Sampling and protocol
In line with this method, we conducted in-depth individual interviews
with purposively sampled experienced generalist physicians who practice
in diverse clinic settings and were willing to tell stories about
memorable personal errors. We defined “experienced” as being in
post-training practice for at least five years. We created this
criterion to ensure that our sample of physicians had a depth of
clinical experiences by which to contextualize their errors; although,
we did not specifically limit the timeframe from which participants
would select their stories. Furthermore, all physicians were based in
Canada or the United States. We involved a wide range of physicians in
order to speak with those who were willing to share rich and detailed
stories. Physicians from Canada and the United States were included due
to an assumed similarity in culture around medical errors that may arise
due to the influence of organizations or projects like the Associated
Medical Services Phoenix Project, which has members from across North
America57.
Given these stories may be seen by some as reflecting poorly on their
professional competence or ability, we identified confidentiality to be
of utmost importance to eliciting rich data. We restricted our data
collection to generalist physicians in the hopes that the commonalities
among their practices and treating and diagnosing patients with a wide
variety of complaints would facilitate comparison of stories across the
whole dataset. We chose not to focus on a single location or specialty
in an effort to look for transferable ideas that are consistent across a
variety of clinical contexts. See Table 1 for detailed inclusion and
exclusion criteria.
(INSERT TABLE 1 AROUND HERE)
After identifying and recruiting participants, we conducted in-depth
interviews either in-person or over the telephone, based on participant
preference. Telephone interviews can drive the gathering of sensitive
information when anonymity is preferred59 and
facilitate the inclusion of participants who were both socially and
geographically distant from our own networks. All interviews were
conducted by non-clinicians with experience conducting qualitative
interviews (MV, EC, SK).
The interviewees were asked to share two memorable stories of personal
errors—one which they chose to share with others and another which
they kept more private. The interviewer elicited the entire story of the
error and asked follow-up questions about how the physician dealt with
the error with a focus on how it affected their practice over time. All
interviews were audio-recorded and transcribed verbatim. See Appendix
1.0 for the detailed interview guide.
We used the theory of information power to establish data sufficiency.
We judged the information from 26 participants to be sufficient due to
the narrow scope of our project, strong dialogue from participants that
produced rich data, and the use of established theory. The research aim,
specificity, dialogue, and analysis drive us toward higher information
power and smaller sample size58.