[341 words]
Methodology :
Clinicians in two tertiary level university teaching hospitals (National
Maternity Hospital (NMH), Dublin and Cork University Maternity Hospital
(CUMH)) and one secondary level unit (Wexford General Hospital (WGH))
were invited to participate. NMH and CUMH each have more than 9,000
births per year and are teaching hospitals at both undergraduate and
postgraduate level. WGH is a peripheral centre of excellence with more
than 1,500 births per annum and provides postgraduate teaching in
Obstetrics and Gynaecology.
The current training scheme in Ireland comprises two parts: basic
specialist training (BST) and the higher specialist training (HST).
After completion of one year of internship trainees enrol into BST which
comprises two years working as a senior house officer and one year as a
junior registrar. While some trainees would start performing OVD under
supervision during BST1 or BST2, the majority would only start
performing OVD on a regular basis during BST3. Following completion of
BST and successful pass in the Royal College of Physicians membership
examinations, trainees then interview for HST, a five-year structured
training program. On successful completion of this, trainees are awarded
a certificate of completion of specialist training (CCST).
Training in OVD comprises of two parts: firstly a theoretical
introduction (as part of BST years 1 and 2 and again prior to the start
of the third year) and secondly an on the job apprenticeship under close
supervision. For the final year of BST trainees are supervised on the
labour ward by a senior obstetrician (year 4/5 HST or consultant) for
every OVD they perform. A logbook of every OVD is required and reviewed
every year at the end of training year assessment.
For this study, clinicians at all levels of obstetrics training from
BST3 level to final year specialist trainees and consultant
obstetricians were invited to participate in the study. Following
consent, participants were interviewed using open ended non-directive
questions (Table I). As interviews progressed and new themes developed
this guide was modified to allow further exploration. The interviews
were recorded as audio (Dictaphone) and later transcribed (Express
Scribe Transcription). Audio files were securely stored after
transcription to allow review, and will be destroyed in the usual
manner. Thematic analysis was performed until saturation.The qualitative
research method was Thematic Analysis19. This was
picked as it is a “flexible and useful research tool ” which can
“potentially provide a rich and detailed, yet complex, account of
data ” 19
The process was as follows: As the interviews progressed and there was
increasing saturation of data, the interviewers took care to carefully
compare findings by checking with new participants and triangulation of
data. Audiotapes were transcribed verbatim by the researchers and the
transcripts were entered into NVivo and coded. Transcripts were read and
reread as codes were assigned by two coders (ZA, LC). The data was first
divided into the sections outlining the interview guide. This helped
with the initial assessment of the data using a deductive approach, as
the pre-existing structure of the interview guide provided base
concepts, ideas and topics that acted as scaffolding for analysis. Data
was then coded following the individual guiding question of the
interview guide, narrowing, and defining the codes that presented in the
data initially. At the end of stage two, codes were identified. Theme
development occurred during stage three: codes were examined
inductively, looking at what the participants were saying and whether
some topics were continuous throughout the interview. The codes were
then observed and grouped several times while the themes were identified
by the researchers. Themes were developed from data that were prevalent
across interview, important and substantial. Saturation of themes was
defined when refinements did not add any new substantial themes.
Trustworthiness was enhanced by two methods: method checking and
triangulation20,21. A variation of member checking was
used, where instead of reviewing themes with the original participants,
themes were instead reviewed with a different participant to see if they
saw them as authentic. Triangulation was via researchers where two
researchers initially analysed data (ZA, LC) and two reviewed identified
themes (FMcA, MH).
The research team had previously reflected on possible personal sources
of bias: MH and FMcA had participated in training in OVD and worked in
clinical academia; ZA is a trainee in Obstetrics and Gynaecology; these
were identified as a possible bias in the research and as such both
identified this bias and worked with the other member (LC) who would not
have this bias. This study is reported following the COREQ
standards22.
The participants were also asked to provide basic demographics including
years of clinical work (both in the speciality and in performing OVD),
numbers of OVD, and preferred instrument. Ethics Committee permission
was approved by the Ethics Committee of the National Maternity Hospital.
There were no Patients involved in this study. A core outcome set (COS)
was not used in the development of the trial; the CROWN database was
checked and no relevant COS was found to be published or in development.