—a position directly opposed to the current system oriented toward profit and steeped in the ideology of personal responsibility.”

Systems thinking

Systems thinking is defined as seeing whole systems as well as their parts and recognising complex relationships, connections and interdependencies.

Suggesting reorientation to new ‘problem’ areas

We found that many ethnographic studies emphasised skills of synthesis and connection-making, reorienting improvement to different areas, for example in overarching policy recommendations (e.g. Hughes [ 36 ]; Liu et al. [ 64 ], Matinga et al. [ 65 ]), or resetting priorities. For example, Manias’ [ 66 ] ethnography of communication relating to family members' involvement in medication management in hospital suggests that “greater attention should be played on health professionals initiating communication in proactive ways ” [p.865]. In another example, Cable-Williams & Wilson’s (2017) focussed ethnography captures cultural factors within long-term care facilities. Their discussion suggests that acknowledgement of death is under-represented in front-line practice and government policy, reorienting discussions towards an integration of living and dying care.

Exposing hidden practices within the everyday

We found that several studies drew attention to ‘hidden’ practices in healthcare work, allowing them to evaluated and improved. For example, we found reference to practices such as coordinating [ 67 ], repair [ 68 ], caretaking [ 69 ], scaffolding [ 68 ], tinkering [ 52 ] and bricolage [ 58 ]. We also found that some studies had new interpretations of ‘the everyday’ or ‘taken-for-granted’ (e.g. nursing culture [ 34 , 35 , 45 , 70 ], interprofessional practice [ 67 , 71 , 72 , 73 , 74 , 75 ]). Authors’ outputs included frameworks [ 76 ] or models [ 69 , 71 , 77 , 78 ] that map these types of practices in a way that is helpful for intervention development or quality improvement. For example, Mackintosh et al. [ 54 ] looked at rescue practices in medical wards and maternity care settings using Strauss’s concept of the patient trajectory. Their findings highlighted the risks inherent in the wider social practices of hospital care, and suggested that improvement was needed at a level “beyond individual and team processes and technical safety solutions.”

Influencing

Influencing is defined as engaging others and gaining buy-in using a range of facilitative processes.

Direct translation of findings to targets for improvement

Lucas suggests that to be influential, ethnographic studies need to have some empathy with clinical reality, whilst being facilitative and comfortable with conflict [ 19 ]. This was shown in ethnographic studies that made pragmatic recommendations, such as in Jensen’s study of clinical simulation. They advised that simulation might be useful in staging “adverse event scenarios with a view to creating more controlled and safer environments.” ( 80). In MacKichan et al. [ 79 ] observations and interviews were used to understand how primary care access influenced decisions to seek help at the emergency department. The authors made empathic, actionable recommendations such as “ simplifying appointments systems and communicating mechanisms to patients.” (p.10).

Evaluating the context of healthcare improvement

By capturing contextual and social aspects of healthcare improvement, ethnographic evaluations can support leaders and managers who are trying to implement improvement activities. This is a particularly helpful trait in ethnographic studies that pay attention to politics, governance and social theory in their evaluation of new interventions, “zooming out” [ 80 ] beyond the patient-clinician interaction to broader social networks. For example, Tietbohl et al. [ 81 ] investigated the difficulties of implementing a patient decision support intervention (DESI) in primary care through the theoretical lens of relational coordination between “physician and clinical staff groups (healthcare professionals)”. The authors’ recommended attention to the “underlying barriers such as the relational dynamics in a medical clinic or healthcare organization” when creating policies and programs that support shared decision-making using support interventions. This sort of insight can make it more likely that new policies or interventions will succeed. This skill was particularly fertile in the tradition of techno-anthropology, exploring technology-induced errors and the real-world interaction between people and technology, e.g. decision-support tools [ 81 , 82 , 83 , 84 , 85 , 86 ], the introduction of robot caregivers [ 87 ] and clinical simulations [ 88 ]. Other approaches included an investigation of one intervention or change but with a theoretical lens of inquiry.

Summary of findings

This scoping review has identified the methodological characteristics of 5 years of published papers that self-identify as ethnography or ethnographic in the field of healthcare improvement. Ethnography is currently a popular research method in a wide range of healthcare topics, particularly in psychiatry, e.g. mental health, dementia and experiential concerns such as quality of life. Focused ethnography is a significant sub-group in healthcare, suggesting that messages about the importance of research timeliness have taken hold [ 89 ].

We have identified ethnographic methods reported in these papers, and considered their utility in developing skills and habits that support healthcare improvement. Specific practices associated with the ethnographic paradigm can encourage good habits (resilience, creativity, learning, systems thinking and influencing) in healthcare, which can support improvement. For example, using relevant theories to look at every day work in healthcare can foster creativity. The use of critical and institutional ethnography could increase skills in ‘systems thinking’ by critically evaluating how healthcare improvement problems are defined and solved, and by whom.

Comparison with previous literature

This scoping review is the first to consider how current ethnographic methods and practices may relate to healthcare improvement. Within the paradigm of applied healthcare research, there is normative value in being ‘useful’ or ‘impactful’ in our research, which affects our prospects for funding and career success [ 12 ]. However, our review has uncovered a multitude of ways that an ethnographic study can be useful in relation to healthcare improvement, without creating actionable findings. We found a spectrum of interactions with healthcare improvement: some authors explicitly eschewed recommendations or clinical implications; others made imperative statements about required changes to policy or practice. However, this diversity was not necessarily a reflection on how ‘traditional’ the ethnographic methodology was. This challenges the paper by Leslie et al. which puts ethnographic studies in two output categories with respect to healthcare improvement: critique versus feedback [ 8 ]. Instead, we uncovered a variety of ways that ethnography can support healthcare improvement habits, such as encouraging reflection, problem-finding and exposing hidden practices in healthcare.

We did find that supporting healthcare improvement through ethnographic research can require strategic effort, however. For example, we noted that several authors wrote multiple articles based on the same project, often for different types of journal to reach different audiences such as diverse readerships in health services and academic settings. For example, Collier and colleagues published two papers based on a video ethnography of end-of-life care (both in 2016), one in a healthcare quality journal [ 32 ] and one in a qualitative research journal [ 76 ]. The former is shorter, with explicit recommendations for patient safety, whereas the latter is longer, has more detailed results and long sections on reflexivity. Similarly, Grant published an article in a sociology journal [ 90 ] and a healthcare improvement paper [ 91 ] on the same work about medication safety. The sociological paper covered “spatio-temporal elements of articulation work” whereas the other put forward “key stages” and risks, suggesting that it was more closely oriented to improvement.

There have been some considerable debates about changes in ethnographic methods and tools, with concerns about lost researcher identity, dilution of the method, and challenges to “upholding ethnographic integrity” [ 92 ] . We contest this, suggesting that new variants such as focussed and cognitive ethnography are evolving in response to the complexity of hospitals and healthcare [ 93 ], while also being highly regulated, standardised and ordered by biomedicine. Such complex environments cannot be studied and improved under one paradigm alone. Ethnographic identity and method have also been affected by the cross-pollination of ethnography with other social science paradigms and applied environments (e.g. clinical trials, technology development). Debates about theoretical and methodological choices are not only made merely with respect to healthcare improvement, but also in response to professional pressures (e.g. university requirements for impact) [ 12 ], and the mores of taste situated within the overlapping communities of practice that evaluate ethnographic healthcare research [ 94 ]. That said, we echo previous authors’ calls for attention to reflexivity, particularly in embedded or clinician-as-researcher roles [ 95 ].

Our scoping review challenges a previously expressed concern that ethnographic studies may not produce findings that are useful for improvement [ 10 , 12 , 16 ]. By considering different ethnographic designs in relation to skills and habits needed for improvement, we have shown that studies need not necessarily produce ‘actionable findings’ in order to make a valuable contribution. Instead, we would characterise ethnography’s role in the canon of healthcare research methodologies as a way of enhancing improvement habits such as comfort with conflict, problem-finding and connection-making.

Strengths and limitations

This review has a number of limitations. The search may not have found all relevant studies, however the retrieved papers are intended as an exemplar rather than an exhaustive or aggregative review. The review is also limited to journal articles as evidence of researchers’ approach to improvement. This ignores many other ‘offline’ and ‘online’ activities such as meetings, presentations, blogs, books, and websites, which are conducted to disseminate findings and ideas. Our reliance on self-report for the identification of ethnographic studies will have excluded some studies within an ethnographic paradigm who chose different terms for their methodology (e.g. critical inquiry, case study). The strengths of this paper are its comprehensive coverage, incorporating all representative studies in healthcare research published within a five year period, and a wide range of ethnographic sub-types and healthcare subjects, drawn from an international pool of research communities.

We did not prescribe the right way for ethnographers to engage in healthcare improvement, indeed, we have identified that a variety of approaches can be relevant to improvement. The habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. Issues of taste, traditionalism and researcher identity need to be scrutinised in favour of value and audience. An important area of future research will be to understand how ethnographic findings are received by decision-makers, and further focused reviews on the relationship(s) between ethnographic methods, quality improvement skills and improvement outcomes.

Availability of data and materials

All papers included in the review are listed in Additional file 4 and are publicly available from their publishers’ websites.

Change history

11 april 2022.

A Correction to this paper has been published: https://doi.org/10.1186/s12874-022-01587-9

Dixon-Woods M. How to improve healthcare improvement—an essay by Mary Dixon-Woods. BMJ. 2019;367:l5514.

Article   PubMed   PubMed Central   Google Scholar  

Dixon-Woods M. What can ethnography do for quality and safety in health care? Qual Saf Health Care. 2003;12(5):326.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Savage J. Ethnography and health care. BMJ. 2000;321(7273):1400.

Waring J, Marshall F, Bishop S. Understanding the occupational and organizational boundaries to safe hospital discharge. J Health Serv Res Policy. 2014;20(1_suppl):35–44.

Article   Google Scholar  

Marcus GE. Multi-sited ethnography: Five or six things I know about it now. In: Coleman S, von Hellerman P, editors. Multi-sited ethnography: Problems and possibilities in the translocation of research methods. New York: Routledge; 2011. p. 16–32.

Google Scholar  

Bentley ME, Pelto GH, Straus WL, Schumann DA, Adegbola C, de la Pena E, et al. Rapid ethnographic assessment: applications in a diarrhea management program. Soc Sci Med. 1988;27(1):107–16.

Article   CAS   PubMed   Google Scholar  

Dixon-Woods M, Martin GP. Does quality improvement improve quality? Future Hosp J. 2016;3(3):191–4.

Leslie M, Paradis E, Gropper MA, Reeves S, Kitto S. Applying ethnography to the study of context in healthcare quality and safety. BMJ Qual Saf. 2014;23(2):99–105.

Article   PubMed   Google Scholar  

Marcus GE. Where have all the tales of fieldwork gone? Ethnos. 2006;71(1):113–22.

Savage J. Ethnography and health care BMJ. 2000;321:1400. https://doi.org/10.1136/bmj.321.7273.1400 .

Waring J, Marshall F, Bishop S. Understanding the occupational and organizational boundaries to safe hospital discharge. Journal of Health Services Research & Policy. 2015;20(1_suppl):35-44. https://doi.org/10.1177/1355819614552512 .

Baim-Lance A, Vindrola-Padros C. Reconceptualising'Impact'through Anthropology's Ethnographic Practices. Anthropol Action. 2015;22(2):5–13.

Latour B. Why Has Critique Run out of Steam? From Matters of Fact to Matters of Concern. Crit Inq. 2004;30(2):225–48.

Zuiderent-Jerak T, Strating M, Nieboer A, Bal R. Sociological refigurations of patient safety; ontologies of improvement and 'acting with' quality collaboratives in healthcare. Soc Sci Med. 2009;69(12):1713–21.

Kitto SC, Sargeant J, Reeves S, Silver I. Towards a sociology of knowledge translation: the importance of being dis-interested in knowledge translation. Adv Health Sci Educ. 2012;17(2):289–99.

Waring J, Allen D, Braithwaite J, Sandall J. Healthcare quality and safety: a review of policy, practice and research. Sociol Health Illn. 2016;38(2):198–215.

Jones L, Pomeroy L, Robert G, Burnett S, Anderson JE, Fulop NJ. How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England. BMJ Qual Saf [Internet]. 2017; Available from: http://qualitysafety.bmj.com/content/early/2017/07/07/bmjqs-2016-006433.abstract .

Lucas B, Cooper A, Willson A. The undervalued role of communication in healthcare improvement and its critical contribution to engaging staff and saving lives. J Communication Healthcare. 2021;14(1):5–7.

Lucas B. Getting the improvement habit. BMJ Qual Saf. 2016;25(6):400–3.

Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5(1):1-9.

Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32.

Collet JP, Skippen PW, Mosavianpour MK, Pitfield A, Chakraborty B, Hunte G, et al. Engaging pediatric intensive care unit (PICU) clinical staff to lead practice improvement: the PICU participatory action research project (PICU-PAR). Implement Sci. 2014;9:6.

Asan O, Chiou E, Montague E. Quantitative ethnographic study of physician workflow and interactions with electronic health record systems. Int J Ind Ergon. 2015;49:124–30.

Riley R, Coghill N, Montgomery A, Feder G, Horwood J. The provision of NHS health checks in a community setting: an ethnographic account. BMC Health Serv Res. 2015;15:546.

Hjelm M, Holst G, Willman A, Bohman D, Kristensson J. The work of case managers as experienced by older persons (75+) with multi-morbidity - a focused ethnography. BMC Geriatr. 2015;15:168.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Tomnay JE, Bourke L, Fairley CK. Exploring the acceptability of online sexually transmissible infection testing for rural young people in Victoria. Aust J Rural Health. 2014;22(1):40–4.

Van Keer R-L, Deschepper R, Francke AL, Huyghens L, Bilsen J. Conflicts between healthcare professionals and families of a multi-ethnic patient population during critical care: an ethnographic study. Crit Care. 2015;19(1):1–13.

Mylopoulos M, Farhat W. "I can do better": exploring purposeful improvement in daily clinical work. Adv Health Sci Educ. 2015;20(2):371–83.

Spitzmueller MC. Shifting practices of recovery under community mental health reform: A street-level organizational ethnography. Qual Soc Work Res Pract. 2014;13(1):26–48.

Sagasser MH, Fluit CRMG, van Weel C, van der Vleuten CPM, Kramer AWM. How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study. Acad Med. 2017;92(6):792–9.

Edberg M, Cleary S, Simmons LB, Cubilla-Batista I, Andrade EL, Gudger G. Defining the "community": Applying ethnographic methods for a Latino immigrant health intervention. Hum Organ. 2015;74(1):27–41.

Collier A, Sorensen R, Iedema R. Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study. Int J Qual Health Care. 2016;28(1):66–73.

Mutchler MG, McKay T, McDavitt B, Gordon KK. Using peer ethnography to address health disparities among young urban Black and Latino men who have sex with men. Am J Public Health. 2013;103(5):849–52.

Nelson MM. NICU Culture of Care for Infants with Neonatal Abstinence Syndrome: A Focused Ethnography. Neonatal Network. 2016;35(5):287–96.

Batch M, Windsor C. Nursing casualization and communication: a critical ethnography. J Adv Nurs. 2015;71(4):870–80.

Hughes N. Homelessness, health, and literacy: An institutional ethnographic study of the social organization of health care in Ontario, Canada. In: Dissertation Abstracts International: Section B: The Sciences and Engineering, vol. 78; 2018. (9-B(E)):No-Specified.

Hoare KJ, Buetow S, Mills J, Francis K. Using an emic and etic ethnographic technique in a grounded theory study of information use by practice nurses in New Zealand. J Res Nurs. 2013;18(8):720–31.

Charmaz K, Smith J. Grounded theory. In: Qualitative psychology: A practical guide to research methods, vol. 2; 2003. p. 81–110.

Armstrong N, Brewster L, Tarrant C, Dixon R, Willars J, Power M, et al. Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame. Soc Sci Med. 2018;198:157–64.

Boissevain J. Towards a sociology of social anthropology. Theory Soc. 1974;1(2):211–30.

McCabe JL, Holmes D. Reflexivity, critical qualitative research and emancipation: A Foucauldian perspective. J Adv Nurs. 2009;65(7):1518–26.

Nightingale R, Sinha MD, Swallow V. Using focused ethnography in paediatric settings to explore professionals' and parents' attitudes towards expertise in managing chronic kidney disease stage 3-5. BMC Health Serv Res. 2014;14:403.

Stevens J, Schmied V, Burns E, Dahlen HG. Video ethnography during and after caesarean sections: Methodological challenges. J Clin Nurs. 2017;26(13-14):2083–92.

Abdulrehman MS. Reflections on Native Ethnography by a Nurse Researcher. J Transcult Nurs. 2017;28(2):152–8.

Bergenholtz H, Jarlbaek L, Holge-Hazelton B. The culture of general palliative nursing care in medical departments: an ethnographic study. Int J Palliat Nurs. 2015;21(4):193–201.

Belanger E, Rodriguez C, Groleau D, Legare F, MacDonald ME, Marchand R. Patient participation in palliative care decisions: An ethnographic discourse analysis. Int J Qual Stud Health Well Being. 2016;11:32438.

Ranasinghe P. The humdrum of legality and the ordering of an ethic of care. Law Soc Rev. 2014;48(4):709–39.

Johnston MS, Hodge E. ‘Dirt, death and danger? I don't recall any adverse reaction ...': Masculinity and the taint management of hospital private security work. Gend Work Organ. 2014;21(6):546–58.

Babaei S, Taleghani F, Kayvanara M. Compassionate behaviours of clinical nurses in Iran: An ethnographic study. Int Nurs Rev. 2016;63(3):388–94.

Mishra A. 'Trust and teamwork matter': community health workers' experiences in integrated service delivery in India. Global Public Health. 2014;9(8):960–74.

Cribb A. Improvement Science Meets Improvement Scholarship: Reframing Research for Better Healthcare. Health Care Anal. 2018;26(2):109–23.

Boonen MJMH, Vosman FJH, Niemeijer AR, Tinker, tailor, deliberate. An ethnographic inquiry into the institutionalized practice of bar-coded medication administration technology by nurses. Appl Nurs Res. 2017;33:30–5.

Thomas GM, Latimer J. In/exclusion in the clinic: Down's syndrome, dysmorphology and the ethics of everyday medical work. Sociology. 2015;49(5):937–54.

Mackintosh N, Sandall J. The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings. Sociol Health Illness. 2016;38(2):252–69.

Alderson SL, Russell AM, McLintock K, Potrata B, House A, Foy R. Incentivised case finding for depression in patients with chronic heart disease and diabetes in primary care: an ethnographic study. BMJ Open. 2014;4(8):e005146.

Bjornsdottir K. The place of standardisation in home care practice: An ethnographic study. J Clin Nurs. 2014;23(9-10):1411–20.

May M. Turning the board blue: America's epiduralized system of birth. a medical ethnography. In: Dissertation Abstracts International Section A: Humanities and Social Sciences, vol. 76; 2015. (5-A(E)):No-Specified.

Allen D. Lost in translation? 'Evidence' and the articulation of institutional logics in integrated care pathways: from positive to negative boundary object? Sociol Health Illn. 2014;36(6):807–22.

Nilsson L, Eriksen S, Borg C. The influence of social challenges when implementing information systems in a Swedish health-care organisation. J Nurs Manag. 2016;24(6):789–97.

Makaroff KS, Storch J, Pauly B, Newton L. Searching for ethical leadership in nursing. Nurs Ethics. 2014;21(6):642–58.

Pavlish C, Brown-Saltzman K, Jakel P, Fine A. The nature of ethical conflicts and the meaning of moral community in oncology practice. Oncol Nurs Forum. 2014;41(2):130–40.

Gesbeck MM. Negotiating diabetes: Professional diabetes care work in the U.S. In: Dissertation Abstracts International Section A: Humanities and Social Sciences, vol. 77; 2016. (1-A(E)):No-Specified.

Ross C, Rogers C, Duff D. Critical ethnography: An under-used research methodology in neuroscience nursing. Can J Neurosci Nurs. 2016;38(1):4–7.

PubMed   Google Scholar  

Liu W, Manias E, Gerdtz M. Medication communication through documentation in medical wards: knowledge and power relations. Nurs Inq. 2014;21(3):246–58.

Matinga MN, Annegarn HJ, Clancy JS. Healthcare provider views on the health effects of biomass fuel collection and use in rural Eastern Cape, South Africa: an ethnographic study. Soc Sci Med. 1982;2013(97):192–200.

Manias E. Communication relating to family members' involvement and understandings about patients' medication management in hospital. Health Expect. 2015;18(5):850–66.

Goldman J, Reeves S, Wu R, Silver I, MacMillan K, Kitto S. A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning. J Interprof Care. 2016;30(2):217–25.

Fleming DJ. Beyond clinical: The exploration and integration of human connection skills in five residency programs at the university of Arizona. In: Dissertation Abstracts International Section A: Humanities and Social Sciences, vol. 76; 2015. (3-A(E)):No-Specified.

Gealogo GA. "A light in the dark": Development of a conceptual model for person-engaged dementia care. In: Dissertation Abstracts International: Section B: The Sciences and Engineering, vol. 77; 2017. (8-B(E)):No-Specified.

Gillespie BM, Gwinner K, Chaboyer W, Fairweather N. Team communications in surgery-Creating a culture of safety. J Interprof Care. 2013;27(5):387–93.

DeKeyser GF, Engelberg R, Torres N, Curtis JR. Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study. Crit Care Med. 2016;44(4):680–9.

Goldman J, Reeves S, Wu R, Silver I, MacMillan K, Kitto S. Medical residents and interprofessional interactions in discharge: An ethnographic exploration of factors that affect negotiation. J Gen Intern Med. 2015;30(10):1454–60.

Kent F, Francis-Cracknell A, McDonald R, Newton JM, Keating JL, Dodic M. How do interprofessional student teams interact in a primary care clinic? A qualitative analysis using activity theory. Adv Health Sci Educ. 2016;21(4):749–60.

Milne J, Greenfield D, Braithwaite J. An ethnographic investigation of junior doctors' capacities to practice interprofessionally in three teaching hospitals. J Interprof Care. 2015;29(4):347–53.

Reeves S, McMillan SE, Kachan N, Paradis E, Leslie M, Kitto S. Interprofessional collaboration and family member involvement in intensive care units: emerging themes from a multi-sited ethnography. J Interprof Care. 2015;29(3):230–7.

Collier A, Wyer M. Researching Reflexively With Patients and Families: Two Studies Using Video-Reflexive Ethnography to Collaborate With Patients and Families in Patient Safety Research. Qual Health Res. 2016;26(7):979–93.

Nastasi BK, Schensul JJ, Schensul SL, Mekki-Berrada A, Pelto PJ, Maitra S, et al. A model for translating ethnography and theory into culturally constructed clinical practices. Cult Med Psychiatry. 2015;39(1):92–120.

Nugus P, Forero R, McCarthy S, McDonnell G, Travaglia J, Hilman K, et al. The emergency department "carousel": an ethnographically-derived model of the dynamics of patient flow. Int Emerg Nurs. 2014;22(1):3–9.

MacKichan F, Brangan E, Wye L, Checkland K, Lasserson D, Huntley A, et al. Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice. BMJ Open. 2017;7(4):e013816.

Nicolini D. Zooming in and out: Studying practices by switching theoretical lenses and trailing connections. Organ Stud. 2009;30(12):1391–418.

Tietbohl CK, Rendle KAS, Halley MC, May SG, Lin GA, Frosch DL. Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination. Med Decis Mak. 2015;35(8):987–98.

Ash JS, Chase D, Wiesen JF, Murphy EV, Marovich S. Studying Readiness for Clinical Decision Support for Worker Health Using the Rapid Assessment Process and Mixed Methods Interviews. AMIA Annu Symp proc AMIA Symposium. 2016;2016:285–94.

Balka E, Tolar M, Coates S, Whitehouse S. Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies. Int J Med Inform. 2013;82(12):e345–57.

Borycki EM, Kushniruk AW. Use of Techno-Anthropologic Approaches in Studying Technology--induced Errors. Stud Health Technol Inform. 2015;215:129–41.

Dixon-Woods M, Redwood S, Leslie M, Minion J, Martin GP, Coleman JJ. Improving quality and safety of care using “technovigilance”: an ethnographic case study of secondary use of data from an electronic prescribing and decision support system. Milbank Q. 2013;91(3):424–54.

Wright A, Sittig DF, Ash JS, Erickson JL, Hickman TT, Paterno M, et al. Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study. Int J Med Inform. 2015;84(11):901–11.

Pfadenhauer M, Dukat C. Robot caregiver or robot-supported caregiving? The performative deployment of the social robot PARO in dementia care. Int J Soc Robot. 2015;7(3):393–406.

Jensen S. Clinical Simulation: For what and how can it be used in design and evaluation of health IT. Stud Health Technol Inform. 2015;215:217–28.

McNall MA, Welch VE, Ruh KL, Mildner CA, Soto T. The use of rapid-feedback evaluation methods to improve the retention rates of an HIV/AIDS healthcare intervention. Eval Program Plann. 2004;27(3):287–94.

Grant S, Mesman J, Guthrie B. Spatio-temporal elements of articulation work in the achievement of repeat prescribing safety in UK general practice. Soc Health Illness. 2016;38(2):306–24.

Grant S, Guthrie B. Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care. BMJ Qual Saf. 2018;27(3):199–206.

Mendenhall E, Yarris K, Kohrt BA. Utilization of standardized mental health assessments in anthropological research: Possibilities and pitfalls. Cult Med Psychiatry. 2016;40(4):726–45.

Street A, Coleman S. Introduction: real and imagined spaces. Space Cult. 2012;15(1):4–17.

Sandelowski M. A matter of taste: evaluating the quality of qualitative research. Nurs Inq. 2015;22(2):86–94.

Vindrola-Padros C, Vindrola-Padros B. Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery. BMJ Qual Saf. 2018;27(4):321–30.

Download references

Acknowledgements

The authors wish to thank Lorelei Jones, Natalie Armstrong, Justin Waring and Bill Lucas for their insightful comments and direction in the undertaking of this work.

This paper is independent research funded by the National Institute for Health Research CLAHRC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

NJF is an NIHR Senior Investigator. GB is supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute.

Author information

Authors and affiliations.

Department of Applied Health Research, UCL, London, UK

Georgia B. Black, Sandra van Os, Samantha Machen & Naomi J. Fulop

You can also search for this author in PubMed   Google Scholar

Contributions

NJF and GB led the development and conceptualization of this scoping review and provided guidance on methods and design of the scoping review. GB, SVO and SM made contributions to study search, study screening, and all data extraction work. All authors analysed the data. All authors contributed to the writing and editing of the paper, and all authors have read and approved the manuscript.

Corresponding author

Correspondence to Georgia B. Black .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors have no competing interests to declare.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: due to incorrect figure 1 and the number of included papers need to be changed from "283" to "274".

Supplementary Information

Additional file 1., additional file 2., additional file 3., additional file 4., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Black, G.B., van Os, S., Machen, S. et al. Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review. BMC Med Res Methodol 21 , 274 (2021). https://doi.org/10.1186/s12874-021-01466-9

Download citation

Received : 21 July 2021

Accepted : 14 October 2021

Published : 05 December 2021

DOI : https://doi.org/10.1186/s12874-021-01466-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Ethnography
• Qualitative research
• Healthcare improvement

BMC Medical Research Methodology

ISSN: 1471-2288

• General enquiries: [email protected]

• Article category
• Most read articles
• Most download articles
• Most cited articles
• Data sharing
• Funded articles
• JEEHP search
• Author index
• Research and publication ethics
• Advertising policies
• Instructions to authors
• Why publish with JEEHP
• For reviewers
• Author checklist
• Article-processing charge
• Aims and scope
• Journal history
• Editorial board
• Best practice
• Abstracting and indexing
• Journal catalog
• How to cite JEEHP
• Management team and credential
• Copyright and open access
• Mass media and press release
• JEEHP Disclaimer

• E-SUBMISSION
• Author information
• Article notes
• Copyright and License information

© 2011, National Health Personnel Licensing Examination Board of the Republic of Korea

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

• 46,401 Views
• 524 Download
• 86 Crossref
• Full Article
• Figure & data

INTRODUCTION

Uses of ethnography, ethnographic studies in healthcare and medical education, limitations of ethnography, article information.

• Research in healthcare settings and medical education has relied heavily on quantitative methods. However, there are research questions within these academic domains that may be more adequately addressed by qualitative inquiry. While there are many qualitative approaches, ethnography is one method that allows the researcher to take advantage of relative immersion in order to obtain thick description. The purpose of this article is to introduce ethnography, to describe how ethnographic methods may be utilized, to provide an overview of ethnography’s use in healthcare and medical education, and to summarize some key limitations with the method.
• Keywords : Ethnography ; Qualitative Research ; Medical Education ; Healthcare

Define a problem when the problem is not yet clear.

Define a problem when it is complex and embedded in multiple systems or sectors.

Indentify participants when the participants, population sectors, stakeholders, or the boundaries of the study population are not yet known or identified.

Clarify the range of settings where a problem or situation currently occurs when not all of the possible settings are fully identified, known, or understood.

Explore the factors associated with a problem in order to indentify, understand, and address them either though research or intervention studies, when they are not known.

Document a process.

Identify and describe unexpected or unanticipated outcomes.

Design measures that match the characteristics of the target population, clients, or community participants when existing measures are not a good fit or need to be adapted.

Answer questions that cannot be addressed with other methods or approaches.

Ease the access of clients to the research process and its products.

This article is available from: http://jeehp.org/

• 1. Creswell JW. Research design: qualitative, quantitative, and mixed methods spproaches. 3rd ed. Thousand Oaks, CA: Sage Publications; 2009. p. 260 p.
• 2. Leung WC. Why is evidence from ethnographic and discourse research needed in medical education: the case of problem-based learning. Med Teach 2002;24:169-72. Article PubMed
• 3. Savage J. Ethnography and health care. BMJ 2000;321:1400-2. Article PubMed PMC
• 4. LeCompte MD, Schensul JJ. Designing and conducting ethnographic research: an introduction. 2nd ed. Lanham, MD: Alta-Mira Press; 2010. p. 356 p.
• 5. Pope C. Conducting ethnography in medical settings. Med Educ 2005;39:1180-7. Article PubMed
• 6. Atkinson P, Pugsley L. Making sense of ethnography and medical education. Med Educ 2005;39:228-34. Article PubMed
• 7. Perry J, Judith Lynam M, Anderson JM. Resisting vulnerability: the experiences of families who have kin in hospital-a feminist ethnography. Int J Nurs Stud 2006;43:173-84. Article PubMed
• 8. Rice PL, Ezzy D. Qualitative research methods: a health focus. Oxford; Oxford University Press; 1999. p. 291 p. PubMed
• 9. Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan J. Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med 2003;56:671-84. Article PubMed
• 10. Garro LY. The ethnography of health care decisions. Soc Sci Med 1982;16:1451-2. Article PubMed
• 11. van der Geest S, Finkler K. Hospital ethnography: introduction. Soc Sci Med 2004;59:1995-2001. Article PubMed
• 12. Fox R. Training for uncertainty. In: Merton RK, Kendell PL, editors. The student physician. Cambridge, MA: Harvard University Press; 1957. Article

Figure & Data

• Nutritional awareness of pregnant women and the underlying influencing factors Weijie Fang, Obireddy Sreekanth Reddy, Wing-Fu Lai Nutrition Reviews .2024; 82(4): 561.      CrossRef
• Pragmatic patchwork ethnography, a call to action for health, nutrition and dietetic researchers Marie Swettenham, Simon C. Langley‐Evans Journal of Human Nutrition and Dietetics .2024; 37(2): 514.      CrossRef
• 'Eco Is Just Marketing' Albin Zeqiri, Pascal Jansen, Jan Ole Rixen, Michael Rietzler, Enrico Rukzio Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies .2024; 8(1): 1.      CrossRef
• Systemic effects of the COVID pandemic on rural black American men’s interpersonal relationships: A phenomenological examination Michael G. Curtis, Elizabeth Wieling, Chalandra Bryant, Rosalyn Denise Campbell, Steven M. Kogan, Ejercito Mangawa Balay-odao PLOS ONE .2024; 19(4): e0297876.      CrossRef
• Learning from the Active Hospital-Based Cancer Registry in India: An Ethnography Study Shubharanjan Jena, Venkatarao Epari, Krushna Chandra Sahoo, Smruti Priyambada Pradhan, Sunil Agrawala, Sanjukta Padhi Discover Public Health .2024;[Epub]      CrossRef
• Addressing Physical Activity among Adults 50+: An Ethnographic Study of Physical Therapists Mariana Wingood, Denise M. Peters, Jeanne L. Shea, Nancy M. Gell Physical & Occupational Therapy In Geriatrics .2023; 41(2): 159.      CrossRef
• Considerations in designing trauma-focused interventions for displaced Afghan women Amaya Alexandra Ramos Frontiers in Global Women's Health .2023;[Epub]      CrossRef
• Complexities of care in a college microbiology laboratory Sarah El Halwany, Steve Alsop International Journal of Science Education .2023; 45(16): 1321.      CrossRef
• Planning an artificial intelligence diabetic retinopathy screening program: a human-centered design approach Angelica C. Scanzera, Cameron Beversluis, Archit V. Potharazu, Patricia Bai, Ariel Leifer, Emily Cole, David Yuzhou Du, Hugh Musick, R. V. Paul Chan Frontiers in Medicine .2023;[Epub]      CrossRef
• Constructing biology education research identities: a duoethnography Rou-Jia Sung, Emily A. Holt, Stanley M. Lo Frontiers in Education .2023;[Epub]      CrossRef
• Health System Transformation Playbook and Unified Care Model: an integrated design, systems & complexity thinking approach to health system transformation Ken Wah Teo, Yun Hu, Kwee Tiang Chew, Wee Yang Pek, Hong Choon Chua, David Bruce Matchar, Yeuk Fan Ng Frontiers in Health Services .2023;[Epub]      CrossRef
• Many Cooks in the Kitchen: Iterating a Qualitative Analysis Process Across Multiple Countries, Sites, and Teams Lauren Suchman, Serah Gitome, Mandayachepa Nyando, Zachary A. Kwena, Pauline Wekesa, Sarah Okumu, Louisa Ndunyu, Chioma Okoli, Aminat Tijani, Ayobambo Jegede, Ivan Idiodi, Grace Nmadu, Shakede Dimowo, Alfred Maluwa, Lynn Atuyambe, Catherine Birabwa, Phoeb Global Health: Science and Practice .2023; 11(6): e2300143.      CrossRef
• Etiquette of the antibiotic decision-making process for surgical prophylaxis in Ethiopia: a triangulated ethnographic study Getachew Alemkere, Gobezie T. Tegegne, Getnet Abebe Molla, Alemu Belayneh, Hanan Muzeyin, Wendwosen Shewarega, Yidnekachew Degefaw, Addisu Melkie, Workineh Getahun, Hailu Tadeg, Abebe Alemayehu, Eshetu Girma, Wondwossen Amogne Frontiers in Public Health .2023;[Epub]      CrossRef
• ‘I think we're getting a bit clinical here’: A qualitative study of professionals' experiences of providing mental healthcare to young people within an Australian rural service Christina Malatzky, Lisa Bourke, Jane Farmer Health & Social Care in the Community .2022; 30(2): 519.      CrossRef
• “Everyone needs rehab, but…”: exploring post-stroke rehabilitation referral and acceptance decisions Kerry Marnane, Louise Gustafsson, Sally Bennett, Ingrid Rosbergen, Rohan Grimley Disability and Rehabilitation .2022; 44(17): 4717.      CrossRef
• How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States Feng-Hang Chang, Beth E. Fields, Jessica M. Kersey, Chao-Yi Wu, Minmei Shih, Elizabeth R. Skidmore Disability and Rehabilitation .2022; 44(19): 5612.      CrossRef
• Integration of a smart multidose blister package for medication intake: A mixed method ethnographic informed study of older adults with chronic diseases Sadaf Faisal, Jessica Ivo, Ryan Tennant, Kelsey-Ann Prior, Kelly Grindrod, Colleen McMillan, Tejal Patel, Christine Leong PLOS ONE .2022; 17(1): e0262012.      CrossRef
• The burden of the caring role: Adaptation of family members to the caring role in surgical wards at a tertiary hospital in Malawi Gwaza Elizabeth International Journal of Nursing and Midwifery .2022; 14(1): 1.      CrossRef
• Understanding Complexity in Care: Opportunities for Ethnographic Research in Palliative Care Matthew P. Grant, Jennifer A. M. Philip, Luc Deliens, Paul A. Komesaroff Journal of Palliative Care .2022; : 082585972210783.      CrossRef
• Exploring Substance Use Disorder Nursing Competency in the Italian Context Johnny Acquaro, Silvia Scalzo, Arianna Procacci Journal of the American Psychiatric Nurses Association .2022; 28(2): 164.      CrossRef
• Medical Education Research Design Maitray D. Patel, Sheryl G. Jordan Journal of the American College of Radiology .2022; 19(6): 693.      CrossRef
• How do general practitioners handle complexities? A team ethnographic study in Japan Junji Haruta, Ryohei Goto, Ozone Sachiko, Shuhei Kimura, Junko Teruyama, Yusuke Hama, Tetsuhiro Maeno BMC Primary Care .2022;[Epub]      CrossRef
• Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study Katie Featherstone, Andy Northcott, Paula Boddington, Deborah Edwards, Sofia Vougioukalou, Sue Bale, Karen Harrison Dening, Karen Logan, Rosie Tope, Daniel Kelly, Aled Jones, Jackie Askey, Jane Harden Health and Social Care Delivery Research .2022; 10(14): 1.      CrossRef
• SINFONIA study protocol: a phase II/III randomised controlled trial examining benefits of guided online group singing in people with chronic obstructive pulmonary disease and interstitial lung disease and their carers Natasha Smallwood, Amy Pascoe, Sara Vogrin, Jennifer Philip Respiratory Research .2022;[Epub]      CrossRef
• Patterns of communicating care and caring in the intensive care unit Hanan Subhi Al‐Shamaly Nursing Open .2022; 9(1): 277.      CrossRef
• Factors influencing chicken farmers' decisions to implement prevention and control measures to reduce avian influenza virus spread under endemic conditions Suman Das Gupta, Guillaume Fournié, Md. Ahasanul Hoque, Joerg Henning Transboundary and Emerging Diseases .2021; 68(1): 194.      CrossRef
• Creating a “Culture of Triage”: A Dual-Perspective Study of Interruptions During ICU Rounds Samuel A. Rosenblatt, Dorene F. Balmer, Donald L. Boyer Pediatric Critical Care Medicine .2021; 22(2): 172.      CrossRef
• Lessons in reflexivity of a pharmacist conducting ethnographic research Sadaf Faisal Research in Social and Administrative Pharmacy .2021; 17(10): 1849.      CrossRef
• Study of EHR-mediated workflows using ethnography and process mining methods M Adela Grando, Vaishak Vellore, Benjamin J Duncan, David R Kaufman, Stephanie K Furniss, Bradley N Doebbeling, Karl A Poterack, Timothy Miksch, Richard A Helmers Health Informatics Journal .2021; 27(2): 146045822110082.      CrossRef
• The effects of webcams on German neonatal intensive care units – study protocol of a randomised crossover trial (Neo-CamCare) Nadine Scholten, Sebastian Bretthauer, Kerstin Eilermann, Anna Hagemeier, Martin Hellmich, Jan Hoffmann, Dirk Horenkamp-Sonntag, Christiane Jannes, Ludwig Kuntz, Pauline Mantell, Laura Mause, Andreas Müller, Alinda Reimer, Christina Samel, Indra Spiecker BMC Health Services Research .2021;[Epub]      CrossRef
• ‘It's cheaper than a dead cow’: Understanding veterinary medicine use on dairy farms Gwen M. Rees, Kristen K. Reyher, David C. Barrett, Henry Buller Journal of Rural Studies .2021; 86: 587.      CrossRef
• Preparation, Expectations, Experience, and Environment of a College/University Athletic Training Residency: An Ethnographic Study Lindsey E. Eberman Athletic Training Education Journal .2021; 16(3): 178.      CrossRef
• A journey into the unknown: An ethnographic examination of drug-resistant epilepsy treatment and management in the United States Glenn D.R. Watson, Pegah Afra, Luca Bartolini, Daniel A. Graf, Sanjeev V. Kothare, Patricia McGoldrick, Bethany J. Thomas, Aneeta R. Saxena, Luke D. Tomycz, Steven M. Wolf, Peter Z. Yan, Eliza C. Hagen Epilepsy & Behavior .2021; 124: 108319.      CrossRef
• Understanding the Science of Other Cultures Paul T. Keyser Aestimatio: Sources and Studies in the History of Science .2021;[Epub]      CrossRef
• Putting patients into the centre: Patient empowerment in everyday health practices Anna Schneider-Kamp, Søren Askegaard Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine .2020; 24(6): 625.      CrossRef
• Patient perception of disease burden in diffuse cutaneous systemic sclerosis Dinesh Khanna, Yannick Allanore, Christopher P Denton, Marco Matucci-Cerinic, Janet Pope, Barbara Hinzmann, Siobhan Davies, Janethe de Oliveira Pena, Oliver Distler Journal of Scleroderma and Related Disorders .2020; 5(1): 66.      CrossRef
• Clerkship students’ use of a video library for training the mental status examination Cecilie Fog-Petersen, Karen Borgnakke, Ralf Hemmingsen, Maria Gefke, Sidse Arnfred Nordic Journal of Psychiatry .2020; 74(5): 332.      CrossRef
• Exploring the role‐based challenges of providing culturally inclusive health care for maternal and child health nurses: Qualitative findings Christina Malatzky, Zubaidah Mohamed Shaburdin, Lisa Bourke Nursing Open .2020; 7(3): 822.      CrossRef
• Perioperative antimicrobial decision making: Focused ethnography study in orthopedic and cardiothoracic surgeries in an Australian hospital Trisha N. Peel, Eliza Watson, Kelly Cairns, Ho Yin (Ashley) Lam, Heidi Zhangrong Li, Ganan Ravindran, Jayan Seneviratne, David Daly, Susan Liew, David McGiffin, Paul Myles, Darshini Ayton Infection Control & Hospital Epidemiology .2020; 41(6): 645.      CrossRef
• Integrating the social sciences into the COVID-19 response in Alberta, Canada Myles Leslie, Raad Fadaak, Jan Davies, Johanna Blaak, PG Forest, Lee Green, John Conly BMJ Global Health .2020; 5(7): e002672.      CrossRef
• Common cognitive pitfalls in emergency medicine Thomas Kilner, Emma Butterfield, Jasmine Poonian Emergency Medicine Australasia .2020; 32(5): 849.      CrossRef
• Implementing a social network intervention: can the context for its workability be created? A quasi-ethnographic study J. Ellis, I. Vassilev, E. James, A. Rogers Implementation Science Communications .2020;[Epub]      CrossRef
• Perceptions of traditional birth attendants and midwives related to neonatal airway management in rural Uganda: a focused ethnographic qualitative study Marvesh M Mendhi, Charlene Pope, Susan D Newman, Kathleen B Cartmell, Shahirose Premji Journal of Global Health Reports .2020;[Epub]      CrossRef
• Technologies of Exposure: Videoconferenced Distributed Medical Education as a Sociomaterial Practice Anna MacLeod, Paula Cameron, Olga Kits, Jonathan Tummons Academic Medicine .2019; 94(3): 412.      CrossRef
• Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study Katie Featherstone, Andy Northcott, Jane Harden, Karen Harrison Denning, Rosie Tope, Sue Bale, Jackie Bridges Health Services and Delivery Research .2019; 7(11): 1.      CrossRef
• Ten tips for conducting focused ethnography in medical education research Marghalara Rashid, Carol S. Hodgson, Thea Luig Medical Education Online .2019; 24(1): 1624133.      CrossRef
• Investigating the Feasibility of Child Mortality Surveillance With Postmortem Tissue Sampling: Generating Constructs and Variables to Strengthen Validity and Reliability in Qualitative Research Elizabeth O’Mara Sage, Khátia R Munguambe, John Blevins, Rui Guilaze, Baindu Kosia, Maria Maixenchs, Quique Bassat, Inácio Mandomando, Reinhard Kaiser, Ahoua Kone, Amara Jambai, Nellie D Myburgh, Noni Ngwenya, Shabir A Madhi, Ketema Degefa, Caroline Ackle Clinical Infectious Diseases .2019; 69(Supplement): S291.      CrossRef
• The value of the ethnographic approach to research issues in palliative care Carla Reigada, Paula Sapeta, Carlos Centeno Current Opinion in Supportive & Palliative Care .2019; 13(4): 337.      CrossRef
• Exploring gendered leadership stereotypes in a shared leadership model in healthcare: a case study Saam Idelji-Tehrani, Muna Al-Jawad Medical Humanities .2019; 45(4): 388.      CrossRef
• Qualitative research in rehabilitation science: opportunities, challenges, and future directions Sandra VanderKaay, Sandra E. Moll, Rebecca E. Gewurtz, Pranay Jindal, Adalberto Loyola-Sanchez, Tara L. Packham, Chun Y. Lim Disability and Rehabilitation .2018; 40(6): 705.      CrossRef
• The tension between person centred and task focused care in an acute surgical setting: A critical ethnography Sandra Sharp, Margaret Mcallister, Mark Broadbent Collegian .2018; 25(1): 11.      CrossRef
• Self-care and entrepreneurism: an ethnography of soft skills development for higher education staff Alison Fixsen, Steven Cranfield, Damien Ridge Studies in Continuing Education .2018; 40(2): 181.      CrossRef
• Activating Technology for Connected Health in Cancer: Protocol for a Research and Training Program Nicola Mountford, Enrique Dorronzoro Zubiete, Threase Kessie, Begonya Garcia-Zapirain, Roberto Nuño-Solinís, David Coyle, Kristin B Munksgaard, Luis Fernandez-Luque, Octavio Rivera Romero, Matilde Mora Fernandez, Pedro Valero Jimenez, Ailish Daly, Ruth Wh JMIR Research Protocols .2018; 7(1): e14.      CrossRef
• Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping Ariane Plaisance, Holly O. Witteman, Annie LeBlanc, Jennifer Kryworuchko, Daren Keith Heyland, Mark H. Ebell, Louisa Blair, Diane Tapp, Audrey Dupuis, Carole-Anne Lavoie-Bérard, Carrie Anna McGinn, France Légaré, Patrick Michel Archambault, Joanna Hart PLOS ONE .2018; 13(2): e0191844.      CrossRef
• Lessons Learned from the Implementation of a Medically Enhanced Residential Treatment (MERT) Model Integrating Intravenous Antibiotics and Residential Addiction Treatment Honora Englander, Talitha Wilson, Devin Collins, Elena Phoutrides, Melissa Weimer, P. Todd Korthuis, Jessica Calcagni, Christina Nicolaidis Substance Abuse .2018; 39(2): 225.      CrossRef
• On patients, doctors and ethnographers: a response to Launer Robert Power, A Jamie Saris Postgraduate Medical Journal .2018; 94(1107): 64.      CrossRef
• The Parker Model: Applying a Qualitative Three-Step Approach to Optimally Utilize Input from Stakeholders When Introducing New Device Technologies in the Management of Chronic Rheumatic Diseases Tanja S. Jørgensen, Marie Skougaard, Peter C. Taylor, Hans C. Asmussen, Anne Lee, Louise Klokker, Louise Svejstrup, Irina Mountian, Henrik Gudbergsen, Lars Erik Kristensen The Patient - Patient-Centered Outcomes Research .2018; 11(5): 515.      CrossRef
• Introduction to Qualitative Research for Novice Investigators Bismah Jameel, Saqib Shaheen, Umair Majid Undergraduate Research in Natural and Clinical Science and Technology (URNCST) Journal .2018; 2(6): 1.      CrossRef
• How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study Elizabeth Taylor, Fiona Jones, Christopher McKevitt BMJ Open .2018; 8(12): e023676.      CrossRef
• A qualitative analysis of staff-client interactions within a breast cancer assessment clinic J.M. Nightingale, F. Murphy, C. Eaton, R. Borgen Radiography .2017; 23(1): 38.      CrossRef
• Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study Ellie Rosenfeld, Sharon Kinney, Carlye Weiner, Fiona Newall, Allison Williams, Noel Cranswick, Ian Wong, Narelle Borrott, Elizabeth Manias Research in Social and Administrative Pharmacy .2017;[Epub]      CrossRef
• What Attitudes and Values Are Incorporated Into Self as Part of Professional Identity Construction When Becoming a Surgeon? Alexandra Cope, Jeff Bezemer, Stella Mavroveli, Roger Kneebone Academic Medicine .2017; 92(4): 544.      CrossRef
• Patients as ethnographers John Launer Postgraduate Medical Journal .2017; 93(1100): 371.      CrossRef
• Implementation in the midst of complexity: Using ethnography to study health care–associated infection prevention and control Mary Jo Knobloch, Kevin V. Thomas, Erin Patterson, Michele L. Zimbric, Jackson Musuuza, Nasia Safdar American Journal of Infection Control .2017; 45(10): 1058.      CrossRef
• Social participation and recovery orientation in a “low threshold” community mental health service: An ethnographic study Toril Anne Elstad, Arne Henning Eide, Udo Schumacher Cogent Medicine .2017; 4(1): 1362840.      CrossRef
• Conducting a team-based multi-sited focused ethnography in primary care A.P. Bikker, H. Atherton, H. Brant, T. Porqueddu, J.L. Campbell, A. Gibson, B. McKinstry, C. Salisbury, S. Ziebland BMC Medical Research Methodology .2017;[Epub]      CrossRef
• Chronic Disease and Self-Injection: Ethnographic Investigations into the Patient Experience During Treatment Michael Schiff, Shane Saunderson, Irina Mountian, Paul Hartley Rheumatology and Therapy .2017; 4(2): 445.      CrossRef
• Aspectos éticos de la investigación etnográfica en salud. El papel del comité de ética de la investigación Fernando Suárez-Obando, Carlos Gómez-Restrepo Persona y Bioética .2017;[Epub]      CrossRef
• The Malay Traditional Food Preparation Mohd Shazali Md. Sharif, Norazmir Md Nor, Salehuddin Mohd Zahari, Mohammad Halim Jeinie Asian Journal of Quality of Life .2017; 2(7): 39.      CrossRef
• Role of ethnographic research for assessing behavior of employees during cleaning and sanitation in food preparation areas Philip G. Crandall, Corliss A. O'Bryan, Dale A. Grinstead, Katie Das, Carolyn Rose, Jessica J. Shabatura Food Control .2016; 59: 849.      CrossRef
• Development of a Decision Aid for Cardiopulmonary Resuscitation Involving Intensive Care Unit Patients' and Health Professionals' Participation Using User-Centered Design and a Wiki Platform for Rapid Prototyping: A Research Protocol Ariane Plaisance, Holly O Witteman, Daren Keith Heyland, Mark H Ebell, Audrey Dupuis, Carole-Anne Lavoie-Bérard, France Légaré, Patrick Michel Archambault JMIR Research Protocols .2016; 5(1): e24.      CrossRef
• Understanding the Culture of Graduate Medical Education: The Benefits of Ethnographic Research Anna MacLeod Journal of Graduate Medical Education .2016; 8(2): 142.      CrossRef
• Defining Patient Centric Pharmaceutical Drug Product Design Sven Stegemann, Robert L. Ternik, Graziano Onder, Mansoor A. Khan, Diana A. van Riet-Nales The AAPS Journal .2016; 18(5): 1047.      CrossRef
• Enhancing the Effectiveness of Significant Event Analysis: Exploring Personal Impact and Applying Systems Thinking in Primary Care Paul Bowie, Elaine McNaughton, David Bruce, Deirdre Holly, Eleanor Forrest, Marion Macleod, Susan Kennedy, Ailsa Power, Denis Toppin, Irene Black, Janet Pooley, Audrey Taylor, Vivien Swanson, Moya Kelly, Julie Ferguson, Suzanne Stirling, Judy Wakeling, An Journal of Continuing Education in the Health Professions .2016; 36(3): 195.      CrossRef
• An anthropological approach to teach and evaluate cultural competence in medical students – the application of mini-ethnography in medical history taking Jyh-Gang Hsieh, Mutsu Hsu, Ying-Wei Wang Medical Education Online .2016; 21(1): 32561.      CrossRef
• An Observational Case Study of Near-peer Teaching in Medical and Pharmacy Experiential Training Bayan Sharif-Chan, Dipti Tankala, Christine Leong, Zubin Austin, Marisa Battistella American Journal of Pharmaceutical Education .2016; 80(7): 114.      CrossRef
• Qualitative research and its methods in epilepsy: Contributing to an understanding of patients' lived experiences of the disease Frances Rapport, Clare Clement, Marcus A. Doel, Hayley A. Hutchings Epilepsy & Behavior .2015; 45: 94.      CrossRef
• Nurses' narratives on workplace English in Taiwan: Improving patient care and enhancing professionalism Susan Bosher, Joel Stocker English for Specific Purposes .2015; 38: 109.      CrossRef
• Dominance of paternalism on family-centered care in the Pediatric Intensive Care Unit (PICU): An ethnographic study Parvaneh Vasli, Nahid Dehghan-Nayeri, Leili Borim-Nezhad, AbouAli Vedadhir Issues in Comprehensive Pediatric Nursing .2015; 38(2): 118.      CrossRef
• Cultural ecosystem services and their effects on human health and well-being – A cross-disciplinary methodological review Ulrike Pröbstl-Haider Journal of Outdoor Recreation and Tourism .2015; 10: 1.      CrossRef
• What Makes the Malay Young Generation had Limited Skills and Knowledge in the Malay Traditional Food Preparation? Mohd Shazali Md. Sharif, Norazmir Md Nor, Mohd Salehuddin Mohd Zahari, Rosmaliza Muhammad Procedia - Social and Behavioral Sciences .2015; 202: 152.      CrossRef
• The Encounters and Challenges of Ethnography as a Methodology in Health Research Marghalara Rashid, Vera Caine, Helly Goez International Journal of Qualitative Methods .2015; 14(5): 160940691562142.      CrossRef
• Ethnographic process evaluation in primary care: explaining the complexity of implementation Arwen E Bunce, Rachel Gold, James V Davis, Carmit K McMullen, Victoria Jaworski, MaryBeth Mercer, Christine Nelson BMC Health Services Research .2014;[Epub]      CrossRef
• Enhancing the public impact of ethnography Emily Martin, Gideon Litchfield, Mehret Mandefro, Farah Parvez, Seth M. Holmes, Danielle Lindemann, Helena Hansen Social Science & Medicine .2013; 99: 205.      CrossRef
• Grounded theory in medical education research: AMEE Guide No. 70 Christopher J. Watling, Lorelei Lingard Medical Teacher .2012; 34(10): 850.      CrossRef
• Review article: Medical education research: an overview of methods Sylvain Boet, Saroo Sharma, Joanne Goldman, Scott Reeves Canadian Journal of Anesthesia/Journal canadien d'anesthésie .2012; 59(2): 159.      CrossRef

• Open access
• Published: 10 May 2024

Novice providers’ success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle

• Helmiina Lilja 1   na1 ,
• Maria Talvisara 1   na1 ,
• Vesa Eskola 2 , 3 ,
• Paula Heikkilä 2 , 3 ,
• Harri Sievänen 4 &
• Sauli Palmu 2 , 3  

BMC Medical Education volume  24 , Article number:  520 ( 2024 ) Cite this article

183 Accesses

Metrics details

Lumbar puncture (LP) is an important yet difficult skill in medical practice. In recent years, the number of LPs in clinical practice has steadily decreased, which reduces residents’ clinical exposure and may compromise their skills and attitude towards LP. Our study aims to assess whether the novel bioimpedance needle is of assistance to a novice provider and thus compensates for this emerging knowledge gap.

This randomized controlled study, employing a partly blinded design, involved 60 s- and third-year medical students with no prior LP experience. The students were randomly assigned to two groups consisting of 30 students each. They performed LP on an anatomical lumbar model either with the conventional spinal needle or the bioimpedance needle. Success in LP was analysed using the independent samples proportion procedure. Additionally, the usability of the needles was evaluated with pertinent questions.

With the conventional spinal needle, 40% succeeded in performing the LP procedure, whereas with the bioimpedance needle, 90% were successful ( p  < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases ( p  = 0.006), respectively. Providers found the bioimpedance needle more useful and felt more confident using it.

Conclusions

The bioimpedance needle was beneficial in training medical students since it significantly facilitated the novice provider in performing LP on a lumbar phantom. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.

Peer Review reports

Lumbar puncture (LP) is one of the essential skills of physicians in medical practice, especially in the fields of neurology, neurosurgery, emergency medicine and pediatrics. It is one of the procedures that medical students practice in their training. LP is an important clinical procedure for diagnosing neurological infections and inflammatory diseases and excluding subarachnoid hemorrhage [ 1 ]. LP can also be used for examining the spread of cancer cells to the central nervous system in diagnosing acute lymphoblastic leukemia (ALL) and for delivering intrathecal administration of chemotherapy in patients with ALL [ 2 ]. In recent years, the number of LPs in clinical practice has steadily decreased [ 3 , 4 ]. Over the past decade, a 37% decrease in LPs was observed across US children’s hospitals [ 3 ]. Similar trends have also been observed in emergency medicine [ 4 ]. Stricter criteria in practice guidelines, changes in patient demographics, and development in medical imaging have likely contributed to this decrease. This trend presumably reduces residents’ clinical exposure and may compromise their skills and attitude towards LP.

When performed by an experienced physician, LP is a relatively safe procedure, albeit not always straightforward or free from complications [ 4 ]. The spinal needle used in LP is thin and flexible, making its insertion into the spinal canal without seeing the location of the needle tip or destination challenging. The physician performing the procedure must master the specific lumbar anatomy to avoid complications [ 5 ]. The LP technique is not the only thing that matters, but patients’ size and comfort also affect the success of the procedure [ 6 ]. Hence, a practitioner lacking adequate experience in LP should be appropriately supervised when performing the procedure [ 4 ]. Nevertheless, there are situations in which such supervision is not possible.

Little experience in performing LPs may require more attempts to obtain cerebrospinal fluid (CSF) samples [ 7 ]. Because of several attempts, blood can be introduced to CSF and result in a traumatic LP. Success at the first attempt is associated with a lower incidence of traumatic LPs [ 2 , 8 , 9 , 10 , 11 , 12 ]. A bloody CSF sample complicates the diagnostics [ 8 ]. It has also been shown that a high number of attempts increases the incidence of postdural puncture headache (PDPH), the most common complication of LP, in addition to other adverse effects [ 9 ].

Considering the possible complications and difficulties of performing LP, a concern arises regarding whether inexperienced physicians can perform LP with adequate confidence and safety. The use of a novel bioimpedance-based spinal needle system could offer a solution. This needle provides real-time feedback from the needle tip when penetrating the lumbar tissues and informs the physician when the needle tip reaches CSF with an audio-visual alarm. This information may make performing the LP procedure smoother, thus decreasing the incidence of the most common complications [ 13 ]. A bioimpedance-based spinal needle system has been recently found clinically feasible in LPs among adults, adolescents, and children, including neonates [ 2 , 14 , 15 ].

The current phantom study aimed to assess whether the novel needle technology can compensate for the lack of experience when a medical student performs LP for the first time. In particular, we compared the performance of the bioimpedance spinal needle and conventional spinal needle in terms of the overall success rate of the LP procedure, success rate at the first attempt, duration of the procedure, and number of stylet removals. We hypothesized that novice users would find the bioimpedance needle more useful in performing LPs than a conventional spinal needle. If so proven, the use of this novel device can contribute to training medical students in this important skill and facilitate situations when an inexperienced physician needs to perform LP without the supervision and guidance of an experienced physician [ 4 ].

We planned to recruit 60 medical students from Tampere University in this randomized controlled trial. Students who were studying medicine for their third year or less were considered eligible for the study. At this stage of studies, they were expected to have no clinical experience and be thus naïve in performing an LP. All students had the same baseline knowledge regarding lumbar spine anatomy.

The participants were recruited by sending an invitation e-mail to all potentially eligible medical students. The email provided information about the study. Of the 177 students who responded to the invitation, 60 students were included on a first-come-first-serve basis. The participants were rewarded with a 10€ voucher to the university campus cafeteria.

Randomization lists in blocks of six were generated for two groups (A and B) before recruitment by an independent person who was not involved in recruitment or data collection. Participants assigned to group A used a conventional spinal needle (90 mm long 22G Quincke-type needle), and those to group B used the bioimpedance needle system (IQ-Tip system with a 90 mm long IQ-Tip needle, Injeq Plc, Tampere, Finland).

The study LPs were performed on an adult-size anatomical lumbar phantom (Blue Phantom BPLP2201, CAE Healthcare, FL, USA) intended for medical training and practising. The phantom is made of a tissue-simulating elastomer material that looks and feels like human soft tissue. Skeletal structures made of hard material and a plastic tube mimicking the spinal canal are embedded in the phantom. The saline inside the tube mimics CSF and is under hydrostatic pressure. The phantom offers a relatively realistic feel in palpating the lumbar anatomy and getting haptic feedback from the advancing needle.

The study LPs were performed in February 2023 in ten different sessions, with 6 participants in each session. Two separate rooms were used to conduct the study. The participants were first admitted to a waiting room and then separately to another room where each student performed the study LP with the assigned spinal needle under supervision (HL and MT). By having these two rooms, we ensured that no information was exchanged after or during the procedure.

Before the study LPs, the participants were shown an instructional video on how to perform an LP from the widely used Finnish medical database Terveysportti [ 16 ] and a video on the operation of the bioimpedance needle [ 13 ]. The first video (duration 3 min) describes the indications, contraindications and a step-by-step instruction on how the procedure is performed. The latter is a 25- second animation showing how the bioimpedance system operates and guides the procedure. In addition, the supervisor gave each participant the following instructions before starting the study LP: When you think you have reached the subarachnoid space, remove the stylet from the needle. If you are in the correct place, the fluid will start flowing from the needle. You may redirect the needle as many times as you wish, but you are only allowed to remove the needle and do a new attempt five times. Please wait a while when you have removed the stylet because it may take a while before the fluid starts dropping. These instructions were given to all participants irrespective of the study group to standardize the information in all sessions.

After watching the videos and listening to the instructions, the participants became aware of their assigned study group. Participants were allowed five attempts, while redirections of the needle and stylet removals could be performed as many times as needed. We measured the duration of the LP procedure and collected data on the number of stylet removals, the number of attempts, and whether the LP was successful.

The duration of the procedure was defined from the point when the needle penetrated the phantom surface to either when the first drop of fluid fell from the needle, or the participant wanted to stop or had used all five attempts. There was no maximum time for completing the LP procedure. The procedure was defined as successful if the participant succeeded in obtaining a drop of fluid from the needle.

In addition, seven relevant statements to this study were chosen from the System Usability Scale (SUS) [ 17 ], which is an industry standard for evaluating the usability of various devices and systems. The seven statements, slightly modified from the original statements, are shown in Table  1 . After performing the study LP and irrespective of their success, all participants were asked to respond to the statements using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

Statistical analysis

For the estimation of statistical power, we assumed that the overall success rate would be 60% with the conventional needle (group A) and 90% with the bioimpedance needle (group B). Then, the sample size of 60 participants divided randomly into two equal-sized groups would be sufficient to detect a between-group at a significance level of p  < 0.05 and with 80% statistical power if such a difference truly exists.

Overall success in performing the lumbar puncture and success at the first attempt in the groups were analysed by the independent samples proportion procedure. The median number of attempts and stylet removals in the successful procedures were compared by independent samples Mann‒Whitney U test. Responses to the seven usability statements were compared by this test as well.

Statistical analyses were performed with IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, NY, USA). A p value less than 0.05 was considered statistically significant.

Sixty medical students were randomly assigned into two groups, 30 performing the LP procedure on the lumbar phantom using a conventional spinal needle and 30 using the bioimpedance needle. None of the participants had previous experience in performing an LP.

With the conventional spinal needle (group A), 12 out of 30 participants (40%) succeeded in performing the LP procedure, whereas with the bioimpedance needle (group B), 27 out of 30 participants (90%) were successful ( p  < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases ( p  = 0.006), respectively.

Figure  1 illustrates the number of attempts and stylet removals in the study groups. Regarding the success of the procedure at any attempt, the median number of attempts was 2 (range 1–5) for the conventional needle and 1 [ 1 , 2 , 3 , 4 , 5 ] for the bioimpedance needle ( p  = 0.56).

In the successful procedures, the median number of stylet removals was 4 [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] and 1 (1–33) ( p  = 0.001), respectively. The mean duration of a successful procedure was 3:51 (SD 3:43) with the conventional needle and 1:59 (2:25) with the bioimpedance needle ( p  = 0.068).

The responses to the seven usability statements are illustrated in Fig.  2 . Regarding the statements on regular use, ease of use, need for support from an experienced user, learning to use, and cumbersomeness, the responses differed significantly between groups, consistently favouring the bioimpedance needle ( p  < 0.001). Regarding the feeling of confidence in use, the responses significantly favoured the bioimpedance needle ( p  = 0.012). Likewise, the responses significantly favoured the bioimpedance needle to less need to learn many things before its use.

Distributions of the number of attempts in successful LP procedures (left panel) with the conventional spinal needle (group A, yellow bars) and with the bioimpedance needle (group B, blue bars). Respective distributions of the number of stylet removals (right panel) in groups A and B

After performing the LP, the provider answered seven statements about the usability of the needle in question on a scale of 1 (strongly disagree) to 5 (strongly agree). Distributions of responses to every seven usability statements in group A (conventional spinal needle, yellow bars) and in group B (bioimpedance needle, blue bars) using the System Usability Scale (SUS)

The decline in the number of LPs during the last decade [ 3 , 4 ] likely weakening the practical knowledge and skills of novice physicians served as the rationale for the current study. Using a solid randomized controlled study design, we assessed whether bioimpedance-based tissue detection technology could help an inexperienced provider perform LP. Our study was conducted among early-stage medical students who had no previous experience with LPs. Following our hypothesis, we found that the use of a bioimpedance needle in simulated phantom LPs was useful to novice providers. The bioimpedance needle decreased not only the number of attempts to achieve a successful LP but also its time, in addition to the significantly lower number of stylet removals during the procedure. Furthermore, the usability of the bioimpedance needle was found to be significantly better than that of the spinal needle used currently in clinical practice.

The users of the bioimpedance needle found the novel device easy and intuitive to learn and use while feeling more confident in performing LP compared to those using the conventional needle. They also expressed their interest in using the bioimpedance needle regularly. It is recalled that the present providers were all novices without earlier experience in LP, and therefore, the observed between-group differences in performance could have been smaller with more experienced providers.

Of common bedside procedures in clinical practice, LP was recently found to be associated with the lowest baseline levels of experience and confidence among 4 th− to 6th -year medical students. However, a single seminar with standardized simulation training brought more confidence to the LP procedure among these students [ 18 ]. Other recent studies have also shown that simulation-based education can improve procedural competence and skills in performing LP [ 19 , 20 , 21 , 22 ]. In these studies, the participants had more experience than in our study, but the benefits of simulation-based learning were significant. A recent study assessing a mixed reality simulator found this approach helpful in learning of LP among residents, faculty, interns, and medical students, approximately 60% having no previous experience in LP [ 23 ]. After mixed reality training, the success rate of LP increased while the time of the procedure decreased [ 23 ], which is in line with our findings. Virtual reality-based training in LP learning has also been studied, and it might have beneficial results in the provider’s skills and confidence [ 24 , 25 ]. All these findings speak for the utility of various simulation approaches in adopting essential (new) clinical skills for LP at different stages of medical studies and careers.

Lumbar puncture is commonly considered a difficult and possibly frightening procedure to perform. In addition to the physician’s experience and skills, there are other factors that affect the success of LP, including patient size, spinal deformities, lumbar anatomy, cooperation and comfort [ 6 ]. Occasionally, a physician may have to insert the needle more than once to succeed in LP. However, repeated attempts are associated with several complications, such as PDPH and traumatic LP [ 7 , 10 , 11 , 12 , 26 , 27 , 28 ]. In our study, the median number of attempts was two for the conventional spinal needle and one for the bioimpedance needle. The low number of attempts may have also contributed to the low incidence of traumatic LP and PDPH observed in pediatric patients with leukemia, whose intrathecal therapy was administered using the bioimpedance needle [ 15 ]. Since the basic use of a bioimpedance needle is virtually similar to that of a conventional spinal needle with no need for additional devices (e.g., ultrasound imaging), it may offer a notable option for effective teaching of LP among medical students. Its real-time CSF detection ability is likely to consolidate the learning experience and increase confidence in one’s skills.

In this study, we found a significantly higher success rate and confidence in procedural skills of medical students associated with using the bioimpedance needle compared to the conventional spinal needle. Should these benefits translate into the real clinical world and manifest as a lower incidence of failed LP procedures and procedure-related complications, a higher incidence of high-quality CSF samples, a lower need for repeated procedures, a lower need for experienced and more expensive physicians to supervise, perform, or complete the LP procedure, substantial savings in the total costs of the lumbar puncture procedure are possible despite the initially higher unit cost of the bioimpedance needle system compared to conventional spinal needles. Further clinical studies on the benefits of the bioimpedance needle system in clinical LP procedures are needed to confirm these speculations.

The major strengths of the present study are the randomized controlled, partly blinded design and adequate sample size. The random assignment of participants to study groups and data analysis were performed by an independent person who was not involved in recruitment or data collection. The participants received the same instructions and information before performing their assigned LP procedure and were asked not to study LP in advance to keep the participants as naïve in performing LP as possible. Obviously, we could not control for this and have full certainty about the prior information on retrieval of the participants. However, the participants were not told before the study session which type of spinal needle they would use in their assigned LP.

During the LP sessions, there were a few technical issues concerning the lumbar phantom and bioimpedance needle. First, since the pressure inside the phantom spinal canal (plastic tube) affects the fluid flow through the needle, we attempted to keep the height of the hydrostatic saline column constant by adding new saline as needed, but slight variation in pressure may have occurred, and concerned all study LP procedures. Second, when the plastic tube and surrounding phantom material are pierced multiple times in succession, it is possible that the leakage of saline moistens the rubbery material and increases markedly its electrical conductivity despite the self-healing property of the material. Had this happened, consequent false detections may have led to unnecessary removals of the stylet in the LP procedures performed with the bioimpedance needle system. Therefore, as a precaution, the maximum number of participants at each session was limited to six to mitigate the risk of moistening of material. Third, in two cases, the bioimpedance needle system did not detect saline, although the needle tip was in the correct place, confirmed by saline flow after stylet removal. This rate of missed detections in line with clinical experience [ 2 , 15 ] and may be due to elastomer remnants stuck at the needle tip compromising the bioimpedance measurement and saline detection. However, despite the failed functionality, the mechanical performance of the bioimpedance needle as a spinel needle is maintained and LP could be performed as usual. Regarding the credibility of the present findings, the bioimpedance needle did not get any undue benefit from these technical issues compared to the conventional spinal needle.

Given that the participants were clinically inexperienced early-stage medical students, the study was conducted using an anatomical lumbar phantom, not on actual patients. Obviously, the haptic feedback from the phantom and anatomic variation in the lumbar region do not fully correspond to a real patient. On the other hand, the use of phantom takes off the pressure from a novice provider and possibly eases the procedure, not having to take thought on a patient’s comfort, anatomy, and condition. Although the LP procedure was performed for the first time without the guidance of an experienced physician, the users of the bioimpedance needle felt more confident and performed significantly better than those with the conventional spinal needle. If used for teaching purposes, the bioimpedance needle and the anatomical lumbar phantom could offer a positive experience of the LP procedure and raise confidence in one’s own skills before the first real patient encounter. Whether the present promising results of a phantom study would translate into improved performance in actual clinical work calls for further investigation.

Lumbar puncture is a widely used but demanding procedure needed for the diagnosis and treatment of several diseases. It is relatively safe when performed correctly, but due to the decreasing trend of performed LP procedures, a concern has arisen concerning novice physicians’ expertise in LP. The bioimpedance needle could offer a solution to this problem and facilitate practical training of LP among early-stage medical students. The present randomized controlled phantom study showed that providers with no previous experience in LP perceived the bioimpedance needle as more useful, became confident, and achieved significantly higher success rates both overall and at the first attempt with fewer stylet removals compared to those using a conventional spinal needle. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Acute lymphoblastic leukemia

Cerebrospinal fluid

• Lumbar puncture

Postdural puncture headache

Ellenby MS, Tegtmeyer K, Lai S, Braner DAV. Videos in clinical medicine. Lumbar puncture. N Engl J Med. 2006;355(13):e12.

Article   Google Scholar  

Långström S, Huurre A, Kari J, Lohi O, Sievänen H, Palmu S. Bioimpedance spinal needle provides high success and low complication rate in lumbar punctures of pediatric patients with acute lymphoblastic leukemia. Sci Rep. 2022;12(1):6799.

Geanacopoulos AT, Porter JJ, Michelson KA, Green RS, Chiang VW, Monuteaux MC, et al. Declines in the Number of Lumbar Punctures Performed at United States children’s hospitals, 2009–2019. J Pediatr. 2021;231:87–e931.

Gottlieb M, Jordan J, Krzyzaniak S, Mannix A, King A, Cooney R, et al. Trends in emergency medicine resident procedural reporting over a 10-year period. AEM Educ Train. 2023;7(1):e10841.

Boon JM, Abrahams PH, Meiring JH, Welch T. Lumbar puncture: anatomical review of a clinical skill. Clin Anat. 2004;17(7):544–53.

Thieme E-. Journals - Seminars in Neurology/Abstract [Internet]. [cited 2023 Sep 19]. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s -2003-40758.

Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, et al. Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. JAMA. 2002;288(16):2001–7.

Coughlan S, Elbadry M, Salama M, Divilley R, Stokes HK, O’Neill MB. The current use of lumbar puncture in a General Paediatric Unit. Ir Med J. 2021;114(5):354.

Google Scholar  

Jaime-Pérez JC, Sotomayor-Duque G, Aguilar-Calderón P, Salazar-Cavazos L, Gómez-Almaguer D. Impact of obesity on lumbar puncture outcomes in adults with Acute Lymphoblastic Leukemia and Lymphoma: experience at an academic reference Center. Int J Hematol Oncol Stem Cell Res. 2019;13(3):146–52.

Flores-Jimenez JA, Gutierrez-Aguirre CH, Cantu-Rodriguez OG, Jaime-Perez JC, Gonzalez-Llano O, Sanchez-Cardenas M, et al. Safety and cost-effectiveness of a simplified method for lumbar puncture in patients with hematologic malignancies. Acta Haematol. 2015;133(2):168–71.

Barreras P, Benavides DR, Barreras JF, Pardo CA, Jani A, Faigle R, et al. A dedicated lumbar puncture clinic: performance and short-term patient outcomes. J Neurol. 2017;264(10):2075–80.

Renard D, Thouvenot E. CSF RBC count in successful first-attempt lumbar puncture: the interest of atraumatic needle use. Neurol Sci. 2017;38(12):2189–93.

Injeq. [Internet]. [accessed 2024 Apr 9]. FAQ. Available from Question 1: https://injeq.com/faq/ .

Halonen S, Annala K, Kari J, Jokinen S, Lumme A, Kronström K, et al. Detection of spine structures with Bioimpedance Probe (BIP) needle in clinical lumbar punctures. J Clin Monit Comput. 2017;31(5):1065–72.

Sievänen H, Kari J, Halonen S, Elomaa T, Tammela O, Soukka H, et al. Real-time detection of cerebrospinal fluid with bioimpedance needle in paediatric lumbar puncture. Clin Physiol Funct Imaging. 2021;41(4):303–9.

Terveysportti. [Internet]. [accessed 2024 Apr 9]. Available from (in Finnish): https://www.terveysportti.fi/terveysportti/koti .

Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usabil Stud. 2009;4:114–23.

von Cranach M, Backhaus T, Brich J. Medical students’ attitudes toward lumbar puncture—and how to change. Brain Behav. 2019;9(6):e01310.

Barsuk JH, Cohen ER, Caprio T, McGaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology. 2012;79(2):132–7.

McMillan HJ, Writer H, Moreau KA, Eady K, Sell E, Lobos AT, et al. Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety. BMC Med Educ. 2016;16:198.

Gaubert S, Blet A, Dib F, Ceccaldi PF, Brock T, Calixte M, et al. Positive effects of lumbar puncture simulation training for medical students in clinical practice. BMC Med Educ. 2021;21(1):18.

Toy S, McKay RS, Walker JL, Johnson S, Arnett JL. Using Learner-Centred, Simulation-based training to Improve Medical Students’ procedural skills. J Med Educ Curric Dev. 2017;4:2382120516684829.

Huang X, Yan Z, Gong C, Zhou Z, Xu H, Qin C, et al. A mixed-reality stimulator for lumbar puncture training: a pilot study. BMC Med Educ. 2023;23(1):178.

Vrillon A, Gonzales-Marabal L, Ceccaldi PF, Plaisance P, Desrentes E, Paquet C, et al. Using virtual reality in lumbar puncture training improves students learning experience. BMC Med Educ. 2022;22(1):244.

Roehr M, Wu T, Maykowski P, Munter B, Hoebee S, Daas E, et al. The feasibility of virtual reality and student-led Simulation Training as methods of lumbar puncture instruction. Med Sci Educ. 2021;31(1):117–24.

Seeberger MD, Kaufmann M, Staender S, Schneider M, Scheidegger D. Repeated Dural Punctures increase the incidence of Postdural puncture headache. Anaesth Analgesia. 1996;82(2):302.

Glatstein MM, Zucker-Toledano M, Arik A, Scolnik D, Oren A, Reif S. Incidence of traumatic lumbar puncture: experience of a large, tertiary care pediatric hospital. Clin Pediatr (Phila). 2011;50(11):1005–9.

Shah KH, Richard KM, Nicholas S, Edlow JA. Incidence of traumatic lumbar puncture. Acad Emerg Med. 2003;10(2):151–4.

Download references

No external funding.

Open access funding provided by Tampere University (including Tampere University Hospital).

Author information

Helmiina Lilja and Maria Talvisara contributed equally to this work.

Authors and Affiliations

Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland

Helmiina Lilja & Maria Talvisara

Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland

Vesa Eskola, Paula Heikkilä & Sauli Palmu

Tampere University Hospital, Elämänaukio 2, Tampere, 33520, Finland

Injeq Plc, Biokatu 8, Tampere, Tampere, 33520, Finland

Harri Sievänen

You can also search for this author in PubMed   Google Scholar

Contributions

H.L. and M.T.: data collection, data analysis, drafting the manuscript, editing the manuscript. V.E. and P.H.: planning the study, editing the manuscript. H.S. and S.P.: conceptualizing and planning the study, data analysis, editing the manuscript.

Corresponding author

Correspondence to Sauli Palmu .

Ethics declarations

Ethics approval and consent to participate.

The protocol was approved by the university medical education board which acts as the licensing committee for trials performed in our institute. The participants gave their informed consent to participate.

Consent for publication

Not applicable.

Competing interests

H.S. is an employee of Injeq Plc.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Lilja, H., Talvisara, M., Eskola, V. et al. Novice providers’ success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle. BMC Med Educ 24 , 520 (2024). https://doi.org/10.1186/s12909-024-05505-z

Download citation

Received : 06 October 2023

Accepted : 02 May 2024

Published : 10 May 2024

DOI : https://doi.org/10.1186/s12909-024-05505-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Spinal needle
• Clinical skill
• Bioimpedance

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]

An overview of ethnography in healthcare and medical education research

Affiliation.

• 1 Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
• PMID: 21637319
• PMCID: PMC3100516
• DOI: 10.3352/jeehp.2011.8.4

Research in healthcare settings and medical education has relied heavily on quantitative methods. However, there are research questions within these academic domains that may be more adequately addressed by qualitative inquiry. While there are many qualitative approaches, ethnography is one method that allows the researcher to take advantage of relative immersion in order to obtain thick description. The purpose of this article is to introduce ethnography, to describe how ethnographic methods may be utilized, to provide an overview of ethnography's use in healthcare and medical education, and to summarize some key limitations with the method.

Keywords: Ethnography; Healthcare; Medical Education; Qualitative Research.

• Search Menu
• Advance articles
• Author Guidelines
• Submission Site
• Open Access
• Why Submit?
• About Public Opinion Quarterly
• About the American Association for Public Opinion Research
• Editorial Board
• Advertising and Corporate Services
• Journals Career Network
• Self-Archiving Policy
• Dispatch Dates
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Anti-semitic attitudes of the mass public: estimates and explanations based on a survey of the moscow oblast.

• Article contents
• Figures & tables
• Supplementary Data

JAMES L. GIBSON, RAYMOND M. DUCH, ANTI-SEMITIC ATTITUDES OF THE MASS PUBLIC: ESTIMATES AND EXPLANATIONS BASED ON A SURVEY OF THE MOSCOW OBLAST, Public Opinion Quarterly , Volume 56, Issue 1, SPRING 1992, Pages 1–28, https://doi.org/10.1086/269293

• Permissions Icon Permissions

In this article we examine anti-Semitism as expressed by a sample of residents of the Moscow Oblast (Soviet Union). Based on a survey conducted in 1920, we begin by describing anti-Jewish prejudice and support for official discrimination against Jews. We discover a surprisingly low level of expressed anti-Semitism among these Soviet respondents and virtually no support for state policies that discriminate against Jews. At the same time, many of the conventional hypotheses predicting anti-Semitism are supported in the Soviet case. Anti-Semitism is concentrated among those with lower levels of education, those whose personal financial condition is deteriorating, and those who oppose further democratization of the Soviet Union. We do not take these findings as evidence that anti-Semitism is a trivial problem in the Soviet Union but, rather, suggest that efforts to combat anti-Jewish movements would likely receive considerable support from ordinary Soviet people.

Email alerts

Citing articles via.

• Recommend to your Library

Affiliations

• Online ISSN 1537-5331
• Copyright © 2024 American Association for Public Opinion Research
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

share this!

May 16, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

trusted source

First-generation medical students face unique challenges and need more targeted support, say researchers

by University of Chicago Medical Center

Medical research is increasingly informed by recognition of diversity's key role in addressing health equity. But when it comes to medical education, there's a group that has remained not just underrepresented but also under-researched: first-generation (first-gen) medical students—those whose parents have not earned bachelor's degrees.

These students are more likely to be older, identify as racial or ethnic minorities, be immigrants or children of immigrants, or come from low-income families . Along with anecdotal evidence, the minimal previous research indicates that these students face some unique struggles on top of the common challenges most medical students encounter.

"It became clear to me that schools—even the great ones that are intentional and diligent about building diverse classes—are not truly ready to receive first-gen students," said Catherine Havemann, MD, an emergency medicine chief resident at UChicago Medicine. "Admission isn't the same as full access to the institution. Sometimes support doesn't exist, and other times it's off-target."

To increase understanding of the first-gen experience and identify opportunities for educators and administrators to provide the most meaningful support, Havemann helped lead a team of researchers to perform an in-depth qualitative study . They analyzed data collected in interviews with a diverse group of medical students recruited from 27 medical schools across the U.S.

The results, published in JAMA , have the potential to inform efforts at increasing educational equity at both the institutional and individual level.

Struggles shared among a diverse first-generation population

Overall, the study confirmed that first-gen medical students feel that they face disproportionate adversity throughout their education and do not receive the support they need to compensate for that. Participants identified four main themes: feelings of isolation and exclusion; difficulties accessing basic resources such as food, rent, transportation and textbooks; a general lack of institutional support; and pressure to rely on personal "grit" and resilience for survival.

Some issues highlighted in the data were relatively unsurprising, such as financial difficulties.

"No matter which subset of first-gen students we talk to, money is a foundational part of the challenges they face—even if they're not technically low-income," said Havemann, the paper's first author. "Within the medical community, we need to talk more about the discomfort of disadvantaged students entering incredibly wealthy institutions with mostly wealthy peers. What does it mean to create some basic degree of equity?"

Other issues emerged as more persistent than the researchers had anticipated. For example, interviewees frequently mentioned transportation problems, such as situations where student loans don't cover the cost of having a car but medical school necessitates one. An especially striking theme was that many students reported being overtly discouraged by mentors or teachers during their education.

"People who meet the criteria for medical school admission are being told 'This is not for you,'" Havemann said. "It's disheartening to see, and it makes me think differently about my career as an aspiring educator. Saying 'yes'—even in a small way—to someone who has heard a lifetime of 'no' can make all the difference. To think there are people out there discouraging others is frankly appalling."

Responding to the findings

Havemann said the paper resonated strongly with student communities online following its publication.

"Responses ranged from 'This is obvious' and 'Water is wet' to 'Why doesn't my school understand this?' or 'We knew this already—where are the solutions?'" she said.

As a former first-gen student herself, she was struck by the consistency of experience revealed by the study's results. "It was validating as a researcher but also profoundly validating as a person."

But while the student response online served as important confirmation that the study's findings are representative, the real target audience is the educators who have the power to make a difference.

"I would love for them to read this paper and feel what a powerful position they're in to make a more equitable world," Havemann said. "Even the little things matter a lot."

Even as she and others conduct more research on this topic, Havemann said institutions can and should already be taking steps to provide better support for first-generation medical students .

"People like to talk about using holistic review in admissions to look at the whole student—we also have to look at holistic support once they enroll," she said.

Future studies will dive deeper into themes like professional identity formation, financial challenges, burnout and sense of belonging. Now that the qualitative groundwork has been laid, researchers can design more nuanced quantitative and mixed-method studies.

"For example, I'd like to quantify the percentage of first-gen students who are not only trying to support themselves but also keeping the lights on for their parents," Havemann said. "I think the answers would be gutting."

Journal information: Journal of the American Medical Association , JAMA Network Open

Provided by University of Chicago Medical Center

Explore further

Feedback to editors

DNA analysis reveals that Jamestown Colony residents ate dogs with Indigenous ancestry

Study shows COVID-related private funding had little effect in 2020 presidential election

3 hours ago

Neutrons open window to explore space glass

Researchers find unique adaptations of fungus associated with bee bread

4 hours ago

Highly sensitive fiber optic gyroscope senses rotational ground motion around active volcano

'Dusty' archives inspire new story about 1886 Charleston earthquake

Study finds widespread 'cell cannibalism' and related phenomena across tree of life

5 hours ago

Detecting odors on the edge: Researchers decipher how insects smell more with less

New catalyst transforms carbon dioxide from industrial emissions into commonly used chemicals

Researchers use hydrogel chemistry and microfabrication to miniaturize and integrate components into bioelectronics

Relevant physicsforums posts, physics education is 60 years out of date, is "college algebra" really just high school "algebra ii".

May 14, 2024

Plagiarism & ChatGPT: Is Cheating with AI the New Normal?

May 13, 2024

Physics Instructor Minimum Education to Teach Community College

May 11, 2024

Studying "Useful" vs. "Useless" Stuff in School

Apr 30, 2024

Why are Physicists so informal with mathematics?

Apr 29, 2024

More from STEM Educators and Teaching

Related Stories

Exploring challenges in learning for nursing students in Morocco

May 6, 2024

Taking a leave of absence can harm medical students' match prospects, finds study

Apr 16, 2024

First study on teacher effectiveness for students with and without disabilities

Mar 25, 2024

Minority students more likely to leave medical school: study

Jul 19, 2022

Study finds clear instruction, parental support predict students' sense of school belonging

Mar 27, 2024

Medical students with disabilities are at higher risk of burnout than peers

Jan 10, 2024

Recommended for you

Investigation reveals varied impact of preschool programs on long-term school success

May 2, 2024

Training of brain processes makes reading more efficient

Apr 18, 2024

Researchers find lower grades given to students with surnames that come later in alphabetical order

Apr 17, 2024

Earth, the sun and a bike wheel: Why your high-school textbook was wrong about the shape of Earth's orbit

Apr 8, 2024

Touchibo, a robot that fosters inclusion in education through touch

Apr 5, 2024

More than money, family and community bonds prep teens for college success: Study

Let us know if there is a problem with our content.

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Phys.org in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter

• Coronavirus Updates
• Education at MUSC
• Adult Patient Care
• Children's Health
• Hollings Cancer Center
• Research at MUSC
• Center for Global Health
• Corey Mealer Reflection

Corey Mealer Reflection – Heart Block: Diagnosis an Management Education in Uganda

Corey Mealer is a College of Medicine student at MUSC. He was awarded a Center for Global Health Student & Trainee Travel Grant in the fall of 2023 to pursue a project with OneWorld Health in Masindi, Uganda. View more photos of Corey's time in Uganda in this Flickr photo gallery .

As our team is walking out of the Kampala, Uganda, airport and into our new home for the next month, we are greeted with a big hug from Joel, the man who will be showing us around for the next month. Joel showed us love and kindness from the moment we met him, and we quickly found out from him and many of the other people who would welcome us during our journey, why Uganda is known as, “the Pearl of Africa.”

The following day, the team – Adam, Austin, Hollis, John B., John M., Kelsey, and I – are taken to Masindi Kitara Hospital (MKH) in Masindi, Uganda. MKH is one of eight medical centers in Uganda that is a self-sustaining center formed in collaboration with OneWorld Health. Mornings would start with devotion, fostering early relationships with the people who are in the hospital every day. After devotion, we would spend the rest of the day rounding with the doctors, collaborating with staff for bidirectional learning, or immersing ourselves in different departments like pre-natal, anti-retroviral therapy, and physical therapy clinics. Early in the experience I received an Empaako, which is a praise or pet name that most people in the community have, Akiiki meaning one with great love, care, honesty, and kindness that I will forever be working to live up to.

While there, I worked on an ongoing project to improve electrocardiogram (ECG) use and interpretation services at MKH with Austin Thomas under the guidance of Claire Milam, M.D. To accomplish this goal, I worked one-on-one with Ugandan providers to help understand and interpret ECGs, offered a lecture with tips and examples of how to interpret atrioventricular block, a pervasive and debilitating condition for many patients in Uganda. The current goal of the project is to improve the use of the ECG so that the hospital can improve diagnostic and treatment capabilities for patients and the use of the ECG is another source of sustainability for the hospital.

Throughout my time in Uganda, there was an early comment that really stuck with me from Joel, “tell people back home what you saw here.” I witnessed a spectrum of humanity: love, kindness, hospitality, grit, ingenuity, intelligence, culture, and patience, juxtaposed with heart-wrenching, difficult realities. For instance, as most people in the community farm, organophosphates are readily available as a cheap pesticide, but also a common source of poison that tragically led to irreversible harm to several patients. These experiences were only amplified when we visited the Kiryandongo Refugee Settlement, home to over 100,000 refugees from Sudan, South Sudan, The Democratic Republic of Congo, Burundi, Rwanda, and Kenya in Bweyale, Uganda. At the refugee settlement, they only had two doctors on staff for all 100,000 potential patients that could come in, which they were responsible for handling surgically and medically. While resources and doctors were scant, their compassion abounded as they welcomed us and patiently served each and every patient they saw.

While these stories are difficult, I am highlighting them to show the great deal of grit and compassion that I witnessed. I was reminded early in my trip of the powerful South Carolina motto, “as I breathe, I hope.” Amidst adversity, the people of Masindi and Bweyale welcomed us with open arms, imparting invaluable lessons about the hard sciences of medicine and the “soft” sciences of compassion and care. I am humbled by the depth of my experiences, and heavily committed to honoring my Empaako, Akiiki, as a reminder to embody love, care, honesty, and kindness in all my future endeavors.

About the Author

Center for  Global Health

• Nebraska Medicine

Midwest Student Biomedical Research Forum

The Midwest Student Biomedical Research Forum provides an opportunity for young researchers from the health sciences, graduate, intern, and resident programs throughout the Midwest to present their research in the biomedical sciences.

 8:00 a.m. – 4:30 p.m.

Mike & Josie Harper Center Creighton University, 602 N 20th Street, Omaha, NE

MSBRF provides the option of presenting research in either an oral or poster format. The forum gives students an excellent opportunity to have their original work reviewed, evaluated, and recognized by their peers and established scientists. Each abstract submitted to the forum is subject to the same type of peer review applied to the selection of manuscripts for publication in major scientific journals.  Financial awards are given in several categories .

MSBRF has grown into an important assembly of young scientists. The previous MSBRF, held in March 2023, was a tremendous success with more than 180 students from Midwestern medical schools presenting their research at the forum.

The forum has been co-sponsored by the University of Nebraska Medical Center and Creighton University since 1987.

Keynote Presenter

Julie K. Freed, MD, PhD, FAHA, FCVS, is associate professor, executive vice chair, and director of clinical research in the Department of Anesthesiology at the Medical College of Wisconsin. Her presentation title is Translational Tales of Resiliency Within the Human Microvasculature.

Joining the Forum

Registration is now closed , cancel/refund policy.

The registration fee for an abstract that is not accepted will be refunded in the same form that the registration payment was received.

No other refunds will be processed.

If for any reason, you will not be able to present at the Forum, you must provide written notification, with the consent of your advisor, no later than Friday, Feb. 16, 2024.

Faculty Advisors

Director, Research Compliance Office; Professor, Department of Pathology, School of Medicine, Creighton University Medical Center

Assistant Professor Emeritus, Department of Pathology and Microbiology, University of Nebraska Medical Center

Planning Committee

The MSBRF Planning Committee is composed of students, faculty, and staff of UNMC and Creighton University.

MSBRF Student Committee

Amanda Christensen (UNMC) Emma Curran (Creighton) Anna Kosmach (UNMC) Justin Rudd (Creighton) Sarah Uhm (UNMC) Aron Lee (Creighton)

Joe Knezetic, PhD Charles Kuszynski, PhD

Administrative Contacts

Colin Dworak (CU) Brenda Ram, CMP, CHCP (UNMC)

Director, Educational Programs, Center for Continuing Education, UNMC

Phone: 402-559-9250

Take the Quiz: Find the Best State for You »

What's the best state for you ».

WHO Chief Asks Israel to Ease Curbs on Gaza Medical Aid

FILE PHOTO: Director-General of the World Health Organisation (WHO) Dr. Tedros Adhanom Ghebreyesus attends an ACANU briefing in Geneva, Switzerland, December 15, 2023. REUTERS/Denis Balibouse/File Photo

GENEVA (Reuters) -The head of the World Health Organization (WHO) called on Tuesday for Israel to lift restrictions on aid into Gaza, saying that the primary pipeline for emergency medical aid into the enclave from Egypt had been cut off.

Israel seized and closed the Rafah border crossing between Gaza and Egypt on May 7, disrupting a vital route for people and aid into and out of enclave.

"At a time when the people of Gaza are facing starvation, we urge Israel to lift the blockade and let aid through," WHO Director-General Tedros Adhanom Ghebreyesus told a news conference in Geneva, describing the situation in the Palestinian enclave as "beyond catastrophic".

"Without more aid flowing into Gaza we cannot sustain our lifesaving support of hospitals and populations," he said.

War in Israel and Gaza

Israel says U.N. agencies are to blame for not distributing aid more efficiently within the enclave, creating backlogs of supplies.

Tedros said Israel's move had impacted six hospitals and nine primary health centres and caused 70 shelters to lose their medical facilities.

"Daily consultations have fallen by close to 40% and immunization by 50%," he said. "Approximately 700 seriously ill patients who would have otherwise been evacuated for medical care elsewhere are stuck in a war zone."

Gaza's healthcare system has essentially collapsed since Israel began its military offensive there after the Oct. 7 cross-border attack on Israel by Palestinian Hamas militants.

Tedros said that Gaza's Al-Awda Hospital in northern Gaza remained under siege since Sunday, with 148 hospital staff and 22 patients and the people accompanying them trapped inside. He said that fighting near Kamal Adwan Hospital, also in northern Gaza, had jeopardised its ability to care for patients.

"These are the only two functional hospitals remaining in northern Gaza," Tedros said. "Ensuring their ability to deliver health services is imperative."

(Reporting by Gabrielle Tetrault-Farber and Emma Farge; Editing by William Maclean and Gareth Jones)

Copyright 2024 Thomson Reuters .

Join the Conversation

Tags: public health , Israel , Middle East , World Health Organization

America 2024

Health News Bulletin

Stay informed on the latest news on health and COVID-19 from the editors at U.S. News & World Report.

Sign in to manage your newsletters »

Sign up to receive the latest updates from U.S News & World Report and our trusted partners and sponsors. By clicking submit, you are agreeing to our Terms and Conditions & Privacy Policy .

You May Also Like

The 10 worst presidents.

U.S. News Staff Feb. 23, 2024

Cartoons on President Donald Trump

Feb. 1, 2017, at 1:24 p.m.

Photos: Obama Behind the Scenes

April 8, 2022

Photos: Who Supports Joe Biden?

March 11, 2020

Key Supreme Court Rulings to Watch For

Laura Mannweiler May 21, 2024

Doomsday Glacier Forecast: What to Know

Cecelia Smith-Schoenwalder May 21, 2024

Trump’s Defense Teams Rests Its Case

Lauren Camera May 21, 2024

Trump’s Defense Gets Its Turn

Lauren Camera May 20, 2024

What to Know: FLiRT COVID-19 Variants

Cecelia Smith-Schoenwalder May 20, 2024

The Unique Burial of a Child of Early Scythian Time at the Cemetery of Saryg-Bulun (Tuva)

<< Previous page

Pages:  379-406

In 1988, the Tuvan Archaeological Expedition (led by M. E. Kilunovskaya and V. A. Semenov) discovered a unique burial of the early Iron Age at Saryg-Bulun in Central Tuva. There are two burial mounds of the Aldy-Bel culture dated by 7th century BC. Within the barrows, which adjoined one another, forming a figure-of-eight, there were discovered 7 burials, from which a representative collection of artifacts was recovered. Burial 5 was the most unique, it was found in a coffin made of a larch trunk, with a tightly closed lid. Due to the preservative properties of larch and lack of air access, the coffin contained a well-preserved mummy of a child with an accompanying set of grave goods. The interred individual retained the skin on his face and had a leather headdress painted with red pigment and a coat, sewn from jerboa fur. The coat was belted with a leather belt with bronze ornaments and buckles. Besides that, a leather quiver with arrows with the shafts decorated with painted ornaments, fully preserved battle pick and a bow were buried in the coffin. Unexpectedly, the full-genomic analysis, showed that the individual was female. This fact opens a new aspect in the study of the social history of the Scythian society and perhaps brings us back to the myth of the Amazons, discussed by Herodotus. Of course, this discovery is unique in its preservation for the Scythian culture of Tuva and requires careful study and conservation.

Keywords: Tuva, Early Iron Age, early Scythian period, Aldy-Bel culture, barrow, burial in the coffin, mummy, full genome sequencing, aDNA

Information about authors: Marina Kilunovskaya (Saint Petersburg, Russian Federation). Candidate of Historical Sciences. Institute for the History of Material Culture of the Russian Academy of Sciences. Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail: [email protected] Vladimir Semenov (Saint Petersburg, Russian Federation). Candidate of Historical Sciences. Institute for the History of Material Culture of the Russian Academy of Sciences. Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail: [email protected] Varvara Busova  (Moscow, Russian Federation).  (Saint Petersburg, Russian Federation). Institute for the History of Material Culture of the Russian Academy of Sciences.  Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail:  [email protected] Kharis Mustafin  (Moscow, Russian Federation). Candidate of Technical Sciences. Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected] Irina Alborova  (Moscow, Russian Federation). Candidate of Biological Sciences. Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected] Alina Matzvai  (Moscow, Russian Federation). Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected]

Shopping Cart Items: 0 Cart Total: 0,00 € place your order

Price pdf version

student - 2,75 € individual - 3,00 € institutional - 7,00 €

Copyright В© 1999-2022. Stratum Publishing House

40 Facts About Elektrostal

Written by Lanette Mayes

Modified & Updated: 21 May 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy , materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes , offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

Elektrostal's fascinating history, vibrant culture, and promising future make it a city worth exploring. For more captivating facts about cities around the world, discover the unique characteristics that define each city . Uncover the hidden gems of Moscow Oblast through our in-depth look at Kolomna. Lastly, dive into the rich industrial heritage of Teesside, a thriving industrial center with its own story to tell.

Was this page helpful?

Our commitment to delivering trustworthy and engaging content is at the heart of what we do. Each fact on our site is contributed by real users like you, bringing a wealth of diverse insights and information. To ensure the highest standards of accuracy and reliability, our dedicated editors meticulously review each submission. This process guarantees that the facts we share are not only fascinating but also credible. Trust in our commitment to quality and authenticity as you explore and learn with us.

Share this Fact: