Using ethnographic fieldwork to cultivate situational awareness.

Abstract

In primary care settings, clinicians' awareness of the situations surrounding physician-patient interactions is crucial for clinical reasoning and decision-making. However, there are limited opportunities to cultivate situational awareness explicitly. To bridge this gap, we conducted a novel one-day workshop informed by ethnographic fieldwork, in which participants were encouraged to attend to compare clinical encounters with other encounters in conspicuously different situations and to engage in 'frame reflection'. In the work, through considering why some areas had a different atmosphere or shop assistants' smiles seemed smarmy, participants found that their interpretations are affected by the typically taken-for-granted notion. One participant then realised that he could have missed the signs and the clues arising both from the patient and the surrounding circumstances. In conclusion, our ethnographic fieldwork session to perform quasi-clinical tasks in unfamiliar settings helped participants to recognise how tacit knowledge and frames guided and influenced their observations and interpretations. This, in turn, led to a reflection on what is taken for granted in familiar clinical encounters. An ethnographic fieldwork with quasi-clinical tasks can facilitate comparative reflection of clinical tasks between familiar and unfamiliar settings, which broadens and sharpens situational awareness through frame reflection.