Material and method
As our method of investigation we used
focus groups and thematic analysis, with specialty registrars in psychiatry as our informants (Box 1) (16) – (18). Focus groups have proven to be well suited for investigating attitudes, experiences and opinions (16, 17). We wished to use focus-group discussions to capture the different ideas about and attitudes to the chosen topic among the doctors involved.
Focus groups (16, 17)
Focus groups are informal group interviews where the discussion provides insight into the participants’ attitudes to and interpretations of a given topic.
Focus groups provide a methodological advantage in allowing space for group dynamics, which may help elucidate the topic from different angles and discover unforeseen issues.
Thematic analysis (18)
Implies a thematic categorisation of statements from the group interviews and identification of patterns of meaning across the group interviews.
The categorisation of meaning forms the basis for the interpretation of the results.
A focus group tends to include 6 – 10 participants and is led by one or two «mediators» (group leaders). The focus-group method is different from other interviews in that in a focus group, the participants to some extent form their opinion during the group discussion. For further information on the method, see Liamputtong
(16) and Malterud (17).
The focus-group sessions took place at three national foundation courses in psychiatry, held in various locations across the country. Because of their participation in the foundation course, the doctors were known to each other beforehand, although they were not personal acquaintances – in focus groups, it is recommended that the participants have no personal relationships as friends, since this is assumed to be an impediment to a free and critical exchange of opinion within the group
Participation was voluntary, and the study was anonymised in accordance with ethical guidelines. The informants were selected with a view to obtaining a broad range in terms of place of residence, type of workplace and gender. A total of 40 doctors participated, whereof 24 were Norwegian and 16 from other countries. The course participants were provided with oral and written information about the project. All doctors consented to participate. The foreign doctors represented a wide range in terms of their countries of origin, which included Scandinavia, Northern Europe, Eastern Europe, the Middle East and Southeast Asia.
A total of five focus group sessions were implemented with 6 – 10 participants in each. At the first two foundation courses we held separate sessions for Norwegian and foreign doctors respectively, in a total of four groups. We chose to use a mixed group at the third foundation course, thus to see whether any other attitudes and opinions would come to light.
The selection to the groups was undertaken on the basis of surnames (ethnically foreign-sounding surnames and Norwegian surnames). None of the participating doctors defined themselves out of the group to which they had been assigned. The reason for choosing such a group composition was based on experience from international studies, showing that group homogeneity is crucial for bringing attitudes out in the open and promoting good discussions
(17). We were afraid that the doctors would be more cautious in their statements when having to discuss a topic that would be perceived as sensitive in a group consisting of foreign and ethnically Norwegian doctors.
Each focus group discussion lasted for approximately 60 minutes and was recorded on an audio device. The groups were led by two doctors – the mediators (the first and second authors). We sought to keep the discussion between the participants as free and open as possible. First, they were asked to describe their personal experiences as a foreign doctor/their personal experiences with foreign colleagues. They were then asked to recount their views on the need for a mentoring scheme and if relevant, how such a scheme should be designed.
Immediately after each group session the two mediators exchanged their impressions from the discussion. After transcription and printing, the audio files were deleted. Names of group participants were not written down or stored, and statements from the audio files could not be linked to specific persons.
The transcribed material was analysed with the aid of
thematic analysis (17, 18). Each focus group interview was reviewed in detail and statements were coded according to the recommended systematic and step-wise procedure. The interviews were subsequently collated.
We searched through the entire data set to identify recurring patterns of meaning, and the topics were interpreted in accordance with applicable principles
(18, 19). In addition, the topics were interpreted independently by the third and last authors, who both possess scientific training. The coding of the content, the topics and the interpretations were subsequently compared and discussed in the research group until consensus was achieved. Only very few discrepancies were detected.