The qualitative component of this study also required the development of a data collection tool in the form of an interview guide. This guide needed to be designed to collect information about intern and supervisor perceptions of how the medical apprenticeship works and what drives interns to learn the way they do.
2.4.1 PILOT INTERN INTERVIEWS
A separate guide to interview interns was developed and piloted. To further investigate the 'apprenticeship' in medicine, the questions were designed to explore intern perceptions of the medical apprenticeship and attempted to gain an understanding of what motivated them to learn.
2.4.1.1 DEVELOPMENT AND PILOT OF INTERN INTERVIEWS
An interview guide for a 20 – 30 minute semi-structured interview with participating interns was developed (Appendix 17). Reference group interns who had completed their learning reflections via the learning survey ‘app’ (N = 3) were invited to participate in the pilot of the semi-structured interview to explore:
55 • what they thought the roles of the registrars and consultants were in their
learning;
• what they thought the main drivers of their learning were as they worked and learnt on the job;
• what the ideal learning situation would be in their internship;
• how important they thought it was to learn things around content, administration and professional identity and which was the most important of these three; and • their perceptions of a ‘medical apprenticeship’ and how they thought it worked. Interviews were recorded using a Phillips digital voice recorder. Interviews were transcribed verbatim by the researcher.
2.4.1.2 PILOT DATA ANALYSIS
The first cycle of coding was completed using the ‘Comments’ feature in Word. ‘Values coding’, which Saldana (2013) describes as an ideal method of individuals reflecting on values, attitudes and beliefs about their experiences, was used for the first cycle of coding. Values coding was developed by Gable & Wolf (1993) to identify intrapersonal and interpersonal experiences of the subjects being interviewed and is ideal for exploring phenomenon such as how the medical apprenticeship works. Saldana (2013, p. 111) defines an ‘attitude’ as “the way we think and feel about ourselves, another person, thing or idea”, a ‘belief’ as “part of a system that includes our values and attitudes, plus our personal knowledge, experiences, opinions, prejudices, morals, and other interpretive perceptions of the social world”, and a ‘value’ as “the importance we attribute to oneself, another person, thing or idea”.
A macro called “Extract comments to new document” (The Doc Tools, 2006) which was downloaded from the Internet, was used to transform the Word comments (values codes) from the analysed transcripts into a table (also in Word). Codes allocated to each question were collated together for the second stage of coding and final identification of themes.
Saldana (2013) indicated that it is not necessary to identify all three types of codes in the transcripts, nor is it essential to differentiate between them (p. 111). Saldana also pointed out that identifying the type of values code to be attributed to a participant statement “can sometimes be a slippery task” (p. 111). To reduce this inherent arbitrary nature of values coding, all the pilot interview documents were sent to one of the
56 supervisors for review of both the process and the results. Further code checking was performed via the principal researcher and another of the supervisors comparing independent NVivo analyses of the transcripts and then cross-checking these with the results generated via the values coding method.
2.4.2 PILOT SUPERVISOR INTERVIEWS
It was important that the questions used in the interviews of the supervisors mirrored those used in the intern interviews so that the responses could be compared. This also assisted in identifying patterns and linkages in the qualitative data that enabled elaboration of the medical apprenticeship. The order in which the questions were asked was explored in a ‘debriefing’ at the end of the interviews. This was necessary to ensure that the questions posed were in a logical order for supervisors to be able to articulate their perspectives on each topic.
2.4.2.1 DEVELOPMENT AND PILOT OF SUPERVISOR INTERVIEWS
To explore the supervisors’ perspectives of the 'apprenticeship' in medicine, a guide for a 20 – 30 minute semi-structured interview with intern supervisors was developed (Appendix 18). Supervisors of interns were invited to participate in the pilot of the semi- structured interview to explore:
• how they thought interns learnt;
• what they thought the role of the registrar and consultant were in interns’ learning;
• what they thought the main drivers of intern learning were as they worked and learnt on the job;
• what the ideal learning situation would be for their interns during internship; • how important they thought it was for interns to learn things around content,
administration and professional identity and which was the most important of these three; and
• what their perceptions were of a ‘medical apprenticeship’ and how it works. Supervisors (N = 3) were provided with an information sheet and written consent was obtained for interviews to be recorded using a Phillips digital voice recorder (Appendices 19 and 20). Interviews were transcribed verbatim by the researcher.
57
2.4.2.2 PILOT DATA ANALYSIS
The first cycle of coding was completed using the same methods trialed in the intern pilot study using the ‘Comments’ feature in Word, and like the intern pilot study, ‘values coding’ was used to code the data (Gable & Wolf, 1993; Saldana, 2013). The macro “Extract comments to new document” (The Doc Tools, 2006) was again used to translate the comments into a table before the allocated codes to responses for each question were collated for the second stage of coding and final thematic analysis.
The coding team for this study consisted of the principal researcher and three of the supervisors. As values coding was a relatively new method for the coding team, a decision was made to undertake coder triangulation. This also had the additional benefit of reducing coder biases. One full interview transcript was randomly chosen by one of the other coders and this was independently coded by two of the supervisors using inductive coding, while the principal researcher used values coding. A comparative analysis of the values codes and the inductive codes was undertaken to check for consensus and validation of the codes generated by the values coding. After analysis of the interview debriefing transcripts, it was decided that the order in which the questions were posed during the semi-structured interviews of the supervisors would be as written.