VREIA Conference 2025 Program

Background: Healthcare faces increasing costs and complexities which the usual approaches to Quality Improvement (QI) cannot address. Video-reflexive ethnography (VRE) claims to do so. VRE involves researchers agreeing with participants a subject for videoing, videoing day to day activities, selecting video clips, and showing these clips to participants at reflexive focus groups – from which participants develop their practice.

Aims: This research investigated the use of VRE as a QI methodology, specifically fidelity and flexibility in the application of VRE, the feasibility and acceptability of VRE in practical and ethical terms, and how power dynamics inherent within the VRE methodology can be managed.

Methods: A systematic review of published VRE and semi-structured interviews with researchers and clinicians who had used VRE for research or QI papers were used to assess the fidelity of VRE projects to the VRE principles and methodology.
Findings: The flexibility of VRE methodology means care must be taken when applying it, however only 1 clear case of low fidelity VRE was found. Generally, VRE was acceptable to both researchers and participants, but again, care should be taken when using VRE – especially regarding the feasibility of research in terms of ethical approvals and informed consent, as these impact on what it is possible to video. Power relationships and dynamics are under-considered in the VRE literature, when using VRE for QI it would benefit from further researcher consideration and reflexivity of this aspect of VRE.

Conclusions: VRE is a valuable tool in the QI toolbox, as it can address problems that other QI methods cannot. But care needs to be taken when applying VRE.

Video-Reflexive Ethnography (VRE) is a research approach and intervention in healthcare optimisation that has been used for more than twenty years by diverse and cross-disciplinary teams. Yet the celebrated success of VRE’s contribution to quality and safety in healthcare is also an opportunity to ask a very real question: what if VRE isn’t possible in certain care contexts? On behalf of the researchers, students and clinicians who have faced a situation where VRE is not ethically possible, in this presentation I showcase the exnovation of VRE research practices in a context marked by acute tragedy and profound grief. Yet with the same drive as a VRE-researcher to intervene in and optimise lactation health care delivery for bereaved mothers using a visual methods, I exnovated the four principles underpinning VRE (care, collaboration, exnovation and reflexivity) to develop and then pilot the Lactation After Loss Commemorative Quilt reflexive workshops. The workshops feature a two-sided, custom-made textile art piece made by artist Dr. Rebecca Mayo. With tear-like milky stains across botanically-dyed fabric, the quilt tenderly reveals the lactation and care experiences of bereaved mothers after infant death through the mordant-printed words of mothers. These quilt-based workshops operate as reflexive sessions that enable a dialogic questioning of habituated meanings and identities by healthcare workers who provide care to bereaved mothers. In this presentation, I share my exnovation of VRE practices through the four VRE principles, the resultant development of a new visual method, and some of the engaged and transformative participant learnings from the quilt workshops. I argue that when VRE cannot be used, it is a moment to exnovate VRE’s underpinning principles in order to develop other visual methods as effective “potentiation technologies” (Iedema 2020) that can be used to optimise healthcare delivery.

Reflexivity is commonly used in qualitative research and is commonly described as a method researchers can use to interrogate the quality of their research practices and experiences. However, reflexivity also proves an uncertain space for researchers and as such can also become somewhat of a confessional or catharsis through which this uncertainty is explained away in self-reflection.

In video reflexive ethnography (VRE), reflexivity is more complex. As one of four methodological principles, it is not positioned only as a way for researchers to reflect on the process, but is central to how researchers and participants relate across multiple dimensions. Put simply, in VRE, reflexivity is not only inward-facing, it is also necessarily about attention and accountability outwards to the multiple others involved in the collaborative projects. Frameworks describing reflexivity as multi-layered accountabilities to others, have been usefully proposed for participatory methods.

The aim of our research project is to further develop a framework of reflexivity to identify and articulate the value and practices of reflexivity, at different levels, of that which might be necessary in participatory methodology, focusing on VRE in particular. In this presentation we will report on the preliminary results of a scoping review, currently underway. The aim of this review is to map and report on how reflexivity is described, at multiple levels, in participatory health research.

Background: Real-time verbal feedback is an important component within experiential clinical communication training. Effective feedback from facilitators, peer-learners and
simulated patients may contribute towards improved learner communication practices and thus patient outcomes. While the published literature provides a foundation for giving feedback, student experiences of receiving feedback are a less researched area. Additionally, much of the published literature originates from Western contexts and its applicability to other contexts is unknown.

Methods: We employed video reflexive ethnography (VRE) to explore medical student experiences of clinical communication feedback interactions in Jordan. Using the lens of aggregate complexity theory, we followed an iterative process resulting in 19 observations, 26 video clips, 20 interviews and 11 reflexive sessions.

Results: The collaborative VRE process revealed the complexity of feedback interactions and generated new insights into feedback experiences. These included negotiating the purposes of feedback; navigating feedback webs and multiple learning opportunities; digesting and filtering feedback; recognising and adjusting power differentials; and mitigating face-threat with politeness strategies and tutor buffering. The Jordanian cultural aspects of reputation and gender conventions were found to influence feedback interactions and accentuate the requirement for politeness practices. In addition to new insights and interpretations, participants reported knowledge and attitudinal changes regarding feedback, as well as potential behavioural changes for future feedback practices.

Conclusion: This study advances the conceptualisation of feedback beyond a unidirectional flow of information or bi-directional situated relational interaction to a complex system of dynamic non-linear processes between multiple individuals from which emerges learning of multiple competencies and attributes for professional development.

Background: Video reflexive ethnography (VRE) is a proactive, collaborative research approach. Its utilisation has been low in non-Western settings, such as the Middle East, possibly due to reservations to adopt new research approaches or cultural influences affecting its acceptability and feasibility. The significance of reputation and gender conventions are prominent features of Arab culture which may affect willingness to participate in video research methods.

Methods: We employed VRE to explore the experiences of medical students in Jordan regarding clinical communication feedback. In total, 11 reflexive sessions took place: 9 with medical students and 2 with tutors. There were 16 male and 13 female participants.

Results: Reflecting on feasibility, gatekeepers provided access and the curricular timetable gave structure to organise the video recording. The educational context also facilitated gaining ongoing consent from participants, as there were no unexpected participants captured in the video recordings. Medical students and tutors readily engaged with the VRE participatory process. Both the maturation and gender of students did not appear to influence consent for video recording or participation in reflexive sessions. The reflexive sessions provided a unique opportunity to view feedback interactions differently: “not being in the spotlight, being outside of it, that helps to see the full picture.” (Student RS-3). The ‘hologrammatic’ effect of video footage was apparent, as participants considered feedback practices beyond those shown in the video clips. Reflexive discussions generated new insights and revealed the complexity of feedback practices. Participants reported changes in their knowledge, attitudes and behaviours regarding feedback.

Conclusion: Reflecting on our experiences, we found VRE to be an acceptable and feasible research approach in the Jordanian context.

Black women (BW) in the UK experience persistent health inequities, perpetuated by gendered discrimination operating at systemic and interpersonal levels in healthcare. However, their lived experiences remain underrepresented in knowledge production and service design. Utilising VRE, this study aimed to centre BW’s experiences and critically examine interactions between BW and clinicians to identify interactional strategies that could facilitate positive patient experience in healthcare consultations. Following over 100 hours of ethnographic observation across three sexual health services and three HIV services in East London, 25 participants were recruited across a 12 month period. Consultations were video-recorded and the footage edited to create short clips for reflexive patient workshops. Within two video-recorded workshops, seven BW articulated their experiences, critiqued care practices, and identified opportunities for transformation. Further workshops will be undertaken. Interactional socio-linguistic analyses of recordings, grounded in Black Feminism and Intersectionality, are ongoing. Initial findings reveal non-verbal microaggressions, perceived power dynamics and prior experiences shaped BW’s clinical interactions. Participants emphasised cultural sensitivity and pace of clinician communication as key influencers. VRE’s reflexive approach enabled the articulation of nuanced narratives often obscured by dominant discourses and foreground patient agency. The researcher’s dual positionality — as a BW and clinician – offers unique insights into trust-building, ethical reciprocity, and the negotiation of insider-outsider dynamics in VRE. This study demonstrates VRE’s potential as a transformative participatory research tool for marginalised communities; disrupting epistemic hierarchies to foster community-driven change. By centring BW’s agency and critiques, VRE is able to generate actionable knowledge that bridges academic rigour and social justice.