Table 9 Category system of stressors during sessions

Group characteristics (13)

Passive or sluggish groups, loud and inattentive groups, or strong differences in prior knowledge. “Very silent participants, hardly any volunteers for history taking exercises.”

Team teaching coordination (13)

Teaching partner shows low involvement, is too dominant, or omits preparatory meetings.

“I took on the largest part of teaching because I felt my partner is not prepared.”

Organisational conditions (13)

Last-minute preparations, especially when devices do not function properly, or late arrivals of standardised patient actors or students.

“The projector’s sound did not work; we then showed the video on a laptop computer instead.”

Leadership role demands (10)

Group instruction (6 mentions), speaking in front of participants, or giving feedback.

“Keeping an eye on participants: who needs further assistance and is too shy to ask.”

Time pressure(9)

Lack of time both during a session and due to the additional workload for preparation and teaching.

“Too little time at the end of the session.” “Time lost due to teaching: I have an exam on Friday.”

Uncertainties in medical knowledge (9)

Limits of own medical knowledge, mostly encountered when preparing and giving presentations.

“A student’s question about thrombosis prophylaxis which I could not answer.”

Supervision (5)

Routine supervisions by faculty staff member. “Supervision was stressful.” “The supervision made me nervous, though mostly before the start of the session.”

Participant characteristics (3)

Single participants’ character traits or behaviour. “One student was very dominant, wants to convey extra knowledge but goes beyond the scope of the course; the group was partly irritated.”

Personal discomfort (2)

Hunger or minor illness. “Dry cough.”

Time pressure (16)

Tight schedule and extensive subject matter, little buffer for delays or participants’ knowledge gaps.

“Much content, little time. I got delayed at the gall bladder.” “Time management and order.”

Ultrasound difficulties (9)

Bad sonographic conditions that complicate detecting structures and locating standard scan planes.

“Both ultrasound demonstrations were poor (overlaying intestinal gases).”

Poor participant performance (9)

Unprepared and unskilled participants. “Participants need a lot of assistance”

“Participants were not properly prepared and had forgotten the last days’ contents.”

Leadership role demands (7)

Difficulties in motivating participants and directing group processes. “Keeping participants attentive so that nobody gets bored.” “When students could not answer theoretical questions.”

Uncertainties in medical knowledge (5)

Limits of own medical knowledge, i.e. when identifying structures or assisting participants.

“Needed help to adjust the device.” “Twice, I did not know how to concretely assist participants.”

Participant characteristics (4)

Single participants’ character traits or behaviour. “Problems of understanding with a foreign student.” “A student’s constant private conversations”.

Group characteristics (3)

Noisy, inattentive, or heterogeneous groups. “Participants vary a lot in terms of prior knowledge.”

Personal discomfort (3)

Minor illness. “I had a cold and was hoarse.”