Table 1.

Objectives, Approaches, Challenges, and Strategies For Implementing Systems Ethnography Roles for Medical Students in the ED

Objectives	Approaches	Challenges	Strategies
To immerse students into authentic care delivery processes, and link them with patients to observe processes related to patient care.	Identify appropriate time and space in the curriculum to integrate systems ethnography roles. Collaborate with ED and nursing leadership in the design phase of the experience.	Staff may be unfamiliar with the students’ roles, the purpose of students’ presence, and potential for clinical and educational benefit .	Ongoing communication with students, staff, and ED leadership to ensure smooth transitions in the experiences.
To provide students the opportunity to practice the use of ethnography and systems thinking skills in conducting observations.	Provide students the prerequisite education and knowledge/skills related to ethnography and systems thinking in the clinical setting. Assist students with regular guidance and “check‐ins” during their ED visits (i.e., reviewing field notes, providing exemplars of best practice).	Educational sessions will likely require collaboration with other educators to develop new strategies that may not be part of the current curriculum. Students may be new to the concepts of ethnography and systems thinking and therefore unfamiliar with its use and applicability.	Assume a developmental model of education by focusing on knowledge/concepts and beginner skills within the experience. Provide rationale of goals and examples of applicability of ethnography and systems thinking to their careers as physicians.
To allow students to work in teams to explore the facilitators, insufficiencies, and potential improvements in the ED.	Highlight the team‐based approach to the students throughout all phases of the educational experience. Design an end‐of‐experience debriefing session to allow students to reflect, explore, and articulate observations of insufficiencies and brainstorm potential improvement efforts.	Students may have limited experience or knowledge with the complexities of the healthcare delivery system, thereby limiting discussions. Students may be apprehensive to report insufficiencies to health system and ED leaders.	Integrate an interdisciplinary team of educators and providers into the debriefing session design. Create a safe environment from the beginning of the experience by highlighting the goals and allowing health system leaders to identify their purpose in participating in the experience.