Table 2 Summary of qualitative results
Use of confidentiality guidance | |
 Summary: Participants had largely positive attitudes towards the GMC’s confidentiality guidance - as a support for them in their work (attitudes). ‘Everybody approved’ of confidentiality guidance (subjective norms). The barriers to using the guidelines were primarily to do with the length of the guidance, and a lack of practical support in maintaining confidentiality in the workplace (perceived behavioural control). Nevertheless, attending the DoaD programme increased knowledge of the confidentiality guidance and confidence in applying it. Some doctors said that as a result of the DoaD programme they would now be more likely to intend to refer to the confidentiality guidelines for difficult cases, such as whether or not do disclose information to the police (intentions). | |
 Indicative quotes: | |
  Attitudes: | It’s the standard advice from the regulator, so if you follow it, it can’t be wrong. And it’s good to have that framework. I think it is so much more clearly written now than it was. - GP-Consultants/UK graduate |
  Intentions | Yes, I don’t think it’s going to change my practice but I think it’s given me more confidence that I was doing the right thing in the first place and to carry on making the same decisions. – Foundation Year 2 Doctors/UK graduate |
Raising a concern | |
 Summary: Raising a concern was considered an appropriate professional attitude particularly in the face of patient safety issues; however, participants expressed unease about actually raising a concern. Having attended DoaD, participants felt that the RLA, and thus the GMC, understood the challenges around the reality of raising a concern (attitudes). Some felt that colleagues would give ‘lip service’ to the need to raise a concern, verbalising approval in principal, but retreating when it became a reality (subjective norms). Some doctors had raised concerns, but due to lack of action and/or feedback, had ceased to raise them. Barriers to raising a concern were substantial and operated at the level of the individual, interpersonal (e.g., potential to cause dysfunctional relationships between colleagues) and organisational (e.g. organisational culture, a lack of supportive leadership) (perceived behavioural control). Foundation doctors expressed that they would prefer to raise an issue with a senior as a first step instead of referring to the GMC guidance. More senior doctors expressed that having all attended the same course, they had gained greater empowerment to raise a concern within their organisation as they could garner support from one another (intentions). | |
 Indicative quotes: | |
  Attitudes | So morally, you might know exactly what you want to do, ethically, you know what you should be doing, but you don’t have the role models of ‘do this because it’s for the common good, and professionally it is a good thing to do’. That doesn’t happen. - Consultant-SAS doctors/UK graduate |
  Subjective norms | They [management] don’t enable, I don’t think that they enable. I don’t think there are barriers put in place, but there’s not a culture … we are not enabled to raise concerns. - Consultant-SAS doctors/UK graduate |
Reflective practice | |
 Summary: Reflection was mostly seen as a positive activity and of benefit to doctors and patients alike, but there were some criticisms of how it is expected to be done. Negative attitudes were about formal reflection which was reported as mandatory and a ‘tick box exercise’ (attitudes). Reflection was felt to be universally positive by others (subjective norms). There were several barriers to carrying out reflection: time, high demands of service delivery, lack of feedback on the quality of written reflection, lack of training, and the absence of a positive workplace culture for disclosing mistakes (perceived behavioural control). Participants generally did not feel that they would reflect more or differently now that they had attended the DoaD programme as they already felt they reflected sufficiently. However the course reinforced the benefits of reflection and as such served to encourage participants to continue to reflect (intentions). | |
 Indicative quotes: | |
  Perceived behavioural control | The other thing is that sometimes when you reflect more in depth, when you have time, you haven’t got anywhere else to go then to discuss your reflections. So, of course, you can look up things yourself, you know, but it’s like you’re just left on your own; you, because of the how the system is, so as an SAS doctor, you haven’t got any time to discuss with colleagues or … and that leaves it a bit unfinished sometimes. – SAS doctor/non-UK graduate |
  Intentions | I don’t think so, it’s just something else to reflect on, I think we all do reflect so I don’t think it will make any difference particularly to how I approach things. But it will – I think I will reflect on it, if that makes any sense, I don’t think it will be life changing in terms of that. I guess because I’ve already done quite a lot of work on it, if that makes sense. - GP/UK graduate |