Table 2 Thematic categories and representative quotes of deductive and inductive coding

“Thoughts and actions” component

“You realize that there are several possible answers and that it’s no because yours is a bit different that you’ve got it wrong, necessarily” (participant no. 8).

“About the ECG, since it’s normal, I don’t do anything, but obviously you reassure [the patient]. Of course, right? Now [during the internship] obviously you always reassure people, you don’t even realize, actually” (participant no. 3).

“You start to think, really thinking, we don’t just watch the ECG so we know what are the stakes” (participant no.4)

ACEI component

Attentive process

“I would put myself in the situation, I’d tell myself, I’m the doctor, this patient is my patient, and yeah, I was really totally in the case” (participant no. 8)

“I really did it like I was the GP” (participant no.1)

Critical process

“So, the thing is, it made me ask myself by the end of the 18 cases: have you been dangerous or not?” (participant no.10)

“I was asking myself about the synthesis: is it really what you should do?“ (participant no.5)

Exploratory process

“You’re going to be judged, they’ll say: “wait a minute, X wrote this, she missed the infarction, she didn’t send him [to the emergency ward] he’d be dead […]”, but the fact that this is completely anonymous [for the participants], I think that for a training program like this it really is very important” (participant no.3)

“(the formation) allowed me to ask myself some questions“(participant no.1)

Iterative process

“after doing this again and again (by answering questions in the LbC ECG) […] I understood that in this kind of situation, I could refer to a cardiologist” (participant no.8)

“Well I adjusted to the answers, anyway – for instance, about reassurance there was a first case where I hadn’t written it down, and in the answer, he put reassurance, and so in the last case where it was anxiety and all that, I put reassurance” (participant n°9)

Self component

“it showed me that there is a lot of situations where ECG can help the physician in his practice” (participant no.2)

“I think it isn’t bad, doing it like this, because in the end when I did it I wasn’t under any pressure, and so you know, you’re not stressed out. When you’re being graded or evaluated, you get stressed out, whereas this is really just for us” (participant no. 5)

Change component

“My way of reasoning is fairly logical, compared to the others, I’m a little bit reassured, I’ve gained a little bit of trust in myself” (participant no. 3)

“for instance, you see [atrial fibrillation] […] I told myself, ‘OK, we have the right to handle that ourselves’” (participant no. 1)

Underlying conceptual frames component

“it’s true that for hyperkalemia it’s a typical picture to recognize directly without reasoning too much like that for hyperkalemia I saw it’s typical and I knew what he had / in that sense it’s easier” (participant no. 14)

“here there was precordialgia = thoracic pain = PIED pericarditis-infarction-pulmonary embolism-dissection [there was a] ST segment anomaly so it can only be infarction or pericarditis” (participant no. 16)

Inductive coding

Thematic categories

Representative quotes

Panel members identity

“they tell us cardiology specialists, but we don’t know who they are at all” (participant no. 2) – “The thing is, we know cardiologists, who… you know… [do a bad job] […] so, people we don’t trust completely” (participant no.1)

No scoring

“Now that we are residents, we don’t to be judged […] we do it because we want to, not because we’re forced to” (participant no.5)

Uncertainty

“they don’t all have the same opinion and that doesn’t mean that if we don’t all do the same […] it doesn’t necessarily mean that we’re wrong I found that these moments when there were different opinions, between the cardiologists as well as between the general practitioners, were a little less demeaning than the MCQ methods which it’s right it’s wrong and that’s it”