Elite Interviewing as a Research Method: A worked example studying Academic Leadership in Health Professions Education

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Without methods capable of engaging with this complexity, research risks producing shallow or instrumental accounts that fail to generate constructive insights or prompt meaningful reform. The HPE literature has limited practical, worked examples of how to conduct such research, particularly with senior leaders. Elite interviewing, a method widely used in political science and sociology, offers a valuable but underutilized methodological approach. It prompts deep exploration of how individuals in positions of authority think, act, and negotiate personal values, organizational priorities and broader sociopolitical contexts. In this paper, we examine elite interviewing as a methodological approach and expand the details of the approach by proposing a framework for elite interviewing in HPE with six interrelated elements: narrative framing, co-construction of meaning, affective vulnerability, institutional critique, credibility building, and ethical reflexivity. Drawing on a worked example of interviews with academic leaders involved in medical education equity initiatives, we demonstrate how employing these elements supports depth, nuance, and reflexivity in both the interview process and analysis. Our aim is to provide practical guidance demonstrating the potential of elite interviewing to methodologically enrich qualitative research in HPE. Qualitative Methods Leadership Health Professional Education Organizational Policy Interviews as Topic. Introduction Research in Health Professions Education (HPE) often involves garnering insights from experts who occupy senior positions of influence - leading scientists, clinicians, hospital executives, medical deans - whose decisions shape educational and institutional directions. In other professions such as politics, religion, and business such individuals are often conceptualized as ‘elites’. What unites these leaders is their institutional authority, specialized expertise, time constraints and relative inaccessibility to researchers. When interviewing these elite leaders, researchers are often in the position of ‘studying up,’ needing to have both the credibility and interview skills to elicit genuine insight, especially on polarizing or controversial topics.(Odendahl et al. 2002 ; Stephens and Dimond 2019 ) The proximity of elite leaders to organizational authority, and their visibility in professional hierarchies, means they may be highly sensitive to external scrutiny, refraining from disclosing their personal views in favor of describing formal organizational perspectives.(Stephens and Dimond 2019 ) Interview-based inquiry with elite leaders must therefore move beyond surface descriptions to consider how their perspectives are constructed through, and constitutive of, institutional logics and practices. In this paper, we introduce and extend the methodological tradition of elite interviewing, adapting principles from other disciplines to the study of leadership in HPE, and illustrate how this technique can be applied through a worked example of a study of academic leadership in health equity initiatives. In HPE research, semi-structured interviews are commonly used to explore personal perspectives and experiences.(Mauldin and Chambers 2024 ) To avoid the risk of facile or platitudinous conclusions, interviews must be designed to engage elite participants in nuanced, contextually situated dialogue that goes beyond institutional rhetoric and rehearsed narratives. To do this, HPE researchers are increasingly employing reflexive and emergent interview approaches, fostering co-constructed dialogue, interpretive depth, contextual meaning, and recognition of the researcher’s influence.(Blalock and Balmer 2023 , 2024 ; Kahlke et al. 2025 ; McOwen et al. 2024 ) However, some researchers still gravitate toward more rigid formats shaped by postpositivist assumptions, prioritizing neutrality, standardization, and data saturation.(Herron 2023 ; Park et al. 2020 ) This interview structure can inadvertently reinforce reductivism or oversimplified questioning, limiting depth of insight and critical reflection.(Finn et al. 2022 ; Jamieson et al. 2023 ) Elite interviewing offers an approach that is particularly valuable when engaging with those in higher institutional positions than the researcher. Arising from traditions in sociology, journalism, and political science, the elite interview is a dialogic, emergent exchange that positions interviewees as experts tied to the institutions they shape.(Boucher 2017 ; Gupta and Harvey 2022 ; Kezar 2003 ; Teixeira and Bridge 2024 ) In contrast to conventional interview formats, elite interviewing foregrounds adaptive interview strategies, credibility work, and trust-building to navigate asymmetrical relationships. Rather than applying uniform questions across interviews, this approach uses tailored, relationally attuned methods to support open-ended engagement and reflection.(Dexter 1970 ; Odendahl et al. 2002 ) Drawing on feminist and narrative inquiry, Kezar highlights how this openness within the interview builds open dialogue and exchange that is transformational for the interviewee and interviewer.(Kezar 2003 ,Kezar 2008 ) When conducted reflexively, elite interviewing can support engagement that centers the lived experience and institutional perspective of leaders, allowing for deeper exploration of meaning, power, and context.(Kezar 2003 ) Elite interviews have potential to address some of the methodological limitations experienced when conducting qualitative research involving HPE leaders, but more guidance, with examples, is needed to support robust application of this method. In the first section of this paper, we outline how elite interviews are conducted in disciplines outside of healthcare and consider how these approaches can be adapted to study academic leadership in HPE. We build on the approach to elite interviewing proposed by Kezar, engaging with Ahmed’s work on institutional performativity, to propose a framework for elite interviewing suitable for use with HPE leadership.(Kezar 2003 ,Ahmed 2012 ) In the second section of this paper, we present a worked example of elite interviewing from a study on diversity, equity, and inclusion (DEI) in postgraduate medical education. In this example, we examine how elite interviews were conducted with academic leaders and explore the interactional, ethical, and analytical dimensions of the method. We focus on the methodological challenges encountered, the interpretive strategies employed, and the implications for future qualitative research in health professions leadership. Organizational elites Defining who is included in the category ‘elite’ is not straightforward. In many disciplines, elites are positioned at the upper levels of a profession or society, marked by their access to resources, power, or status.(Odendahl et al. 2002 ) In disciplines such as law, political science, or journalism, elites are often defined by institutional authority or specialized knowledge - experts whose insights shape policy or public discourse.(Damele and Campos 2022 ; Ma et al. 2021 ; Teixeira and Bridge 2024 ) In corporate and business professions, elites are well connected, and hold highly contextualized information about operations and strategies that other employees do not have access to.(Ma et al. 2021 ) Although these roles often are also associated with wealth or social prestige, they are considered elite because of their strategic positioning within systems of influence. This description of an elite, however, is rarely absolute. For instance, is someone ‘elite’ by virtue of their societal standing, professional position, or simply in relation to the researcher? Definitions shift depending on the topic, the context, and the relational dynamics of the study.(Stephens and Dimond 2019 ) In HPE, the term ‘elite’ can feel discordant, imbued with hierarchical connotations that sit uncomfortably at odds with the collegiality and inclusion that underpin much of health professions research.(Jones and Fulop 2021 ) In this project, we define HPE elites contextually as those in formal health leadership roles with decision-making authority over academic structures, strategic direction and policy implementation.(Clay-Williams et al. 2017 ; Denis and Gestel 2016 ; Jones and Fulop 2021 ) These include medical deans, department chairs, senior clinicians, directors, and executives who make decisions that shape the everyday practice of institutions supporting HPE. These individuals have access to the levers of organizational change and can offer insight into how organizational policies and commitments are enacted around structural, operational and professional constraints.(Goldman and Swayze 2012 ) Approaches to elite interviewing Elite interviewing has its origins in the focused interview: an interviewing technique where participants are chosen because of their expertise or experiences with a specific situation or topic.(Dexter 1970 ; Merton et al. 1990 ; Merton and Kendall 1946 ) Table 1 outlines some of the different approaches to elite interviewing and how these vary in their application and core features, and we then describe each in depth below. Table 1 Approaches, features and applications of elite interview methodology Approach Core features Benefits and Risks Applications Investigative Journalism (Dexter 1970 ; Dodson et al. 2007 ; Mellado 2015 ) Employ scrutiny-based questioning techniques. Attribute ‘expert’ status to informants. Often uses linguistic and discourse analysis. Prompts unexpected disclosures. Measure shifts in power and control. High risk of withdrawal or backlash. Political reporting, corporate scandals, conflict studies in sociology and policy research. Strategic/Campaign approaches (Teixeira and Bridge 2024 ; Vaagland 2024 ) Use deliberate and targeted recruitment approaches to directly access elites. Interviews treated as high-stakes negotiations. ‘Strategic ambiguity’ is used to guide the agenda and framing. Gains access and disclosure from hard-to-reach individuals. Interviewee statements may be misrepresented or used for agendas that are contrary to their values. Corporate leadership, executive hiring, lobbying, medical innovation and diplomatic research. Ethnography (Harvey 2011 ; Ma et al. 2021 ; Stephens and Dimond 2019 ) Employ social ethnography methods. Secure candid insights through trust and long-term immersive relationships. Immersion in the culture of interest and gradual rapport-building can be time-consuming. Immersion in one group may limit perspectives; additional interviews might be needed when comparing groups with differing power/agency. Social communities, corporate governance and leadership studies. Institutional discourse (Ahmed 2012 ) Empolys critical theory (phenomenology). Shift inquiry from individuals to the ways individuals constitute institutions. Examines how power structures shape visibility and embodiment. Disrupts normalized perspectives. Useful for interrogating dominant institutional discourses, revealing contradictions in institutional messaging and silences. DEI research, queer studies, organizational culture, and leadership studies. Feminist approaches * (Hesse-Biber 2013 ; Reinharz 1993 ) Applies feminist theory. Emphasizes mutuality, care, and power asymmetries. Useful to challenge institutional authority. Women studies, social work, organizational research. Transformational approach (Kezar 2003 ) Co-constructed interviews where leaders participate in reflecting on their roles. Reveal leaders’ perspectives on change, institutional barriers, and reform. Can include multiple interview iterations for longitudinal study. Higher education and leadership research. *Whilst Feminist interview approaches are not strictly part of the elite interview tradition, we have included them in this summary as they offer important guidance on how build inclusivity into interview practices. In investigative journalism , elite interviews have commonly been used to interrogate those in power, often aiming to provoke candid or even unintended disclosures through carefully sequenced questioning. (Mellado 2015 ) These approaches often emphasize the strategic use of probing questions and discursive cues to surface contradictions, exposure institutional misalignment, or reveal concealed decision-making processes. This approach has also been applied in sociology research that explores organizational power, conflict and ideological asymmetry.(Dodson et al. 2007 ) This type of elite interview is focused on interrogating authority, and can often challenge or undermine the credibility of the interviewee.(Boucher 2017 ; Glas 2021 ) Conflict may arise from how interviewees manage this critique and questioning of their accountability, especially if they deflect blame or reframe failures to retain narrative control and manage reputational risk. (Dodson et al. 2007 ) Attempts by the interviewer to push back on rehearsed accounts or simplistic narratives may generate discomfort, observed through emotional or physical cues like hesitation, silence or shifts in tone.(Gupta and Harvey 2022 ; Mbohou and Tomkinson 2022 ; Thuesen 2011 ) Too much antagonism, however, may may hinder long-term engagement and future access.(Boucher 2017 ) Closely aligned to the interview models in journalism, are strategic or campaign-style models of elite interviewing. Common in corporate, business or diplomatic research, the interview is approached as a high-stakes negotiation.(Teixeira and Bridge 2024 ; Vaagland 2024 ) The research methodology is oriented around the campaign to gain access to targeted senior figures, and the tactics used by the researchers for this are viewed as critical enablers to what is disclosed.(Boucher 2017 ; Teixeira and Bridge 2024 ) For example, Teixeira and Bridge outline a carefully planned direct outreach campaign through social media and email to gain interviews with senior executives in the oil and gas sector. Deliberately non-committal neutral language, described as ‘strategic ambiguity’, created the conversational conditions for maximal disclosure in their interviews.(Teixeira and Bridge 2024 ) These models prioritize data collection in what are often limited interactions, viewing the interview as an opportunity to extract information and less as a relational exchange or shared meaning making. In ethnographic research traditions, elite interviews are often embedded within ongoing fieldwork, as part of representing a comprehensive social context.(Aldridge 1993 ; Harvey 2011 ; Leech 2002 ) Ethnographic approaches view the researchers’ familiarity with the field they are researching as critical part of the research process; they must build the credibility required to draw out candid accounts from interviewees in power-laden environments. (Ma et al. 2021 ; Stephens and Dimond 2019 ) This contextual legitimacy helps researchers gain access to people in power, building rapport, shared language and cultural fluency that improves the quality and richness of interviews.(Bakkalbasioglu 2020 ; Jones and Fulop 2021 ; Ma et al. 2021 ; Morris 2009 ) While framed as ethnographic, the institutional discourse approach (developed by Ahmed in her book ‘On Being Included’) provides a distinctly different model to traditional ethnographic elite interviewing; one that is less about balance or conventional measures of representation, and more about interrogating the role of institutions as enacted through individuals.(Ahmed 2012 ) Phenomenology, (i.e., the study of how people experience, feel, and make sense of the world through their embodied, lived encounters) is positioned as a ‘critical lens through which to think about institutional life’.(Ahmed 2012 ) She highlights how the interviewee, in ‘giving their story, also gave the story of their institutions’. This ability to open a space for deeper description of organizational politics, power and mission (and an individual’s role within that institution), is a critical element to Ahmed’s interview approach. (Ahmed 2012 ) Although distinct from the elite interview, feminist approaches offer contributions to those conducting elite interviews by centering relational ethics, reflexivity, and the co-production of meaning between researcher and participant. These approaches call for attentiveness to power dynamics and promote practices that support trust, dialogic engagement, and mutual understanding as part of the credibility building activities within the interview. Reinharz and Hesse-Biber have written extensively on how feminist interviews prioritize the lived experiences and agency of participants, grounding interviews in care, accountability, and ethical responsiveness.(Hesse-Biber 2013 , 2019 ; Reinharz 1993 ) Further, Lokot emphasizes how positionality and intersecting identities shape both disclosure and interpretation,(Lokot 2021 ) while Herron explores how feminist-informed interviews create space for reflection and relational responsibility.(Herron 2023 ) Whilst these approaches have often been used in research with historically marginalized groups, their principles can inform elite interview methods by encouraging depth, responsiveness, and attention to the interview relationship and the broader context. Finally, Kezar develops a model of transformative elite interviews, exemplified in her studies of senior university leaders and presidents.(Kezar 2003 , 2008 ) She describes how critical-constructivist techniques intended to empower disenfranchised individuals are challenging to apply within the power dynamic of ‘interviewing up’ with elites.(Boucher 2017 ; Dodson et al. 2007 ; Lokot 2021 ) Drawing on feminist interviewing and critical theory (i.e., an approach that centers power and inequity), she describes how the narrative exchange occurring in the interview raises consciousness, deliberately creating space for two-way dialogue and knowledge sharing, resulting in a transformative shift away from pre-existing assumptions and reasoning. Critical to this exchange is building mutual trust, reflexivity and egalitarianism. Unlike earlier postpositivist approaches to elite interviewing, Kezar repositions elite interviews within the critical-constructivist paradigm as relational exchanges where emancipatory transformational change occurs in both interviewee and researcher. (Kezar 2003 ) We have shown that elite interviewing techniques vary substantially in both ontological approaches and practical considerations. Most descriptions of elite interviews focus on gaining access to people in power, appropriate sampling methods, and the process of conducting the interview. Fundamental to elite interviews is the need to prompt a more nuanced probing of the interviewee’s decisions, practices, and interpretation. Researchers must be attuned to what remains unsaid and create conditions where more complex and difficult topics can be voiced. At times, the trust and reciprocity that builds over the temporal course of the interview allows “the happier language…to wear out, and a very different account [to be] generated” .(Ahmed 2012 ) Other times, this may require the interviewee to interrogate, question or push back at explanations and assumptions that are overly simplified or inconsistent. Discomfort may arise from this, which some have viewed as a critical part of a high-quality elite interview.(Gupta and Harvey 2022 ) Because elites are individuals invested with substantial power, researchers may need to cultivate openness by signaling genuine interest, demonstrating contextual fluency, and carefully managing power dynamics in the interview space. Whilst methods to handle these power dynamics differ between elite interviewing traditions, most agree that power is a critical component that influences the success of the interview. Strategies such as sustained listening, careful pacing, and the judicious use of personal disclosure can support rapport and trust, improving the interview quality. Steps to set up and conduct an elite interview From our exploration of the literature above, we offer guidance on the practical steps commonly required to set up and conduct an elite interview (Table 2 ). Sampling methods are typically highly targeted, and achieving the first step of recruiting individuals can take extensive time and effort (e.g., by drawing on pre-existing personal networks, or approaching administrative staff or intermediaries).(Kezar 2008 ) The role of an internal institutional ‘champion’ is valuable to gain access to the necessary elite leaders, vouching for the researcher’s credibility, and confirming the project value.(Stephens and Dimond 2019 ; Teixeira and Bridge 2024 ) Table 2 Steps in the setup and processes of an Elite Interview Steps Suggested strategies 1. Recruitment and access Highly targeted sampling approach; may require a ‘champion’ to confirm researcher credibility and help gain access to relevant senior leaders; pre-distribute interview agenda and ethics documentation (if required). 2. Interview Preparation Conduct deep background research (on individual and institution); develop a tailored interview guide specific to each individual interview. 3. Establishing Consent Confirm informed consent/ethics approvals and recording methods (if required); clarify scope of intended distribution early and discuss anonymization approaches. 4. Conducting the Interview Adhere strictly to time scheduled; choose recording method (audio or video recording and/or field notes); consider number of interviewers and roles; may refer to statistics/documents identified in background research. 5. Post-Interview Engagement Journal reflections after interview; Provide summaries/transcripts/manuscripts for validation, including follow-up questions via email or subsequent interviews; ensure ethical transparency in representation and use of data. Once an appointment is obtained, it is essential that the researcher comes into the interview fully prepared to make the most of the brief time allocated (e.g., by pre-researching background information and context). The interview structure revolves around the interviewee’s definition of the situation or topic, and so they are given space to direct the conversation, drawing attention to what they see as most relevant, rather than relying solely on the researcher’s framing.(Odendahl et al. 2002 ) This means that the researcher needs to be well prepared, with a high level of fluidity and responsiveness. Leigh Sales, a prominent Australian journalist and author, describes her approach to an elite interview as: “the way I structure each interview, and the kind of questions I ask, gives you a sense of the things I think are important... For example, my questions depend on what the other person says in their answer. I don't just go down a preprepared list of questions. And so therefore, what I ask depends on what the other person says… I will craft my [pre-prepared] questions in the same way that I edit a piece of writing. I'm trying to make them as brief as possible, as few words as possible, as active voice as possible.” (Sales 2024 ) The third step, establishing consent, has some unique ethical considerations. Elite leaders are vulnerable in different ways to patient or student research participants and employing an ethic of care is just as important when researching elites as it is with other members of communities.(Stephens and Dimond 2019 ) The highly specialized nature of niche leadership fields mean elites can be inadvertently identifiable, and their public image or reputation can challenge standard anonymization approaches. (Stephens and Dimond 2019 ) Being upfront and clear about the degree of identification and intended distribution of the research is essential and researchers need to take additional care to preserve anonymity (e.g., presenting field notes and interview quotations without formal attribution to roles or organizations, or withholding quotes or descriptions where the risk of repercussions with inadvertent identification is unacceptable).(Ahmed 2012 ) Practical considerations for how interviews are conducted are described in step four. It is helpful to reconfirm the time allocated at the commencement of the interview and adhere strictly to this. In some of the published examples, interviews were conducted by two researchers. (Kezar 2008 ; Teixeira and Bridge 2024 ) Interviewing in pairs can help to readily access pertinent documents or statistics during the interview. It is also important to confirm how the interview will be recorded, (e.g., if audio or video recording will be supplemented by field notes). In certain instances, field notes alone may be preferred to encourage openness and protect anonymity, and the interviewer needs to be prepared to change at short notice if requested. We provide a more in-depth discussion of elements of an elite interview below. In the final step, post-interview engagement can help the interviewer maintain trust and credibility (e.g., by providing summaries of key points and suggested quotes, or follow up questions by email or phone).(Kezar 2008 ) Ideally, researchers should provide copies of outputs to interviewees prior to publication. Reflexive journalling and memos are also an important part of the post-interview process, especially as the affective elements within the interview may be poorly captured by transcripts. Elements of an elite interview From their critical/constructivist positions, both Ahmed and Kezar offer models that position the elite interview as a space for transformation, reflexivity, and institutional critique.(Ahmed 2012 ; Kezar 2003 ) Drawing heavily on their work, we synthesize the findings from our exploration of the literature to propose that in an elite interview information is exchanged, and meaning conveyed, through six interrelated elements: narrative framing, co-construction of meaning, affective vulnerability, institutional critique, credibility building and ethical reflexivity. This framework is presented in Table 3 , linking these six elements to interaction techniques to guide researchers using elite interviews. Table 3 Proposed framework for elite interviewing in HPE Element Interaction Techniques Interpretive value 1) Narrative framing Interviewee opens with their own framing; interviewer uses broad or pre-researched prompts with minimal interruption; researcher adjusts questioning pace, tone, and depth based on role, time constraints, and setting. Reveals how leaders prioritize and sequence institutional meaning; surfaces implicit agendas or bias; provides explanations for background research findings. 2) Co-construction of meaning Use of affirmations, returning to earlier statements, highlighting shared experiences or examples; interviewer adopts/expands interviewee framing; uses comparative or relational framing to prompt clarification or reflection; may use humor, metaphors or stories to help explain concepts. Generates shared language and alignment; allows mutual shaping of knowledge and reflection; helps refine/transform perspectives of both interviewee and interviewer. 3) Institutional critique Sequentially layering or using follow-up questions to invite increasing depth of institutional critique; prompts structure around organizational processes, decision points, or inconsistencies. Surfaces contradictions, implementation gaps, and underlying policy logics; raises tensions between institutional roles and personal ethics. 4) Affective vulnerability Use of disclaimers, pauses, tone shifts, or clarifying questions; may need boundaries around what is shared; interviewer signals when responses may carry reputational implications; requires an openness to reveal emotions from both interviewer and interviewee. Encourages exploration of identity, values, and alignment within institutional roles; reveals guardedness or vulnerability; invites openness and revelation through trust. 5) Credibility building Interviewer demonstrates topic expertise; shows familiarity with institutional data or governance; interviewer may disclose their own context, identity and experiences; mutual reference to external people or examples. Establishes relational parity and fluency; enables deep engagement and openness in short, targeted interviews. 6) Ethical reflexivity Researcher remains attentive to the unique ethical issues of elite interviewing; consciously considers intersectional identities and attends to power asymmetries; acknowledges positionality and influences on interaction; responds to external environment and political climate. Considers how intersecting identities shape experience and engagement; unveils invisible labor and marginalization; supports deeper insight into power, identities, and prevailing organizational values and orientation. A Worked Example of Elite Interviewing to HPE Research Despite the centrality of leadership in shaping institutional practice, the application of elite interviewing within HPE remains limited. The few published examples of elite interviews in healthcare contexts focus on interviews with knowledge specialists and clinical experts, rather than organizational leaders, and are centered on addressing logistical concerns such as access and confidentiality.(Goldman and Swayze 2012 ; Stephens and Dimond 2019 ) Leadership in HPE often requires aligning competing priorities, such as equity guidelines, accreditation standards, workforce demands, and academic culture within institutions that are themselves sites of professional hierarchy and normative authority.(Orrick et al. 2025 ) This complexity requires an interview approach that can elicit not only policy rationale or decision-making logic but also how leaders experience and interpret their roles within broader institutional and social structures. In this second part of this paper, we provide a worked example of elite interviewing in a study on diversity, equity, and inclusion (DEI) policy implementation in postgraduate medical training. We are not sharing the findings from that work, but rather we use those data to examine how elite interview methodology, when used with medical deans, department chairs, and program directors, helped to give insight into how leaders make complex decisions about this area of organizational policy and practice. Through this example, we aim to highlight the methodological characteristics of elite interviewing in this HPE setting, show an application of our six elements, and reflect on the ethical, relational, and analytic considerations of this technique. Methods Study synopsis This worked example draws on a subset of elite interviews from a larger qualitative project on academic leaders’ conceptualization and implementation of diversity and equity policies in medical education. Whilst the purpose of this larger project informed the development and adaptation of the interview approach, we do not present the empirical findings here. The study design was informed by critical theory, which seeks to examine and challenge the power structures, institutional norms, and ideologies that shape experience and knowledge production.(Paradis et al. 2020 ) Hence, we lean heavily on elite interview techniques within the critical theory paradigm.(Ahmed 2012 ; Kezar 2003 ) The study processes followed the steps outlined in Table 2 , and the interviewee identities, institutions, and geographical locations have been anonymized. In this methodological analysis, we elaborate how the six elements we propose for an elite interview (see Table 3 ) operated in practice within the interviewer-interviewee dynamics and institutional contexts and how these elements assisted data collection, engagement, and interpretation. Reflexivity and Positionality All four authors are experienced HPE academics and leaders in their fields. All interviews were conducted by the primary author (SJA), who is a senior academic and surgical education leader based at an Australian university, who was undertaking this research during a fellowship in the United States. Her institutional responsibilities include oversight of medical school admissions, faculty workforce planning, and leadership development. These experiences informed her familiarity with the leadership contexts and decision-making responsibilities of the interviewees, while her position outside the U.S. medical education system provided distance. She identifies as a woman living with disability, specifically deafness. While this aspect of her identity was not always foregrounded in the interviews, it contributed to her attentiveness to non-verbal cues and the language of inclusion, access, and leadership representation throughout the research process. The remaining authors are based in U.S. medical education institutions, leading equity programs, curriculum design, and faculty development. Ethics This study received ethics exemption approval from the University of California, San Francisco Institutional Review Board [IRB24-42887]. All participants provided informed verbal consent. Findings Elite interviewing was applied as a methodological strategy in 35 interviews with senior academic leaders at nine U.S. medical education institutions between January-September 2025. A further two institutions and one individual declined the invitation to participate due to concerns about potential political and reputational risks. Interview duration ranged from 20 to 60 minutes. Interviewees included Medical Deans, Department Chairs, and institutional leaders responsible for faculty affairs, equity portfolios, recruitment and strategic planning. In the examples below, we describe how each of the elements in our framework surfaced during these interviews. Element 1: Narrative Framing Interviewees frequently directed the opening structure of the conversation. In response to broad contextual prompts (e.g., Can you tell me about your approach to equity work? or When I was preparing for our interview, I read an editorial you wrote… ), the interview often commenced by interviewees recounting organizational histories, describing a recent structural change, or referencing a significant event. This narrative framing indicated what they considered relevant to the topic and revealed how they understood their institutional role. In many cases, interviewees sustained a single narrative for several minutes before pausing, during which the interviewer allowed the structure to unfold without interruption. Interviewee 1 ‘I thought we were doing really well as a department, and then George Floyd [murder] happened, and the pandemic happened, and I realized that as much progress as I thought we had made dealing with things like pay equity and dealing with the recruiting [of diverse faculty]… we were completely unprepared to address the needs of the department.’ In this example, the interviewee uses the 2020 #BlackLivesMatter protests to frame the subsequent discussion, providing both a contextual and reasoning point to explain their subsequent strategic actions; with both interviewee and interviewer returning to this event as a conversational anchor on several occasions during the interview. Element 2: Co-Construction of Meaning Several interviews evolved through iterative and reciprocal exchanges. At times, the interviewer referenced previous interviews or described her own context to probe further or invite reflection. Interviewees returned to earlier points, clarified their position, or introduced comparisons to other contexts. The interviewer adopted the interviewee’s framing, enabling interviewees to expand or revisit initial statements to describe their answers in more detail. In this way, it allowed for co-construction of meaning, where interviewer and interviewee both contributed to how the topic was interpreted. Interviewer When I’m doing DEI activities at home, I often get a lot of pressure to make it more about wellbeing. Do you get this too? Interviewee 2 I think it's this kind of, how do I say this?[makes a wry expression] I think wellness and burnout are really, really important, but they don't always create space for us to have some of those really difficult conversations around racism or sexism. Interviewer Yeah, yeah, let's actually talk about and name it for what it is. It's not burnout, it's perpetual patriarchy... Interviewee 2 And it's like, PTSD, like, the microaggression stuff, dealing with that long term… Interviewer So, yoga on the lawn is not going to fix that. Interviewee 2 Right! [laughter] It's changing the structures and systems… Let me give you an example… [describes a wellness intervention] Here, by sharing from her own perspective, the interviewer was able to prompt the interviewee to a more nuanced description of what they meant by ‘DEI activities’. The quick repartee, stories and sardonic humor within this conversation rapidly facilitated a sense of shared meaning and agreement about what was implied by the term ‘DEI’, beyond public facing documents and catch phrases. Element 3: Institutional Critique When invited to reflect on policy implementation or institutional effectiveness, many interviewees offered deeply reasoned answers. These were often in response to implicit cues from the interviewer, including comparisons to policy environments in Australia or statements of shared experience in faculty leadership. Interviewee responses identified organizational tensions, structural limitations, or decision-making processes that were not documented in formal strategy statements. These accounts were most detailed when the interviewer questioned taken-for-granted institutional messaging, structuring questions in sequential layers to progressively prompt the interviewee to elaborate, clarify, or reflect more deeply on earlier responses. Interviewer I'll come back to some of the other things, but that is interesting, because there does seem to be this tension [refers to multiple parallel equity initiatives within department]. It's kind of, 'how do you link together’? Interviewee 3 I'm glad you picked up on that, because it's one of the things I complain about. In some ways, it’s… [gestures frustration] I mean, if you're not talking about DEI, it kind of makes sense, but like, when you're trying to do a broader initiative for everyone, it makes it very challenging. In this example, by deliberately pointing out the tension in a statement, the interviewer prompted the interviewee to be more openly critical about their feelings and frustrations with the organization. Element 4: Affective Vulnerability Interviewees signaled the reputational or emotional weight of certain topics by slowing their speech, qualifying their language, or pausing before responding when discussing institutional risk, failed initiatives, or contested decisions. In these moments, the interviewer needed to acknowledge the sensitivity of the topic, pausing or inviting the interviewee to reframe or clarify. These adjustments reflected the real-time affective dimensions of the interview, building trust and encouraging openness. Interviewee 4 We're waiting to understand how to respond [to Executive Orders on DEI] in a way that is legal and consistent with our values. And the challenge will be that what's legal may be directly in opposition to what's consistent with our values and, and, well that'll be tough. That'll be moral distress. Interviewer Mmmm…. [reflective pause] How are you feeling about that? In your role as a leader? Interviewee 4 So, a lot of leaders have moral distress. And I'll go back, actually, to last year around this time, with, you know, with the Middle East, [I felt] a lot of moral distress because you [I] wanted to help people, and you [I] wanted to help all people. At times, this also meant that the interviewer showed vulnerability through openness about their own feelings and emotions. In this conversation, the interviewer went on to reciprocate with a similar personal experience, an exchange that shifted the direction of the interview away from abstract organizational responses to more personal reflections about the emotional cost of academic leadership in the broader global political context. This openness required both parties to clarify the boundaries of the conversation, including how information would be shared. Element 5: Credibility Building Establishing credibility quickly was essential to fostering substantive dialogue and openness. Credibility building was bidirectional – the interviewer had to establish their credibility but was also assessing the credibility of the interviewee. This process began before the interview by endorsement from the institutional contact, or mutual recognition of professional standing and affiliations. Within the interview itself, the interviewer reinforced their credibility to the interviewee by demonstrating detailed preparation, fluency in sector-specific terminology, well-informed questioning and referencing shared professional networks. Warmth, responsiveness, and genuine interest further supported rapport and signaled competence. Interviewer I did notice, [referring to background research] you have pathway programs to try and build exposure and experience... Were these deliberately developed as part of this strategy? [indicates DEI strategy pamphlet provided by interviewee] Interviewee 5 I think that the pillars helped as we developed a strategy around our work and [the programs] provide examples of the framework that we use for the work… [But we need to resolve] how these fit together into a coherent structure that helps to describe exactly the work that we do. In this example, the interviewer’s preliminary research and contextual fluency with the institutional strategy positioned her with the credibility to quickly direct the conversation towards exploring gaps in the organization’s strategic logic and cohesion, without necessitating detailed explanatory descriptions. Element 6: Ethical Reflexivity Interviews were conducted during a period of heightened political scrutiny toward ‘DEI’ in the U.S., including evolving federal legislative mandates and the rolling back of institutional protections.(Sands and Ferraro 2025 ; Trump 2025) This broader political context shaped the ethical and methodological complexity of the study, requiring reflexivity and awareness, especially around consent for dissemination, as described by this interviewee: Interviewee 6 [On consenting for dissemination of study findings] Of course, but being careful, because of everything we just said. DEI is just such a tough term for anybody to talk about right now… You know, [our University] is viewed in the country as very left, very liberal, very out there, and I think we want to have that streak, but you know… [I don’t] want to create a big, spinning target for ourselves. As the risk of institutional repercussions increased, interviewees started to refer to equity activities more obliquely, which required the interviewer to employ interpretative awareness and pay careful attentiveness to silence or redirection, along with navigating complex emotional reactions. Ethical interviewing in this context required the interviewer to acknowledge reputational risks, affirm safety and confidentiality, and remain alert to moments where expression was deferred or deflected. Employing ethical reflexivity also meant being attuned to how intersectional dynamics shaped the formality, disclosure, and control during interviews. While reciprocity and dialogical engagement were evident, relational dynamics were influenced by underlying gendered or racial hierarchies. For example, some senior leaders adopted a more directive approach, maintaining structured conversational boundaries and a formal tone, or used presentation slides. In contrast, other interviewees expressed hesitancy or guardedness, reflecting the complex interplay of positional authority, perceived institutional vulnerability, and relational trust. At other times, the interviews became safe, therapeutic spaces in which leaders could work through their tensions between personal commitment and organizational alignment. These patterns were not uniformly linked to any single identity marker but were mediated by intersecting roles, histories, and the relational dynamic between interviewer and interviewee. This required the interviewer to be deeply reflexive about how Whiteness, gender and professional status shaped the conditions of each interview, recognizing that mistrust is not merely interpersonal but historically embedded in and supported by systems of power and exclusion. Without this critical awareness, the interview process risked reproducing the very hierarchies it sought to interrogate. Discussion Elite interviewing can enrich HPE research by providing a methodology that helps facilitate deeper, more reflexive inquiry into leadership and institutional decision-making. In our worked example, the six elements described in this paper helped to guide the research process and interviews. We illustrated how the two-way dialogical approach helped to frame the narrative of the interview, provoke institutional critique and co-construct meaning, assisting the interviewer to navigate the interview space by building credibility, demonstrating vulnerability and sustaining ethical reflexivity. These elements created the conditions for candid and nuanced discussion that gave insights into the decisions academic leaders were making, and how they interpret and rationalize their approaches towards equity initiatives. Ahmed comments how interviews with organizational leaders often default to ‘mission speech’, smoothing over institutional failures and reproducing narratives of success.(Ahmed 2012 ) Our approach to elite interviewing gives some practical techniques for researchers to push beyond these surface narratives and gain a deeper understanding of the complexities of leadership within organizational power and structures. We have argued that elite interviewing techniques hold value for HPE researchers seeking to examine leadership and complex organizational decision-making. Yet, some of the greatest value of this technique comes from its potential contribution to qualitative methodology training and educational pedagogy, helping researchers to shift away from postpositivist paradigms toward more constructivist and critically reflexive approaches. This ontological reorientation arises from the practical demands of the method itself. Elite interviewing requires the researcher to relinquish tightly scripted formats and fixed frameworks in order to use the fluid, dialogic approach we describe. To do this well, the researcher needs to cultivate a deep and emergent reflexivity, attending closely to their own positionality at every stage of the interview process. The openness in the elite interview technique, especially the affective vulnerability and ethical reflexivity elements, exposes the limitations of postpositivist assumptions about neutrality and objectivity. Without the rigor provided by a strong reflexive focus, this technique has the potential to become unstructured and haphazard, garnering only superficial or directionless insights. However, by foregrounding reflexivity, we found that the researcher was better able to recognize and navigate power dynamics, respond ethically and adaptively during interviews, and garner more nuanced interpretations. In doing so, the interview became a space of transformative inquiry and reflection. Despite its value, there are limitations in our current application of elite interviewing that warrant reflection. In our worked example, the interviewer and interviewees shared similar ideological commitments to diversity, equity and inclusion which fostered rapport and enabled rich, reflective conversations. However, this also constrained the opportunity to examine how elite interviewing performs in more contested, oppositional, or hostile environments. Power and hierarchy are inherent within elite interviewing, and researchers may find themselves in ethically or philosophically challenging situations, particularly if confronting leaders about divisive or exclusionary topics. This raises questions about how the researcher can uphold an ethic or care whilst still applying necessary critique. Is it possible to remain open and respectful without neutralizing difficult topics? Kezar argues that empathy enhances trust and depth in elite interviews, but there remains a tension between relational authenticity and moral acceptability.(Kezar 2003 ) These complexities highlight the need for reflexivity but also question the limits of what can or should be said in elite interviews. DEI remains a politically divisive topic in many academic settings in the United States, and this has impacted how we have been able to engage with and disseminate the findings of the larger research project. It is worth considering whether the individuals and institutions who declined to participate may have done so because of perceived risks in the depth and openness required from this interview methodology. Beyond the limitations listed above, it is also worth pausing to reconsider the term ‘elite’ interviewing in the context of HPE. While the term is commonly used in other disciplines to elicit the perspectives of leaders, there is an inherent tension that arises in the healthcare sector. Whilst we have adhered to the term ‘elite’ for the sake of continuity and comparison to the broader tradition of this interview technique, we are highly conscious that the concept of elite does not align well with the inclusive values central to healthcare and medical education. Accordingly, we advocate for consideration of an alternative term like ‘expert informant’, which better reflects the intention to seek insights from individuals with specialized knowledge and experience in HPE, without reinforcing social hierarchies or exclusionary language. Whilst our worked example focused on academic health equity leadership, elite interviewing holds broader potential to explore underexamined questions in HPE, where strategic decisions shape institutional direction and educational priorities. Areas such as curriculum reform, accreditation standards, and workforce credentialing standards often involve high-stakes deliberations by senior leaders, yet their rationale remains poorly articulated in the HPE literature. Research in these contexts requires sensitivity to reputational risk and to the potential tensions between an individual’s personal views and those of their institution. Elite interviewing can help elicit the values, negotiations and contextual pressures that underpin institutional decisions, giving insights that are often inaccessible through conventional research methods. As the HPE profession continues to navigate increasingly complex socio-political demands and shifting societal values, this way of interviewing provides a methodology for examining the institutional processes that are actively shaping the future of this field. Declarations Corresponding author Sarah J Aitken [email protected] Funding: This work was funded by The Commonwealth Fund Harkness Fellowship (recipient Author SJA). Conflicts of Interest/Competing interests: The authors have no relevant financial or non-financial interests to disclose. Ethics Approval: This study received ethics exemption approval from the University of California, San Francisco Institutional Review Board [IRB24-42887]. Consent to participate: Explicit verbal consent, after review of participant information documents, was provided by all participants. Data availability: Due to the confidential nature of these transcripts, data sharing is not available. Author Contribution SJA conceived the study, developed the methodology, collected study data, and wrote the original draft. AWK and CD reviewed and advised on the research findings and contributed to the editing of the manuscript; PSO supervised the research process and contributed to the study design, analysis, and editing of the manuscript. All authors read and approved the final version of the manuscript. Acknowledgements: Funding for this research was provided by the Commonwealth Fund Harkness Fellowship (recipient Sarah J Aitken). Data Availability Due to the confidential nature of these transcripts, data sharing is not available. References Ahmed, S. (2012). On being included: racism and diversity in institutional life . Durham, NC; Duke University. Aldridge, A. (1993). Negotiating Status. Journal of Contemporary Ethnography , 22 (1), 97–112. https://doi.org/10.1177/089124193022001007 Bakkalbasioglu, E. (2020). How to access elites when textbook methods fail: Challenges of purposive sampling and advantages of using interviewees as fixers. 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Humanities & social sciences communications , 11 (1), 431. https://doi.org/10.1057/s41599-024-02939-0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviews received at journal 05 Feb, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers agreed at journal 11 Jan, 2026 Reviewers invited by journal 19 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 08 Dec, 2025 First submitted to journal 05 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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12:42:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1009235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8286458/v1/2e50b9a7-a3a5-49ca-8fce-febca141f2db.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Elite Interviewing as a Research Method: A worked example studying Academic Leadership in Health Professions Education","fulltext":[{"header":"Introduction","content":"\u003cp\u003eResearch in Health Professions Education (HPE) often involves garnering insights from experts who occupy senior positions of influence - leading scientists, clinicians, hospital executives, medical deans - whose decisions shape educational and institutional directions. In other professions such as politics, religion, and business such individuals are often conceptualized as \u0026lsquo;elites\u0026rsquo;. What unites these leaders is their institutional authority, specialized expertise, time constraints and relative inaccessibility to researchers. When interviewing these elite leaders, researchers are often in the position of \u0026lsquo;studying up,\u0026rsquo; needing to have both the credibility and interview skills to elicit genuine insight, especially on polarizing or controversial topics.(Odendahl et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) The proximity of elite leaders to organizational authority, and their visibility in professional hierarchies, means they may be highly sensitive to external scrutiny, refraining from disclosing their personal views in favor of describing formal organizational perspectives.(Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Interview-based inquiry with elite leaders must therefore move beyond surface descriptions to consider how their perspectives are constructed through, and constitutive of, institutional logics and practices. In this paper, we introduce and extend the methodological tradition of elite interviewing, adapting principles from other disciplines to the study of leadership in HPE, and illustrate how this technique can be applied through a worked example of a study of academic leadership in health equity initiatives.\u003c/p\u003e \u003cp\u003eIn HPE research, semi-structured interviews are commonly used to explore personal perspectives and experiences.(Mauldin and Chambers \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) To avoid the risk of facile or platitudinous conclusions, interviews must be designed to engage elite participants in nuanced, contextually situated dialogue that goes beyond institutional rhetoric and rehearsed narratives. To do this, HPE researchers are increasingly employing reflexive and emergent interview approaches, fostering co-constructed dialogue, interpretive depth, contextual meaning, and recognition of the researcher\u0026rsquo;s influence.(Blalock and Balmer \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kahlke et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; McOwen et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) However, some researchers still gravitate toward more rigid formats shaped by postpositivist assumptions, prioritizing neutrality, standardization, and data saturation.(Herron \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Park et al. \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) This interview structure can inadvertently reinforce reductivism or oversimplified questioning, limiting depth of insight and critical reflection.(Finn et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Jamieson et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eElite interviewing offers an approach that is particularly valuable when engaging with those in higher institutional positions than the researcher. Arising from traditions in sociology, journalism, and political science, the elite interview is a dialogic, emergent exchange that positions interviewees as experts tied to the institutions they shape.(Boucher \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Gupta and Harvey \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) In contrast to conventional interview formats, elite interviewing foregrounds adaptive interview strategies, credibility work, and trust-building to navigate asymmetrical relationships. Rather than applying uniform questions across interviews, this approach uses tailored, relationally attuned methods to support open-ended engagement and reflection.(Dexter \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1970\u003c/span\u003e; Odendahl et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) Drawing on feminist and narrative inquiry, Kezar highlights how this openness within the interview builds open dialogue and exchange that is transformational for the interviewee and interviewer.(Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e,Kezar \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) When conducted reflexively, elite interviewing can support engagement that centers the lived experience and institutional perspective of leaders, allowing for deeper exploration of meaning, power, and context.(Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) Elite interviews have potential to address some of the methodological limitations experienced when conducting qualitative research involving HPE leaders, but more guidance, with examples, is needed to support robust application of this method.\u003c/p\u003e \u003cp\u003eIn the first section of this paper, we outline how elite interviews are conducted in disciplines outside of healthcare and consider how these approaches can be adapted to study academic leadership in HPE. We build on the approach to elite interviewing proposed by Kezar, engaging with Ahmed\u0026rsquo;s work on institutional performativity, to propose a framework for elite interviewing suitable for use with HPE leadership.(Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e,Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) In the second section of this paper, we present a worked example of elite interviewing from a study on diversity, equity, and inclusion (DEI) in postgraduate medical education. In this example, we examine how elite interviews were conducted with academic leaders and explore the interactional, ethical, and analytical dimensions of the method. We focus on the methodological challenges encountered, the interpretive strategies employed, and the implications for future qualitative research in health professions leadership.\u003c/p\u003e\n\u003ch3\u003eOrganizational elites\u003c/h3\u003e\n\u003cp\u003eDefining who is included in the category \u0026lsquo;elite\u0026rsquo; is not straightforward. In many disciplines, elites are positioned at the upper levels of a profession or society, marked by their access to resources, power, or status.(Odendahl et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) In disciplines such as law, political science, or journalism, elites are often defined by institutional authority or specialized knowledge - experts whose insights shape policy or public discourse.(Damele and Campos \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ma et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) In corporate and business professions, elites are well connected, and hold highly contextualized information about operations and strategies that other employees do not have access to.(Ma et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Although these roles often are also associated with wealth or social prestige, they are considered elite because of their strategic positioning within systems of influence. This description of an elite, however, is rarely absolute. For instance, is someone \u0026lsquo;elite\u0026rsquo; by virtue of their societal standing, professional position, or simply in relation to the researcher? Definitions shift depending on the topic, the context, and the relational dynamics of the study.(Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn HPE, the term \u0026lsquo;elite\u0026rsquo; can feel discordant, imbued with hierarchical connotations that sit uncomfortably at odds with the collegiality and inclusion that underpin much of health professions research.(Jones and Fulop \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) In this project, we define HPE elites contextually as those in formal health leadership roles with decision-making authority over academic structures, strategic direction and policy implementation.(Clay-Williams et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Denis and Gestel \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Jones and Fulop \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) These include medical deans, department chairs, senior clinicians, directors, and executives who make decisions that shape the everyday practice of institutions supporting HPE. These individuals have access to the levers of organizational change and can offer insight into how organizational policies and commitments are enacted around structural, operational and professional constraints.(Goldman and Swayze \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eApproaches to elite interviewing\u003c/h2\u003e \u003cp\u003e Elite interviewing has its origins in the focused interview: an interviewing technique where participants are chosen because of their expertise or experiences with a specific situation or topic.(Dexter \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1970\u003c/span\u003e; Merton et al. \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1990\u003c/span\u003e; Merton and Kendall \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1946\u003c/span\u003e) Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines some of the different approaches to elite interviewing and how these vary in their application and core features, and we then describe each in depth below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eApproaches, features and applications of elite interview methodology\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproach\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCore features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBenefits and Risks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eApplications\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInvestigative Journalism\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Dexter \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1970\u003c/span\u003e; Dodson et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Mellado \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmploy scrutiny-based questioning techniques.\u003c/p\u003e \u003cp\u003eAttribute \u0026lsquo;expert\u0026rsquo; status to informants.\u003c/p\u003e \u003cp\u003eOften uses linguistic and discourse analysis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrompts unexpected disclosures.\u003c/p\u003e \u003cp\u003eMeasure shifts in power and control.\u003c/p\u003e \u003cp\u003eHigh risk of withdrawal or backlash.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePolitical reporting, corporate scandals, conflict studies in sociology and policy research.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStrategic/Campaign approaches\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Vaagland \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse deliberate and targeted recruitment approaches to directly access elites.\u003c/p\u003e \u003cp\u003eInterviews treated as high-stakes negotiations.\u003c/p\u003e \u003cp\u003e\u0026lsquo;Strategic ambiguity\u0026rsquo; is used to guide the agenda and framing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGains access and disclosure from hard-to-reach individuals.\u003c/p\u003e \u003cp\u003eInterviewee statements may be misrepresented or used for agendas that are contrary to their values.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorporate leadership, executive hiring, lobbying, medical innovation and diplomatic research.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnography\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Harvey \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Ma et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmploy social ethnography methods.\u003c/p\u003e \u003cp\u003eSecure candid insights through trust and long-term immersive relationships.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImmersion in the culture of interest and gradual rapport-building can be time-consuming.\u003c/p\u003e \u003cp\u003eImmersion in one group may limit perspectives; additional interviews might be needed when comparing groups with differing power/agency.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSocial communities, corporate governance and leadership studies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInstitutional discourse\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmpolys critical theory (phenomenology).\u003c/p\u003e \u003cp\u003eShift inquiry from individuals to the ways individuals constitute institutions.\u003c/p\u003e \u003cp\u003eExamines how power structures shape visibility and embodiment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDisrupts normalized perspectives.\u003c/p\u003e \u003cp\u003eUseful for interrogating dominant institutional discourses, revealing contradictions in institutional messaging and silences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDEI research, queer studies, organizational culture, and leadership studies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFeminist approaches\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(Hesse-Biber \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Reinharz \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1993\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApplies feminist theory.\u003c/p\u003e \u003cp\u003eEmphasizes mutuality, care, and power asymmetries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUseful to challenge institutional authority.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWomen studies, social work, organizational research.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransformational approach\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-constructed interviews where leaders participate in reflecting on their roles.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReveal leaders\u0026rsquo; perspectives on change, institutional barriers, and reform.\u003c/p\u003e \u003cp\u003eCan include multiple interview iterations for longitudinal study.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigher education and leadership research.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e*Whilst Feminist interview approaches are not strictly part of the elite interview tradition, we have included them in this summary as they offer important guidance on how build inclusivity into interview practices.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn \u003cem\u003einvestigative journalism\u003c/em\u003e, elite interviews have commonly been used to interrogate those in power, often aiming to provoke candid or even unintended disclosures through carefully sequenced questioning. (Mellado \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) These approaches often emphasize the strategic use of probing questions and discursive cues to surface contradictions, exposure institutional misalignment, or reveal concealed decision-making processes. This approach has also been applied in sociology research that explores organizational power, conflict and ideological asymmetry.(Dodson et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) This type of elite interview is focused on interrogating authority, and can often challenge or undermine the credibility of the interviewee.(Boucher \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Glas \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Conflict may arise from how interviewees manage this critique and questioning of their accountability, especially if they deflect blame or reframe failures to retain narrative control and manage reputational risk. (Dodson et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) Attempts by the interviewer to push back on rehearsed accounts or simplistic narratives may generate discomfort, observed through emotional or physical cues like hesitation, silence or shifts in tone.(Gupta and Harvey \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mbohou and Tomkinson \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Thuesen \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) Too much antagonism, however, may may hinder long-term engagement and future access.(Boucher \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eClosely aligned to the interview models in journalism, are \u003cem\u003estrategic or campaign-style\u003c/em\u003e models of elite interviewing. Common in corporate, business or diplomatic research, the interview is approached as a high-stakes negotiation.(Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Vaagland \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) The research methodology is oriented around the campaign to gain access to targeted senior figures, and the tactics used by the researchers for this are viewed as critical enablers to what is disclosed.(Boucher \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) For example, Teixeira and Bridge outline a carefully planned direct outreach campaign through social media and email to gain interviews with senior executives in the oil and gas sector. Deliberately non-committal neutral language, described as \u0026lsquo;strategic ambiguity\u0026rsquo;, created the conversational conditions for maximal disclosure in their interviews.(Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) These models prioritize data collection in what are often limited interactions, viewing the interview as an opportunity to extract information and less as a relational exchange or shared meaning making.\u003c/p\u003e \u003cp\u003eIn \u003cem\u003eethnographic\u003c/em\u003e research traditions, elite interviews are often embedded within ongoing fieldwork, as part of representing a comprehensive social context.(Aldridge \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1993\u003c/span\u003e; Harvey \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Leech \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) Ethnographic approaches view the researchers\u0026rsquo; familiarity with the field they are researching as critical part of the research process; they must build the credibility required to draw out candid accounts from interviewees in power-laden environments. (Ma et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) This contextual legitimacy helps researchers gain access to people in power, building rapport, shared language and cultural fluency that improves the quality and richness of interviews.(Bakkalbasioglu \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jones and Fulop \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ma et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Morris \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWhile framed as ethnographic, the \u003cem\u003einstitutional discourse\u003c/em\u003e approach (developed by Ahmed in her book \u0026lsquo;On Being Included\u0026rsquo;) provides a distinctly different model to traditional ethnographic elite interviewing; one that is less about balance or conventional measures of representation, and more about interrogating the role of institutions as enacted through individuals.(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) Phenomenology, (i.e., the study of how people experience, feel, and make sense of the world through their embodied, lived encounters) is positioned as a \u0026lsquo;critical lens through which to think about institutional life\u0026rsquo;.(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) She highlights how the interviewee, in \u0026lsquo;giving their story, also gave the story of their institutions\u0026rsquo;. This ability to open a space for deeper description of organizational politics, power and mission (and an individual\u0026rsquo;s role within that institution), is a critical element to Ahmed\u0026rsquo;s interview approach. (Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlthough distinct from the elite interview, \u003cem\u003efeminist\u003c/em\u003e approaches offer contributions to those conducting elite interviews by centering relational ethics, reflexivity, and the co-production of meaning between researcher and participant. These approaches call for attentiveness to power dynamics and promote practices that support trust, dialogic engagement, and mutual understanding as part of the credibility building activities within the interview. Reinharz and Hesse-Biber have written extensively on how feminist interviews prioritize the lived experiences and agency of participants, grounding interviews in care, accountability, and ethical responsiveness.(Hesse-Biber \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Reinharz \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1993\u003c/span\u003e) Further, Lokot emphasizes how positionality and intersecting identities shape both disclosure and interpretation,(Lokot \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) while Herron explores how feminist-informed interviews create space for reflection and relational responsibility.(Herron \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) Whilst these approaches have often been used in research with historically marginalized groups, their principles can inform elite interview methods by encouraging depth, responsiveness, and attention to the interview relationship and the broader context.\u003c/p\u003e \u003cp\u003eFinally, Kezar develops a model of \u003cem\u003etransformative\u003c/em\u003e elite interviews, exemplified in her studies of senior university leaders and presidents.(Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) She describes how critical-constructivist techniques intended to empower disenfranchised individuals are challenging to apply within the power dynamic of \u0026lsquo;interviewing up\u0026rsquo; with elites.(Boucher \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Dodson et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Lokot \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Drawing on feminist interviewing and critical theory (i.e., an approach that centers power and inequity), she describes how the narrative exchange occurring in the interview raises consciousness, deliberately creating space for two-way dialogue and knowledge sharing, resulting in a transformative shift away from pre-existing assumptions and reasoning. Critical to this exchange is building mutual trust, reflexivity and egalitarianism. Unlike earlier postpositivist approaches to elite interviewing, Kezar repositions elite interviews within the critical-constructivist paradigm as relational exchanges where emancipatory transformational change occurs in both interviewee and researcher. (Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWe have shown that elite interviewing techniques vary substantially in both ontological approaches and practical considerations. Most descriptions of elite interviews focus on gaining access to people in power, appropriate sampling methods, and the process of conducting the interview. Fundamental to elite interviews is the need to prompt a more nuanced probing of the interviewee\u0026rsquo;s decisions, practices, and interpretation. Researchers must be attuned to what remains unsaid and create conditions where more complex and difficult topics can be voiced. At times, the trust and reciprocity that builds over the temporal course of the interview allows \u003cem\u003e\u0026ldquo;the happier language\u0026hellip;to wear out, and a very different account [to be] generated\u0026rdquo;\u003c/em\u003e.(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) Other times, this may require the interviewee to interrogate, question or push back at explanations and assumptions that are overly simplified or inconsistent. Discomfort may arise from this, which some have viewed as a critical part of a high-quality elite interview.(Gupta and Harvey \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) Because elites are individuals invested with substantial power, researchers may need to cultivate openness by signaling genuine interest, demonstrating contextual fluency, and carefully managing power dynamics in the interview space. Whilst methods to handle these power dynamics differ between elite interviewing traditions, most agree that power is a critical component that influences the success of the interview. Strategies such as sustained listening, careful pacing, and the judicious use of personal disclosure can support rapport and trust, improving the interview quality.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSteps to set up and conduct an elite interview\u003c/h3\u003e\n\u003cp\u003eFrom our exploration of the literature above, we offer guidance on the practical steps commonly required to set up and conduct an elite interview (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Sampling methods are typically highly targeted, and achieving the first step of recruiting individuals can take extensive time and effort (e.g., by drawing on pre-existing personal networks, or approaching administrative staff or intermediaries).(Kezar \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) The role of an internal institutional \u0026lsquo;champion\u0026rsquo; is valuable to gain access to the necessary elite leaders, vouching for the researcher\u0026rsquo;s credibility, and confirming the project value.(Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSteps in the setup and processes of an Elite Interview\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSteps\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuggested strategies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Recruitment and access\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly targeted sampling approach; may require a \u0026lsquo;champion\u0026rsquo; to confirm researcher credibility and help gain access to relevant senior leaders; pre-distribute interview agenda and ethics documentation (if required).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Interview Preparation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConduct deep background research (on individual and institution); develop a tailored interview guide specific to each individual interview.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Establishing Consent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConfirm informed consent/ethics approvals and recording methods (if required); clarify scope of intended distribution early and discuss anonymization approaches.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Conducting the Interview\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdhere strictly to time scheduled; choose recording method (audio or video recording and/or field notes); consider number of interviewers and roles; may refer to statistics/documents identified in background research.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5. Post-Interview Engagement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal reflections after interview; Provide summaries/transcripts/manuscripts for validation, including follow-up questions via email or subsequent interviews; ensure ethical transparency in representation and use of data.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnce an appointment is obtained, it is essential that the researcher comes into the interview fully prepared to make the most of the brief time allocated (e.g., by pre-researching background information and context). The interview structure revolves around the interviewee\u0026rsquo;s definition of the situation or topic, and so they are given space to direct the conversation, drawing attention to what they see as most relevant, rather than relying solely on the researcher\u0026rsquo;s framing.(Odendahl et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) This means that the researcher needs to be well prepared, with a high level of fluidity and responsiveness. Leigh Sales, a prominent Australian journalist and author, describes her approach to an elite interview as:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;the way I structure each interview, and the kind of questions I ask, gives you a sense of the things I think are important... For example, my questions depend on what the other person says in their answer. I don't just go down a preprepared list of questions. And so therefore, what I ask depends on what the other person says\u0026hellip; I will craft my [pre-prepared] questions in the same way that I edit a piece of writing. I'm trying to make them as brief as possible, as few words as possible, as active voice as possible.\u0026rdquo;\u003c/em\u003e (Sales \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe third step, establishing consent, has some unique ethical considerations. Elite leaders are vulnerable in different ways to patient or student research participants and employing an ethic of care is just as important when researching elites as it is with other members of communities.(Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) The highly specialized nature of niche leadership fields mean elites can be inadvertently identifiable, and their public image or reputation can challenge standard anonymization approaches. (Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Being upfront and clear about the degree of identification and intended distribution of the research is essential and researchers need to take additional care to preserve anonymity (e.g., presenting field notes and interview quotations without formal attribution to roles or organizations, or withholding quotes or descriptions where the risk of repercussions with inadvertent identification is unacceptable).(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePractical considerations for how interviews are conducted are described in step four. It is helpful to reconfirm the time allocated at the commencement of the interview and adhere strictly to this. In some of the published examples, interviews were conducted by two researchers. (Kezar \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Teixeira and Bridge \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) Interviewing in pairs can help to readily access pertinent documents or statistics during the interview. It is also important to confirm how the interview will be recorded, (e.g., if audio or video recording will be supplemented by field notes). In certain instances, field notes alone may be preferred to encourage openness and protect anonymity, and the interviewer needs to be prepared to change at short notice if requested. We provide a more in-depth discussion of elements of an elite interview below.\u003c/p\u003e \u003cp\u003eIn the final step, post-interview engagement can help the interviewer maintain trust and credibility (e.g., by providing summaries of key points and suggested quotes, or follow up questions by email or phone).(Kezar \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) Ideally, researchers should provide copies of outputs to interviewees prior to publication. Reflexive journalling and memos are also an important part of the post-interview process, especially as the affective elements within the interview may be poorly captured by transcripts.\u003c/p\u003e\n\u003ch3\u003eElements of an elite interview\u003c/h3\u003e\n\u003cp\u003eFrom their critical/constructivist positions, both Ahmed and Kezar offer models that position the elite interview as a space for transformation, reflexivity, and institutional critique.(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) Drawing heavily on their work, we synthesize the findings from our exploration of the literature to propose that in an elite interview information is exchanged, and meaning conveyed, through six interrelated elements: narrative framing, co-construction of meaning, affective vulnerability, institutional critique, credibility building and ethical reflexivity. This framework is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, linking these six elements to interaction techniques to guide researchers using elite interviews.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProposed framework for elite interviewing in HPE\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInteraction Techniques\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterpretive value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1) \u003cb\u003eNarrative framing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterviewee opens with their own framing; interviewer uses broad or pre-researched prompts with minimal interruption; researcher adjusts questioning pace, tone, and depth based on role, time constraints, and setting.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReveals how leaders prioritize and sequence institutional meaning; surfaces implicit agendas or bias;\u003c/p\u003e \u003cp\u003eprovides explanations for background research findings.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2) \u003cb\u003eCo-construction of meaning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of affirmations, returning to earlier statements, highlighting shared experiences or examples; interviewer adopts/expands interviewee framing; uses comparative or relational framing to prompt clarification or reflection; may use humor, metaphors or stories to help explain concepts.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGenerates shared language and alignment; allows mutual shaping of knowledge and reflection; helps refine/transform perspectives of both interviewee and interviewer.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3) \u003cb\u003eInstitutional critique\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSequentially layering or using follow-up questions to invite increasing depth of institutional critique; prompts structure around organizational processes, decision points, or inconsistencies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurfaces contradictions, implementation gaps, and underlying policy logics; raises tensions between institutional roles and personal ethics.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4) \u003cb\u003eAffective vulnerability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of disclaimers, pauses, tone shifts, or clarifying questions; may need boundaries around what is shared; interviewer signals when responses may carry reputational implications; requires an openness to reveal emotions from both interviewer and interviewee.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEncourages exploration of identity, values, and alignment within institutional roles; reveals guardedness or vulnerability; invites openness and revelation through trust.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5) \u003cb\u003eCredibility building\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterviewer demonstrates topic expertise; shows familiarity with institutional data or governance; interviewer may disclose their own context, identity and experiences; mutual reference to external people or examples.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEstablishes relational parity and fluency; enables deep engagement and openness in short, targeted interviews.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6) \u003cb\u003eEthical reflexivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearcher remains attentive to the unique ethical issues of elite interviewing; consciously considers intersectional identities and attends to power asymmetries; acknowledges positionality and influences on interaction; responds to external environment and political climate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConsiders how intersecting identities shape experience and engagement; unveils invisible labor and marginalization; supports deeper insight into power, identities, and prevailing organizational values and orientation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eA Worked Example of Elite Interviewing to HPE Research\u003c/h3\u003e\n\u003cp\u003eDespite the centrality of leadership in shaping institutional practice, the application of elite interviewing within HPE remains limited. The few published examples of elite interviews in healthcare contexts focus on interviews with knowledge specialists and clinical experts, rather than organizational leaders, and are centered on addressing logistical concerns such as access and confidentiality.(Goldman and Swayze \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Stephens and Dimond \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Leadership in HPE often requires aligning competing priorities, such as equity guidelines, accreditation standards, workforce demands, and academic culture within institutions that are themselves sites of professional hierarchy and normative authority.(Orrick et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) This complexity requires an interview approach that can elicit not only policy rationale or decision-making logic but also how leaders experience and interpret their roles within broader institutional and social structures.\u003c/p\u003e \u003cp\u003eIn this second part of this paper, we provide a worked example of elite interviewing in a study on diversity, equity, and inclusion (DEI) policy implementation in postgraduate medical training. We are not sharing the findings from that work, but rather we use those data to examine how elite interview methodology, when used with medical deans, department chairs, and program directors, helped to give insight into how leaders make complex decisions about this area of organizational policy and practice. Through this example, we aim to highlight the methodological characteristics of elite interviewing in this HPE setting, show an application of our six elements, and reflect on the ethical, relational, and analytic considerations of this technique.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy synopsis\u003c/h2\u003e \u003cp\u003eThis worked example draws on a subset of elite interviews from a larger qualitative project on academic leaders’ conceptualization and implementation of diversity and equity policies in medical education. Whilst the purpose of this larger project informed the development and adaptation of the interview approach, we do not present the empirical findings here. The study design was informed by critical theory, which seeks to examine and challenge the power structures, institutional norms, and ideologies that shape experience and knowledge production.(Paradis et al. \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) Hence, we lean heavily on elite interview techniques within the critical theory paradigm.(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) The study processes followed the steps outlined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and the interviewee identities, institutions, and geographical locations have been anonymized. In this methodological analysis, we elaborate how the six elements we propose for an elite interview (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) operated in practice within the interviewer-interviewee dynamics and institutional contexts and how these elements assisted data collection, engagement, and interpretation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReflexivity and Positionality\u003c/h3\u003e\n\u003cp\u003eAll four authors are experienced HPE academics and leaders in their fields. All interviews were conducted by the primary author (SJA), who is a senior academic and surgical education leader based at an Australian university, who was undertaking this research during a fellowship in the United States. Her institutional responsibilities include oversight of medical school admissions, faculty workforce planning, and leadership development. These experiences informed her familiarity with the leadership contexts and decision-making responsibilities of the interviewees, while her position outside the U.S. medical education system provided distance. She identifies as a woman living with disability, specifically deafness. While this aspect of her identity was not always foregrounded in the interviews, it contributed to her attentiveness to non-verbal cues and the language of inclusion, access, and leadership representation throughout the research process. The remaining authors are based in U.S. medical education institutions, leading equity programs, curriculum design, and faculty development.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e This study received ethics exemption approval from the University of California, San Francisco Institutional Review Board [IRB24-42887]. All participants provided informed verbal consent.\u003c/p\u003e "},{"header":"Findings","content":"\u003cp\u003eElite interviewing was applied as a methodological strategy in 35 interviews with senior academic leaders at nine U.S. medical education institutions between January-September 2025. A further two institutions and one individual declined the invitation to participate due to concerns about potential political and reputational risks. Interview duration ranged from 20 to 60 minutes. Interviewees included Medical Deans, Department Chairs, and institutional leaders responsible for faculty affairs, equity portfolios, recruitment and strategic planning. In the examples below, we describe how each of the elements in our framework surfaced during these interviews.\u003c/p\u003e\u003ch2\u003eElement 1: Narrative Framing\u003c/h2\u003e\u003cp\u003eInterviewees frequently directed the opening structure of the conversation. In response to broad contextual prompts (e.g., \u003cem\u003eCan you tell me about your approach to equity work?\u003c/em\u003e or \u003cem\u003eWhen I was preparing for our interview, I read an editorial you wrote…\u003c/em\u003e), the interview often commenced by interviewees recounting organizational histories, describing a recent structural change, or referencing a significant event. This narrative framing indicated what they considered relevant to the topic and revealed how they understood their institutional role. In many cases, interviewees sustained a single narrative for several minutes before pausing, during which the interviewer allowed the structure to unfold without interruption.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 1\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e‘I thought we were doing really well as a department, and then George Floyd [murder] happened, and the pandemic happened, and I realized that as much progress as I thought we had made dealing with things like pay equity and dealing with the recruiting [of diverse faculty]… we were completely unprepared to address the needs of the department.’\u003c/em\u003e \u003c/p\u003e\u003cp\u003eIn this example, the interviewee uses the 2020 #BlackLivesMatter protests to frame the subsequent discussion, providing both a contextual and reasoning point to explain their subsequent strategic actions; with both interviewee and interviewer returning to this event as a conversational anchor on several occasions during the interview.\u003c/p\u003e\u003ch2\u003eElement 2: Co-Construction of Meaning\u003c/h2\u003e\u003cp\u003eSeveral interviews evolved through iterative and reciprocal exchanges. At times, the interviewer referenced previous interviews or described her own context to probe further or invite reflection. Interviewees returned to earlier points, clarified their position, or introduced comparisons to other contexts. The interviewer adopted the interviewee’s framing, enabling interviewees to expand or revisit initial statements to describe their answers in more detail. In this way, it allowed for co-construction of meaning, where interviewer and interviewee both contributed to how the topic was interpreted.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewer\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWhen I’m doing DEI activities at home, I often get a lot of pressure to make it more about wellbeing. Do you get this too?\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 2\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI think it's this kind of, how do I say this?[makes a wry expression] I think wellness and burnout are really, really important, but they don't always create space for us to have some of those really difficult conversations around racism or sexism.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewer\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eYeah, yeah, let's actually talk about and name it for what it is. It's not burnout, it's perpetual patriarchy...\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 2\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eAnd it's like, PTSD, like, the microaggression stuff, dealing with that long term…\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewer\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eSo, yoga on the lawn is not going to fix that.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 2\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eRight! [laughter] It's changing the structures and systems… Let me give you an example… [describes a wellness intervention]\u003c/em\u003e \u003c/p\u003e\u003cp\u003eHere, by sharing from her own perspective, the interviewer was able to prompt the interviewee to a more nuanced description of what they meant by ‘DEI activities’. The quick repartee, stories and sardonic humor within this conversation rapidly facilitated a sense of shared meaning and agreement about what was implied by the term ‘DEI’, beyond public facing documents and catch phrases.\u003c/p\u003e\u003ch2\u003eElement 3: Institutional Critique\u003c/h2\u003e\u003cp\u003eWhen invited to reflect on policy implementation or institutional effectiveness, many interviewees offered deeply reasoned answers. These were often in response to implicit cues from the interviewer, including comparisons to policy environments in Australia or statements of shared experience in faculty leadership. Interviewee responses identified organizational tensions, structural limitations, or decision-making processes that were not documented in formal strategy statements. These accounts were most detailed when the interviewer questioned taken-for-granted institutional messaging, structuring questions in sequential layers to progressively prompt the interviewee to elaborate, clarify, or reflect more deeply on earlier responses.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewer\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI'll come back to some of the other things, but that is interesting, because there does seem to be this tension [refers to multiple parallel equity initiatives within department]. It's kind of, 'how do you link together’?\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 3\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI'm glad you picked up on that, because it's one of the things I complain about. In some ways, it’s… [gestures frustration] I mean, if you're not talking about DEI, it kind of makes sense, but like, when you're trying to do a broader initiative for everyone, it makes it very challenging.\u003c/em\u003e \u003c/p\u003e\u003cp\u003eIn this example, by deliberately pointing out the tension in a statement, the interviewer prompted the interviewee to be more openly critical about their feelings and frustrations with the organization.\u003c/p\u003e\u003ch2\u003eElement 4: Affective Vulnerability\u003c/h2\u003e\u003cp\u003eInterviewees signaled the reputational or emotional weight of certain topics by slowing their speech, qualifying their language, or pausing before responding when discussing institutional risk, failed initiatives, or contested decisions. In these moments, the interviewer needed to acknowledge the sensitivity of the topic, pausing or inviting the interviewee to reframe or clarify. These adjustments reflected the real-time affective dimensions of the interview, building trust and encouraging openness.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 4\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWe're waiting to understand how to respond [to Executive Orders on DEI] in a way that is legal and consistent with our values. And the challenge will be that what's legal may be directly in opposition to what's consistent with our values and, and, well that'll be tough. That'll be moral distress.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewer\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eMmmm…. [reflective pause] How are you feeling about that? In your role as a leader?\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 4\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eSo, a lot of leaders have moral distress. And I'll go back, actually, to last year around this time, with, you know, with the Middle East, [I felt] a lot of moral distress because you [I] wanted to help people, and you [I] wanted to help all people.\u003c/em\u003e \u003c/p\u003e\u003cp\u003eAt times, this also meant that the interviewer showed vulnerability through openness about their own feelings and emotions. In this conversation, the interviewer went on to reciprocate with a similar personal experience, an exchange that shifted the direction of the interview away from abstract organizational responses to more personal reflections about the emotional cost of academic leadership in the broader global political context. This openness required both parties to clarify the boundaries of the conversation, including how information would be shared.\u003c/p\u003e\u003ch2\u003eElement 5: Credibility Building\u003c/h2\u003e\u003cp\u003eEstablishing credibility quickly was essential to fostering substantive dialogue and openness. Credibility building was bidirectional – the interviewer had to establish their credibility but was also assessing the credibility of the interviewee. This process began before the interview by endorsement from the institutional contact, or mutual recognition of professional standing and affiliations. Within the interview itself, the interviewer reinforced their credibility to the interviewee by demonstrating detailed preparation, fluency in sector-specific terminology, well-informed questioning and referencing shared professional networks. Warmth, responsiveness, and genuine interest further supported rapport and signaled competence.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewer\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI did notice, [referring to background research] you have pathway programs to try and build exposure and experience... Were these deliberately developed as part of this strategy? [indicates DEI strategy pamphlet provided by interviewee]\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 5\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI think that the pillars helped as we developed a strategy around our work and [the programs] provide examples of the framework that we use for the work… [But we need to resolve] how these fit together into a coherent structure that helps to describe exactly the work that we do.\u003c/em\u003e \u003c/p\u003e\u003cp\u003eIn this example, the interviewer’s preliminary research and contextual fluency with the institutional strategy positioned her with the credibility to quickly direct the conversation towards exploring gaps in the organization’s strategic logic and cohesion, without necessitating detailed explanatory descriptions.\u003c/p\u003e\u003ch2\u003eElement 6: Ethical Reflexivity\u003c/h2\u003e\u003cp\u003eInterviews were conducted during a period of heightened political scrutiny toward ‘DEI’ in the U.S., including evolving federal legislative mandates and the rolling back of institutional protections.(Sands and Ferraro \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Trump 2025) This broader political context shaped the ethical and methodological complexity of the study, requiring reflexivity and awareness, especially around consent for dissemination, as described by this interviewee:\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInterviewee 6\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e[On consenting for dissemination of study findings] Of course, but being careful, because of everything we just said. DEI is just such a tough term for anybody to talk about right now… You know, [our University] is viewed in the country as very left, very liberal, very out there, and I think we want to have that streak, but you know… [I don’t] want to create a big, spinning target for ourselves.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e As the risk of institutional repercussions increased, interviewees started to refer to equity activities more obliquely, which required the interviewer to employ interpretative awareness and pay careful attentiveness to silence or redirection, along with navigating complex emotional reactions. Ethical interviewing in this context required the interviewer to acknowledge reputational risks, affirm safety and confidentiality, and remain alert to moments where expression was deferred or deflected.\u003c/p\u003e\u003cp\u003eEmploying ethical reflexivity also meant being attuned to how intersectional dynamics shaped the formality, disclosure, and control during interviews. While reciprocity and dialogical engagement were evident, relational dynamics were influenced by underlying gendered or racial hierarchies. For example, some senior leaders adopted a more directive approach, maintaining structured conversational boundaries and a formal tone, or used presentation slides. In contrast, other interviewees expressed hesitancy or guardedness, reflecting the complex interplay of positional authority, perceived institutional vulnerability, and relational trust. At other times, the interviews became safe, therapeutic spaces in which leaders could work through their tensions between personal commitment and organizational alignment. These patterns were not uniformly linked to any single identity marker but were mediated by intersecting roles, histories, and the relational dynamic between interviewer and interviewee. This required the interviewer to be deeply reflexive about how Whiteness, gender and professional status shaped the conditions of each interview, recognizing that mistrust is not merely interpersonal but historically embedded in and supported by systems of power and exclusion. Without this critical awareness, the interview process risked reproducing the very hierarchies it sought to interrogate.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eElite interviewing can enrich HPE research by providing a methodology that helps facilitate deeper, more reflexive inquiry into leadership and institutional decision-making. In our worked example, the six elements described in this paper helped to guide the research process and interviews. We illustrated how the two-way dialogical approach helped to frame the narrative of the interview, provoke institutional critique and co-construct meaning, assisting the interviewer to navigate the interview space by building credibility, demonstrating vulnerability and sustaining ethical reflexivity. These elements created the conditions for candid and nuanced discussion that gave insights into the decisions academic leaders were making, and how they interpret and rationalize their approaches towards equity initiatives. Ahmed comments how interviews with organizational leaders often default to \u0026lsquo;mission speech\u0026rsquo;, smoothing over institutional failures and reproducing narratives of success.(Ahmed \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) Our approach to elite interviewing gives some practical techniques for researchers to push beyond these surface narratives and gain a deeper understanding of the complexities of leadership within organizational power and structures.\u003c/p\u003e \u003cp\u003eWe have argued that elite interviewing techniques hold value for HPE researchers seeking to examine leadership and complex organizational decision-making. Yet, some of the greatest value of this technique comes from its potential contribution to qualitative methodology training and educational pedagogy, helping researchers to shift away from postpositivist paradigms toward more constructivist and critically reflexive approaches. This ontological reorientation arises from the practical demands of the method itself. Elite interviewing requires the researcher to relinquish tightly scripted formats and fixed frameworks in order to use the fluid, dialogic approach we describe. To do this well, the researcher needs to cultivate a deep and emergent reflexivity, attending closely to their own positionality at every stage of the interview process. The openness in the elite interview technique, especially the affective vulnerability and ethical reflexivity elements, exposes the limitations of postpositivist assumptions about neutrality and objectivity. Without the rigor provided by a strong reflexive focus, this technique has the potential to become unstructured and haphazard, garnering only superficial or directionless insights. However, by foregrounding reflexivity, we found that the researcher was better able to recognize and navigate power dynamics, respond ethically and adaptively during interviews, and garner more nuanced interpretations. In doing so, the interview became a space of transformative inquiry and reflection.\u003c/p\u003e \u003cp\u003eDespite its value, there are limitations in our current application of elite interviewing that warrant reflection. In our worked example, the interviewer and interviewees shared similar ideological commitments to diversity, equity and inclusion which fostered rapport and enabled rich, reflective conversations. However, this also constrained the opportunity to examine how elite interviewing performs in more contested, oppositional, or hostile environments. Power and hierarchy are inherent within elite interviewing, and researchers may find themselves in ethically or philosophically challenging situations, particularly if confronting leaders about divisive or exclusionary topics. This raises questions about how the researcher can uphold an ethic or care whilst still applying necessary critique. Is it possible to remain open and respectful without neutralizing difficult topics? Kezar argues that empathy enhances trust and depth in elite interviews, but there remains a tension between relational authenticity and moral acceptability.(Kezar \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) These complexities highlight the need for reflexivity but also question the limits of what can or should be said in elite interviews. DEI remains a politically divisive topic in many academic settings in the United States, and this has impacted how we have been able to engage with and disseminate the findings of the larger research project. It is worth considering whether the individuals and institutions who declined to participate may have done so because of perceived risks in the depth and openness required from this interview methodology.\u003c/p\u003e \u003cp\u003eBeyond the limitations listed above, it is also worth pausing to reconsider the term \u0026lsquo;elite\u0026rsquo; interviewing in the context of HPE. While the term is commonly used in other disciplines to elicit the perspectives of leaders, there is an inherent tension that arises in the healthcare sector. Whilst we have adhered to the term \u0026lsquo;elite\u0026rsquo; for the sake of continuity and comparison to the broader tradition of this interview technique, we are highly conscious that the concept of elite does not align well with the inclusive values central to healthcare and medical education. Accordingly, we advocate for consideration of an alternative term like \u0026lsquo;expert informant\u0026rsquo;, which better reflects the intention to seek insights from individuals with specialized knowledge and experience in HPE, without reinforcing social hierarchies or exclusionary language.\u003c/p\u003e \u003cp\u003eWhilst our worked example focused on academic health equity leadership, elite interviewing holds broader potential to explore underexamined questions in HPE, where strategic decisions shape institutional direction and educational priorities. Areas such as curriculum reform, accreditation standards, and workforce credentialing standards often involve high-stakes deliberations by senior leaders, yet their rationale remains poorly articulated in the HPE literature. Research in these contexts requires sensitivity to reputational risk and to the potential tensions between an individual\u0026rsquo;s personal views and those of their institution. Elite interviewing can help elicit the values, negotiations and contextual pressures that underpin institutional decisions, giving insights that are often inaccessible through conventional research methods. As the HPE profession continues to navigate increasingly complex socio-political demands and shifting societal values, this way of interviewing provides a methodology for examining the institutional processes that are actively shaping the future of this field.\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003eCorresponding author\u003c/h2\u003e \u003cp\u003eSarah J Aitken [email protected]\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was funded by The Commonwealth Fund Harkness Fellowship (recipient Author SJA).\u003c/p\u003e \u003cp\u003eConflicts of Interest/Competing interests:\u003c/p\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003cp\u003eEthics Approval:\u003c/p\u003e \u003cp\u003eThis study received ethics exemption approval from the University of California, San Francisco Institutional Review Board [IRB24-42887].\u003c/p\u003e \u003cp\u003eConsent to participate:\u003c/p\u003e \u003cp\u003e Explicit verbal consent, after review of participant information documents, was provided by all participants.\u003c/p\u003e \u003cp\u003eData availability:\u003c/p\u003e \u003cp\u003eDue to the confidential nature of these transcripts, data sharing is not available.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSJA conceived the study, developed the methodology, collected study data, and wrote the original draft. AWK and CD reviewed and advised on the research findings and contributed to the editing of the manuscript; PSO supervised the research process and contributed to the study design, analysis, and editing of the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eFunding for this research was provided by the Commonwealth Fund Harkness Fellowship (recipient Sarah J Aitken).\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDue to the confidential nature of these transcripts, data sharing is not available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhmed, S. (2012). \u003cem\u003eOn being included: racism and diversity in institutional life\u003c/em\u003e. Durham, NC; Duke University.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldridge, A. (1993). 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How \u0026lsquo;going online\u0026rsquo; mediates the challenges of policy elite interviews. \u003cem\u003eHumanities \u0026amp; social sciences communications\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 431. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1057/s41599-024-02939-0\u003c/span\u003e\u003cspan address=\"10.1057/s41599-024-02939-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"advances-in-health-sciences-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ahse","sideBox":"Learn more about [Advances in Health Sciences Education](http://link.springer.com/journal/10459)","snPcode":"10459","submissionUrl":"https://submission.nature.com/new-submission/10459/3","title":"Advances in Health Sciences Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Qualitative Methods, Leadership, Health Professional Education, Organizational Policy, Interviews as Topic.","lastPublishedDoi":"10.21203/rs.3.rs-8286458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8286458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eExploring how academic leaders shape the delivery and structure of health professions education (HPE) requires research approaches that move beyond descriptive accounts of students, programs, and systems to elicit the reasoning and values underpinning leadership decisions. Without methods capable of engaging with this complexity, research risks producing shallow or instrumental accounts that fail to generate constructive insights or prompt meaningful reform. The HPE literature has limited practical, worked examples of how to conduct such research, particularly with senior leaders. Elite interviewing, a method widely used in political science and sociology, offers a valuable but underutilized methodological approach. It prompts deep exploration of how individuals in positions of authority think, act, and negotiate personal values, organizational priorities and broader sociopolitical contexts. In this paper, we examine elite interviewing as a methodological approach and expand the details of the approach by proposing a framework for elite interviewing in HPE with six interrelated elements: narrative framing, co-construction of meaning, affective vulnerability, institutional critique, credibility building, and ethical reflexivity. Drawing on a worked example of interviews with academic leaders involved in medical education equity initiatives, we demonstrate how employing these elements supports depth, nuance, and reflexivity in both the interview process and analysis. Our aim is to provide practical guidance demonstrating the potential of elite interviewing to methodologically enrich qualitative research in HPE.\u003c/p\u003e","manuscriptTitle":"Elite Interviewing as a Research Method: A worked example studying Academic Leadership in Health Professions Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 08:53:02","doi":"10.21203/rs.3.rs-8286458/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-22T16:47:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T01:19:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-05T17:17:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177056201884286392206799361931618453653","date":"2026-01-14T14:07:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111288005344277046779067621307387077111","date":"2026-01-11T21:05:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-19T13:31:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T16:42:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-08T16:41:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Advances in Health Sciences Education","date":"2025-12-05T09:35:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"advances-in-health-sciences-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ahse","sideBox":"Learn more about [Advances in Health Sciences Education](http://link.springer.com/journal/10459)","snPcode":"10459","submissionUrl":"https://submission.nature.com/new-submission/10459/3","title":"Advances in Health Sciences Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e26c22e9-d26d-49a3-9d7c-cae8edcdccdf","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T09:26:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 08:53:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8286458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8286458","identity":"rs-8286458","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}