6.1.- CUESTIONARIO KIDSCREEN

Through the presentation of five examples from my interview data, I aim to illustrate my insider status and reflect on how it shaped this study. I have labelled these as follows:

1. Rapport and the interviewer-interviewee relationship 2. Interviewee seeking something from me in my role 3. Navigating the system

4. Assumptions about me 5. Trust

Relevant Researcher Features

General Practitioner features

General Practitioner (GP) GP in West of Scotland GP in a deprived practice

GP in a practice affected by recruitment difficulties

Teaching roles within practice

Undergraduate Tutor Foundation Supervisor Postgraduate Trainer Multilevel teacher

External education roles

Director of Community Based Medical Education Education Associate for GMC

CSA Examiner for RCGP

Personal features

Female

Age - "in my 40s" UK Graduate

Dual citizenship - British and Australian Key:

GMC - General Medical Council CSA - Clinical Skills Assessment

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5.7.3.1 Rapport and the interviewer-interviewee relationship

As a local GP and clinical teacher for the past 12 years, I knew my interviewees to varying degrees. While I would consider one of the participants a good friend, others I only knew of through their involvement with teaching at the University. As GPs, we are trained in how to establish rapport with patients, to ensure their trust. In the following example I try to establish rapport with an interviewee by sharing her joke while also reiterating my status as a fellow doctor.

F13: Because they all say ‘we’ll just have water’. [They] are never going to survive another surgery of crying middle-aged women if [they] just have water. (laughter) Have a coffee!...That’s a bit tongue in cheek, sorry.

LP: I realise that… I do remember that realisation myself though as a doctor. (laughter)

Unlike an outsider researcher, when considering the relationship between us, I was also mindful of the likelihood of an ongoing relationship with my

interviewees and the potential impact of their interview experience on that. 5.7.3.2 Interviewee seeking something from me

Researchers must consider the potential for power dynamics to influence the self that interviewees present. It would have been dishonest and unfair to interviewees not to be upfront regarding my role at the medical school. My impression was that the impact of this was negligible, given the openness with which the GPs appeared to speak. However, as a researcher you can never truly know if this is the case. In this example, prompted by my questioning, the interviewee seeks my guidance.

Well I suppose from the angle of the questions do you think we should be more formalised in what we do, in [teaching both] postgraduate and undergraduate? (M8)

In a further example, one tutor, lamenting their difficulties in recruiting new GPs to the practice, offered me a job in the practice, When I declined, they tried to explore my reasons for not being interested in a job there – a discussion that would not have occurred had I been a non-GP interviewer.

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5.7.3.3 Navigating the system

An advantage of being an insider was that it helped me negotiate the familiar territory of teaching in general practice. I speak the language of GP as well as the differing languages of postgraduate and undergraduate medical education. On arriving at unfamiliar practices, I was able to introduce myself as “Dr Pope from the medical school” and on the majority of occasions, this ensured I was promptly escorted into the clinical area. On meeting the GPs, I made a point of thanking them for time in their busy day, as I am very aware how precious time can be on a clinical day. On a few occasions, prior to the interview starting, this prompted discussion of various challenges they had faced that day. Sharing in these experiences helped me to appreciate the context for those individuals and also facilitated establishing rapport.

5.7.3.4 Assumptions about me

Interviewees made a range of assumptions about me, both personally and

professionally. Some of these were correct and some were not. This matters as a researcher’s actual identity can affect what they get told but also who

participants think someone is can equally shape what is said (Richards & Emslie, 2000). Assumptions made about me ranged from assumptions about personal attributes (e.g. age) to assumed knowledge and roles. For example, the issue of age arose in several interviews as GPs described the age gap between

themselves and their learners and the impact of that gap. Both younger GPs, as well as those nearing retirement, flagged this gap as important. As I am in my forties, I am “somewhere in the middle” and I think this helped me to

appreciate the range of views.

As a perceived insider, interviewees regularly made assumptions about my understanding of particular issues and processes. While this was often as accurate assumption, I was mindful not to assume their understanding was the same as mine. A challenge with being an insider was to ensure I had the curiosity of an outsider when conducting my interviews (Mercer, 2007). Failure to do this can mean the researcher can fail to see the obvious or may take things for granted. At times this was challenging as I worked to balance my desire to

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In a couple of the interviews, I was assumed to be a representative of a

postgraduate training organisation. In those interviews, the interviewees were reflecting difficulties they had experienced in that relationship so I felt the need to correct that assumption in case it was influencing what they were saying to me.

5.7.3.5 Trust

Trust is crucial in qualitative research as you are trying to understand the world through your participants’ eyes. Trust arose in the interviews in a couple of key ways. Several interviewees disclosed to me that they have deviated from the recommended teaching plans issued by the University and did so by prefacing it with a “don’t tell” type of statement. Meanwhile, another couple wanted to establish my motives before sharing specific information with me.

I think with the postgraduate side it is a bit more structured…there is a bit more monitoring…because there’s certain things [you] have to do within the practice and that’s monitored…whereas with the

students…there’s more latitude…How do you monitor that? Is that what you’re trying to do? (M3)