Data collection and sampling

Data collection, sampling, management and analysis followed Susman and Evered cycle’s steps of enquiry as presented in Table 5.1 and Figure 5.1.

5.4.2.1 Individual Interviews

In-depth, individual interviews were conducted with all seven registered emergency medicine residents (clinical ultrasound trainees) whom had actively partaken in the training programme activities within the last two years (April 2014 to April 2016). The activities include the attendance of an accredited introductory CUS course and any logged scans recorded in their personal portfolio log. In-depth individual interviews were an appropriate choice considering the small study population and the logistical difficulty to arrange the trainees into focus groups due to their demanding work schedules. The interviews were conducted in two phases.

The first phase was exploratory considering the context specific nature of the study and how little was known on the topic. One randomly selected study participant (trainee) was individually interviewed by asking open-ended exploratory questions about the trainees, trainers, setting, logistics and eLP design roles in improving the future credentialing success (Appendix C). The primary researcher conducted the interview in November 2015 at the trainee’s Cape Town based hospital. First level analysis was completed up to the point of establishing provisional themes. The purpose of the exploratory interview was to use the codes and themes to refine the semi-structured questions for the second phase interviews that focused on the eLP design components,

P a g e | 74 Chapter 5: E-learning platform to improve learning delivery

namely communication improvement, educational content, end-user interface, ultrasound images upload and transfer, trainer feedback, add-ons and quality assurance (Appendix D).

The second phase interviews included all seven active trainees located within Cape Town’s public hospitals domain (sample matches the study population). All interviews were conducted between November 2015 and April 2016 at the base hospitals of the study participants. The interviews lasted 31 minutes on average.

5.4.2.2 Electronic mail survey

Trainees, who attended the introductory course of the Cape Town training centre between 1 June 2009 and 30 June 2013, were eligible to partake in the survey. Two hundred and eighteen trainees were invited by e-mail to complete an online questionnaire conducted in October 2013 to investigate the barriers that caused the low credentialing success. All trainees who responded to the survey were followed until the end of the required two year training period in 2015 to stratify whether they successfully credentialed as clinical ultrasound providers (credentialed group) or not (non- credentialed group) to reduce the impact of responder bias in the analysis.

5.4.2.3 Systematic review

The PRISMA-P statement (2015) was followed to source and critically analyse relevant data for this study.33 _{Searching databases and other sources identified the appropriate} records. Duplicate records were removed after a systematic screening process. Remaining records were assessed and included, if eligible. Non-eligible records were excluded with reasons. All remaining eligible studies were included for qualitative and quantitative synthesis via critical analysis. Studies were included for analysis only after they met both inclusion criteria:

 Studies that reported on the clinical ultrasound training of physicians (non- radiologists), irrespective which speciality they represented.

 Studies where the training programme’s credentialing or certification outcome was reported specifically.

P a g e | 75 Chapter 5: E-learning platform to improve learning delivery

Table 5.1 Data collection, sampling and analyses for each of Susman and Evered cycle’s steps of enquiry Susman and

Evered cycle(S) Data collection Sampling methods Analyses

Problem

diagnosis Individual interviews Emergency medicine residents who entered the CUS training programme by attending an accredited introductory CUS course and actively logged any of the required 65 ultrasound scan investigations to their personalised portfolio within the last two years (2014 – 2016) were eligible to partake in the study (n = 7)

Inductive thematic qualitative analysis

Individual interviews Same as above (n = 7) Deductive qualitative analysis informed

by focal and instrumental theories Electronic mail survey Cape Town introductory ultrasound courses attendees between 1 June 2009 and

30 June 2013 who responded by completing a questionnaire (n = 86) Descriptive statistics as informed by Check and Connect focal theory Systematic review

(Prisma-P statement) Studies were included for analysis if they reported on the CUS training of physicians (irrespective of speciality represented) and where training programme’s credentialing or certification outcome was reported specifically

Critical analysis as informed by Check and Connect focal theory

Action planning Individual interviews Same as above (n = 7) Inductive thematic qualitative analysis

Individual interviews Same as above (n = 7) Deductive qualitative analysis informed

by focal and instrumental theories Researcher notes from

group meetings Researchers and e-learning developers (n = 4) Deductive qualitative analysis informed by focal and instrumental theories

Intervention Individual interviews Same as above (n = 7) Inductive thematic qualitative analysis

Individual interviews Same as above (n = 7) Deductive qualitative analysis informed

by focal and instrumental theories Researcher notes from

group meetings Same as above (n = 4) Deductive qualitative analysis informed by focal and instrumental theories

Evaluation Individual interviews Same as above (n = 7) Deductive qualitative analysis informed by focal and instrumental theories Researcher notes from

group meetings Same as above (n = 4) Deductive qualitative analysis informed by focal and instrumental theories

Reflection Reflective journal First and second researchers (n = 2) Deductive qualitative analysis informed by focal and instrumental theories

P a g e | 76 Chapter 5: E-learning platform to improve learning delivery

5.4.2.4 Group meetings

Five group meetings were held from July 2013 to May 2016 at the e-learning developer’s offices lasting 79 minutes on average. All meetings were audio recorded and included the first author and three e-learning developers. Meetings followed a strict practical agenda, different for each meeting, depending on the eLP development stage. Although invited none of the clinical ultrasound trainees managed to attend any of the five meetings due to conflict with their busy clinical schedules. The first author acted as the mediator between the trainees and e-learning developer to assure the link between the participant’s needs and requirements were kept intact by including the trainees’ design proposals in the construction of the eLP.