Participant observation for inquiry-based learning: a document analysis of exam papers from an internship-course for master’s students in health services research in Germany | BMC Medical Education

Sample and internship characteristics

In total, 49 IBL assignments from four cohorts (defined by the year students were enrolled in the master’s program) of the years 2020–2022 were included (see Table 2). This corresponds to all presentations held during that time. Within two assignments field protocols were missing. Nonetheless, these could be included in the analysis, since the presentations comprised sufficient extracts of the field protocols. Variation in numbers of course participants were related to part-time students. Presentations typically included 15 slides, field protocols on average two to four pages per observation. All presentations and field protocols were in German, the main language of instruction within the master’s program. Of the students providing the presentation, five of the 49 were male and about a third had a professional background in health care, mirroring the general characteristics of the student population. Internship length was 140 to 280 h, either fulfilled over three to eight weeks full-time or part-time over a period of several months.

For the IBL assignment, most students selected internship experience (n = 40); the remaining students (n = 9) selected their professional employment in health care. Work places were (a) organizations providing health care (n = 28), including nursing homes (n = 2) and hospitals (n = 26), of which 22 were university hospitals; (b) other organizations in health care (n = 8), such as government departments and health insurances and (c) research institutes (n = 13), mostly universities (n = 8). The focus of work experiences reflected these employer types to some extent: Most students were mainly involved in research activities (n = 31), such as literature reviews, developing questionnaires and interview guides, data analysis and overall research management. Some students (n = 5) were involved in academic teaching, mainly in the role of (assistant) teachers. Provision of health care (n = 4) included assisting nursing and patient involvement. Administrative tasks (n = 8) included preparation of meetings and reports, often based on literature research.

Research objectives

A research objective was specified in all presentations, most addressed either communication in videoconferences, e.g., concerning active participation or technical difficulties (n = 14) or some aspect of research practice (n = 11), e.g., conducting interviews. Further objectives included patient care (n = 7), teaching (n = 4) and handling of Covid-19 regulations (n = 4) (see Table 3: section A). Observation settings were largely either virtual (n = 20) or face-to-face meetings (n = 23), with two observations of telephone conversation and four with mixed settings. Research participants varied and often included a mix of people: Researchers were observed most often (n = 29), followed by health care providers (n = 16) and patients/relatives (n = 11). In 35 cases, observing students included themselves in the descriptions.

Field protocols

Most protocolled observations within reports included room description (n = 45), most contained direct quotes (n = 42), some used description of persons (n = 12) and a few comprised sketches and/or pictures of places observed (n = 4) (see Table 3: section B). Overall, detail of description varied, ranging from rather abstract monosyllabic reports with little situation-specific portrayal to comprehensive, in-depth reports with lively accounts. Within all reports (n = 49), anonymization was used, primarily employing pseudonyms for people observed. However, the degree of anonymization differed, some omitting indicating professions, gender and employment titles and some masking identifying characteristics of employers. While anonymization did not limit documenting observation within most reports, observations were reduced to mere generic enumeration of events in a few exceptional ones. For structuring field protocols all students used the suggested columns to separate observations and analytical notes (n = 49). All but one also included the third column on emerging codes and themes. The level of detail within columns and accuracy of separation differed.

Presentation and reporting

All IBL assignments included a description of the characteristics of the employer and information on the work activities (n = 49) (see Table 3: section C). Most presentations (n = 39) included literature-based background informationon communication and use of online meetings (n = 16), challenges in health care (n = 7), good research practice and scientific integrity (n = 7), organization and management (n = 5) or the impact of Covid-19 regulations (n = 2). Some students explicitly listed theoretical concepts used (n = 15), which were mostly communication or organizational theories.

Most (n = 39) presentations included a description of data conduction: The majority was based on participant observation (n = 30), often using open observation (n = 16). Overall, methods of data analysis were sparsely reported (n = 34): General description of data analysis without references to theoretical or methodological schools or authors (n = 16) usually shortly indicated whether themes/codes were derived inductively and/or deductively. For describing methods of data conduction and data analysis, recommended readings of the IBL course (n = 18) and/or the overall master’s’ course (n = 14) were often used. 27 did not refer to methodological literature at all.

All presentations (n = 49) included some kind of conclusion addressing results, reflections and/or recommendations. Most students discussed their observations on the content level (n = 34) providing primarily neutral descriptions. This was discernible when students were reporting on “general conditions, settings and factors” (n = 11) or “factors influencing virtual and face-to-face meetings” (n = 10). Many students addressed the meaning of their findings in relation to the observed participants (n = 19) and stated that certain communication strategies (n = 7) or coping strategies and leadership behavior (n = 6) could be instructive for them at future work places. Only the minority of students discussed their results on a personal level (n = 7), and most of them valued the internship combined with the participant observation assessment as an exciting and stimulating experience (n = 4) which made them aware of new career prospects (n = 2). Only one student reported that she experienced the internship as a “one-sided activity” (n = 1).

Reflection

Reflection on the methods and research experience were part of most presentations (n = 30) (see Table 3: section D). Predominantly mentioned topics were observer roles, field access and participants’ consent. The first topic (n = 23) included problematizations of observing while participating and the risk of overidentifying with observed people’s perspectives (“going native”) as well as observer bias due to previous experience within the field. Additionally, students saw challenges in cases where they perceived that there were too many or too few people and/or interactions accessible for observation. Field access and identification of observable situations (n = 12) largely referred to limitations within home-office-settings and online-meetings. Reflections on informed consent (n = 10) addressed the extent of consent, e.g., when, and how many times the student’s own role as researcher should be thematized, whom to inform, and how to handle confidentiality agreements regarding internship content. In addition, some students reflected on difficulties in determining a research focus (n = 5).