Methods
In this study, we used constructivist grounded theory9to explore how physicians interacted and reacted to a variety of data
elements presented in ED audit and feedback. This project is the second
in a multiphase needs assessment aimed at developing a new approach to
A&F. In prior work, we conducted a regional needs assessment for A&F
for emergency physicians, soliciting which practice data elements were
most desired regarding practice measurement.10 The
results of this regional needs assessment were stratified into the
subgroups of respondents. These were divided by gender, duration of
practice, and type of practice (community vs academic). By asking
physicians to provide their own reactions as well as their perceptions
on differences we observed between subgroups, we looked to gain insight
into how they may react to their own practice data.
Reflexivity. Before engaging in any analyses, our investigatory
team met to discuss our inherent stances and assumptions in order to
assist us in achieving reflexivity. Each member of the analysis team
sought to declare their perceptions about the role and value of A&F and
the predicted view of A&F by the participating subgroups. We also
discussed our prior training (if we had any), and the sensitizing
concepts/frameworks brought to the analysis process. The research team
then made a plan for the theme extraction of interviews.
Population/Recruitment . A total of 15 participants were recruited
for interview participation. Intentional sampling was performed to
ensure that participants represented a variety of practice
characteristics that were identified in the needs assessment (gender,
community vs. academic practice, and duration of independent practice).
Participants were emergency physicians practicing in the Hamilton region
amongst 7 practice sites which were included in our needs analysis. All
interviews were conducted between July 15th and
September 2nd, 2019.
Interview Procedure. The interview guide was constructed by a
single author (SM) based on the needs assessment survey data. This was
refined and finalized by a second author with significant qualitative
research experience (TC). Interviews were conducted by our first author
(RK) after undergoing training with the more experienced members (TC,
SM) of the team and receiving feedback. A training interview was
conducted with this author before the inclusion of the research
subjects. Impressions and insights from participants were collected
during a single phase of interviews with all participants. Interview
scripts are available in Appendix A.
Ethical review. T his project received an ethical exemption for
the Hamilton Integrated Research Ethics Board (HiREB).
Analysis. I nterviews were audio-recorded and then transcribed
without identifiers. The author who interviewed participants was the
only author who was privy to the identity of the respondents. We
analyzed the data using a constant comparative method to identify these,
initially starting with an open coding process for all of the
transcripts. Once this was complete, we proceeded with axial coding to
group relevant themes and subthemes.
For the first transcript, the entire research team met to normalize the
process of open coding for all. Thereafter, two authors (SM, RK) met and
coded all the subsequent transcripts. With each analysis meeting, codes
were discussed, added, or collapsed our previous coding. Our team opted
to resolve disagreements through a discussion and consensus-building
process. We eventually came to a consensus on all themes presented in
our final analysis. Two authors subsequently met (SM, TC) for the axial
coding of the data into larger themes.
Methods to Increase Rigor. As a form of member check, we sent the
penultimate version of our newly developed model to our participants for
their review and comment. We asked them to review the figure and
associated explanations and provide insights about whether this model
suited their worldview. Amendments and questions were used to revise the
model to generate our final version.