3.2. Video-assisted fieldwork methods to study radiology work practice
Participant observation is typically coupled with other fieldwork methods for data gathering. In studying radiology work practice I had to employ a repertoire of methods with a varying emphasis on participation, observation and interviewing because of the different nature of specialised radiology occupations.
My idea of using video has been based on recording actual work activities during fieldwork to enhance the observation of practitioners’ work (see Figure 5, p. 68) and then using these tapes for analysis and design (for a more detailed discussion on the use of video see Karasti (1997b), publication II). This section describes the use of video in connection to fieldwork methods whereas the use of video as design material, e.g. video collages in workshops, is elaborated later.
Figure 5. Sari is sitting on the table and preparing the video camera to record Maija’s work with the teleradiology system in the small room where the scanner and computer workstation were located in the Kuusamo Primary Care Center. An interested by-passer on the left has stepped into the room to follow what was going on.
3.2.1. In situ interviewing with radiology nurses
In situ interviewing[1] combines observation of work activities with asking questions from the practitioners while they are engaged in their work activities. I used this method for studying work activities where the practitioners could tolerate such observation coupled with interrogative interruptions and still carry out their everyday practice. For instance, I studied the work of roentgen nurses who assist radiologists in examinations and take care of patients’ well-being before, during and after examinations.
To support my observation of three radiology nurses collaboratively working at the CT scanner used for neurological examinations I used a stationary video camera with a wide-angle lens and an external microphone, positioned to cover as much as possible of the activities going on around the CT workstation. Gradually I learned when it was appropriate to intervene without intruding too much. I asked questions which were motivated by my observations of the unfolding events and activities (see Figure 6).
Questions in in situ interviews typically are asked on-the-fly as they arise in actual situations. Thus they produce data of greater ‘ecological validity’ than interviews which are not conducted on the job. (Jordan 1996a.) The questions I posed to the nurses evolved according to my increasing familiarity with the setting and my evolving understanding of their work. As I started out the nurses introduced me to the technologies and equipment used in patient examinations. They also told me about the division of labour and responsibilities between nurses and radiologists in conducting patient examinations.
Figure 6. In situ interviewing while observing roentgen nurses doing head examinations on a CT scanner. Sirkka and Arja, two roentgen nurses (on the left), explain to me (facing the camera) the next procedure while Anne, the patient nurse (who can be seen through the window), is preparing the patient. A medical student (on the right) observes.
I was explained the system developed for three nurses rotating between three roles during a shift on the CT-scanner. The ‘patient’ nurse would prepare the patient to the examination and take care of her/him throughout the examination. The ‘CT’ nurse would be in charge of programming and running the CT scanner. The ‘administrative’ nurse would take care of current routines and co-ordination of resources, e.g. answering the phone, making reservations and updating the schedules in the X-RAY, fetching or forwarding PEFs. Progressively I learned more about the procedures, schedules and lists that are used for organising and co-ordinating the available resources as well as the typical or standard ways applied in carrying out specific routines.
Through in situ interviewing I could both learn about how the nurses comprehend their everyday work and observe actual everyday activities that comprise the work of ‘doing heads’. By combining their rich contextual understanding and my outside view I constructed my understanding of the highly structured and procedurised work which, however, is situationally constructed and co-ordinated through mutual awareness and unfolding collaboration.
3.2.2. Shadowing film developers
The fieldwork method of shadowing[2] could be characterised as ‘thick’ combination of open, on the job interviewing coupled with participant observation on the move. I used it to study the work of film developers because the nature of their work of managing film and patient document logistics is highly mobile (see Figure 7, p. 71 and Table 5, p. 72). As the film developers need to find and in some cases also actually fetch patients’ previous films, they move around both within the department to which they are assigned and also in other locations of the hospital, e.g. other roentgen departments and patient wards, and the film file storage rooms. For managing and co-ordinating the availability of films along the patient examination trajectory the film developers continuously engage in brief communicative encounters with co-workers in the hospital as they move around searching, gathering, selecting, organising and delivering films.
As I followed a film developer through her everyday activities I would adjust the emphasis of my mode of interaction with her between participation, observation and inquiry as it seemed appropriate to the situation at hand. Most of the time the film developer could keep me informed of what was going on by explaining the activities while engaged in them. I would also probe with questions to elicit on aspects of work I could not yet understand. At times the tasks would get so intensive that I retreated to peripheral observation and these events were scrutinised together after they were over.
I would audio record the entire period of shadowing and videotape certain interesting events and activities as they unfolded. For documentary data I made printouts of computer screens and copies of documents that the film developers handled. I also used the video camera to capture documents ‘on the fly’ as it often would have been impossible to make copies of all documents in the course of activities. Thus, shadowing resulted in a combination of elicited, observed, and documentary data.
Figure 7. Liisa, a film developer, is preparing the next day’s roentgen meeting for surgeons. I am videotaping (reflection in the mirror) her intensively material oriented activities.
Shadowing film developers gave a more holistic understanding of their work. Until then I had only observed their work as part of the collaborative activities within the roentgen departments. By shadowing them I learned how film developers sort through the routines and problems of their intensively materially mediated work and become engaged in the work of the radiology community by using their local knowledge and lived expertise of film work.
Film developers take care that patient materials are available and organised for examinations, image interpretation sessions, roentgen meetings and demonstrations. In selecting and arranging images for image interpretation sessions the film developers use their knowledge of the images as radiological representations, of their technical quality, of their relevance to the specific patient case, of the common ways and traditions in image interpretation, and even of radiologists’ personal preferences in image interpretation. In the frequent searches for missing films the film developers draw on their knowledge of the film ‘trails’ and ‘pools’ within the roentgen departments that mark the patient examination trajectories, as well as the typical routes of patients and the networks of trusted co-workers within the hospital.
Instances of film developers’ everyday work practice.
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| Picture A. In one of the film archives Liisa searches for the film files of patients to be examined by their birthdays (day and month displayed on the left). | Picture B. Liisa assembles patients’ previous films, roentgen histories, current requests and microtapes into PEFs. |
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| Picture C. In tracking down a missing film Liisa phones a ward. While waiting she receives a request sent by tube-mail. | Picture D. Liisa takes dictated cases over to Tuija, a department secretary, who types out the reports on tapes. |
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| Picture E. Marita and Liisa go over the stacks of PEFs at the ‘unfinished pool’ counter when their shifts change. | Picture F. Marita uses the X-RAY for checking the wards of examined in-patients to forward the film files. |
3.2.3. Stimulated recall interviews with radiologists
Stimulated recall interviews[3] were used especially in relation to the radiologists’ image interpretation work. The interpretive diagnostics were hard to grasp for a lay person by mere observation, and interviews with radiologists about image interpretation provided just approximations or typifications. The intensively cognitive character of activities excluded the possibility of inquiring interventions during the sessions. The situations only allowed for the passive presence of the fieldworker enhanced by videotaping. Any detailed analysis of these tapes was nearly impossible by a non-radiologist, especially if there was only one radiologist working. The method of stimulated recall interviews based on reviewing video tapes collaboratively after the actual work had taken place had the advantage of not being too intrusive yet staying close to the actual events.
The stimulated recall interviews were organised as soon as possible after the actual image interpretation sessions, so that the radiologists would still remember the event. The possibility to freeze and repeatedly review the tape allowed for scrutinising the activities more thoroughly (see Figure 8, p. 74). The method allowed for minimal structure of sessions as the discussions were open to all questions, comments, interpretations and explications evoked by the videotaped instances of work. However, different emphases could be employed in regard to the particular purpose, e.g. whether to elicit specific information about actions and events the meaning and importance of which were vague to fieldworker, or to let the radiologist do all the commenting when something strikes her/him as noteworthy. In the first fieldwork phase the method was used to gain a broad coverage of collaborative image interpretation by organising interviews with each individual radiologist whose collaborative work on image interpretation had been observed and videotaped. During the teleradiology fieldwork the attempt was to get into more in-depth analyses and the sessions gradually grew into instances of collaborative analysis as all interviews were conducted with the same teleradiologist. The sessions were either audio or video recorded to provide material for further analyses.
The stimulated recall interviews allowed the radiologists a chance to reflect on their work from within a distance to actually carrying out the work. We engaged in detailed analysis of the unfolding activities. As the radiologist could still remember the case and recall what he had been thinking of during interpretation, we were not limited just to the observable phenomena but also the cognitive processes became accessible (at least to a certain point). As the teleradiologist gained experience in taking a more analytic stance towards his work, he started to articulate the embodied routines and tacit details of image interpretation that in ordinary practice remain unremarkable. The fieldworkers gained a possibility to analyse the observable activities on the video tape intertwined with descriptions of the invisible and tacit aspects of seeing, interpreting and diagnostic problem solving. The fieldworkers learned about the radiologists employing their professional expertise of human internal anatomy, physiology and pathology as well as their practical experience of clinical work on reading and analysing unique sets of patient materials in the course of everyday interpretive diagnostics.
