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Medical Students as Systems Ethnographers: Exploring Patient Experiences and Systems Vulnerabilities in the Emergency Department
Author(s) -
Gonzalo Jed D.,
Graaf Deanna,
Kass Lawrence E.,
Promes Susan B.,
Wolpaw Daniel R.,
George Daniel R.
Publication year - 2017
Publication title -
aem education and training
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 9
ISSN - 2472-5390
DOI - 10.1002/aet2.10038
Subject(s) - debriefing , likert scale , medical education , ethnography , emergency department , qualitative research , psychology , health care , nursing , medicine , sociology , developmental psychology , social science , anthropology , economic growth , economics
Objectives The objectives were 1) to design systems ethnography roles for first‐year medical students that could enhance student learning with regard to healthcare systems, ethnography, and systems thinking and 2) to describe strategies for other education programs seeking to implement systems ethnography roles in clinical settings. Methods Fourteen medical students were educated about ethnography and systems thinking and linked with patients in the emergency department ( ED ) for 12 to 15 hours to observe patient experiences and clinical processes. Students submitted written assignments, participated in a debriefing exercise with ED and medical education leadership, and completed an electronic survey regarding educational benefits and perceived clinical value conferred to the ED using 5‐point Likert‐scale questions. Qualitative methods were used to analyze both students’ assignments and notes taken during the debriefing session, including small‐group report‐outs and discussions, and to identify vulnerabilities in the patient experience. Results Students identified one overarching theme of the patient experience—prolonged waiting in close proximity to the fast‐paced, hectic “world” of the ED . Four key categories of systems vulnerabilities were identified through student observations: 1) patient experience; 2) communication and collaboration; 3) processes, physical space, and resources; and 4) professionalism. Students reported improved appreciation for challenges experienced by patients (3.92/5), importance of communication between providers and patients (3.92/5), and improved understanding of the patient experience while receiving care (3.77/5). Conclusions These results demonstrate how innovative systems ethnography experiences for medical students can provide unique educational opportunities while at the same time adding value by highlighting shortcomings in the care environment that can be used for system improvement.