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.