Table 1 Themes, sub-themes, and representative comments

1. Definition (n = 226)

1.1 Translation

“Able to integrate evidence-based medicine (EBM)” changed to “receive and apply EBM.”

“Can adjust quickly” changed to “Know when to consult others.”

1.2 Critics

The medical records can show the “medical decision-making process and the promotion of patient care,” but also “succinct”; there is a certain degree of conflict and contradiction with each other.

What is meant by an “ideal role model,” just like the previous “master model,” is difficult to quantify, empty and vague, and difficult to evaluate.

Without specific instructions, it is difficult to imagine the ability to “balance.”

1.3 Key work definition

Development of organizational policies and procedures for “impaired physicians”: Is there such a thing?

“Conditional,” “complex,” and “challenging” all need to be defined first.

The details of the anesthesia care goals set by the CCC are unclear.

2. Relevance (n = 354)

3.1 Highly relevant

In a modern society where medical disputes are increasing, residents must learn this during the training process.

Troubleshooting should not just be the job of an anesthesia technician. Residents should also be able to troubleshoot problems in emergencies.

3.2 Currently irrelevant

The existing mechanism does lack the evaluation indicators of long-term results. Suggest to delete it.

Pain injections, scar injections, lumbar epidural steroid injections, and intravenous regional blockades are the items not easy to have opportunities to practice.

It is an appropriate indicator for the attending but not practical for the resident.

3.3 Irrelevant

As far as R1 is concerned, some subspecialty topics have exceeded their capabilities

We don’t have this kind of resources and power ourselves; how do we evaluate the subjects?

3. Evaluability (n = 412)

3.1 Assessment tool

We can consider breaking up those milestones and incorporated them into the written test, oral test, simulation.

We can evaluate a part of it through reflective writing and discussion. However, I suspect whether a clinical practice can be easily assessed through reflection.

We can apply the ISBAR checklist to the education and evaluation of hand-over.

3.2 Policy and resource

Physicians’ dedication to teaching might need to reduce their clinical workload.

There should be a particular department or unit to take up this job.

3.3 Implementation strategy

Evaluation speed or contingency results? I recommend evaluating separately and use simulation to add the “time” factor to the evaluation process.

Try to reflect on clinical practice with EBM methods (not necessarily requiring conclusions or alteration.)

4. Others (n = 153)

4.1 Learning resource

Each hospital has a different system, but you should know what resources you have in your hospital.

Need equipment support or relevant training in the department.

There was no training course in the past. I recommend holding this training course.

4.2 Competency level

It is a bit high for Level 2

Level 1 trainees will not handle disagreements under general anesthesia.

4.3 Socio-cultural diversity

Different medical institutions handle medical disputes in different ways. Some institutions do not recommend that doctors individually report medical errors. In this case, how to evaluate it?

Such an intervention might not be suitable in a different national context!!

4.4 Faculty development

The younger generation nowadays is even better at mastering ultrasound than senior attending physicians. How do we know attending physicians care capable of assessing residents? That is the problem I concern most.

Not every training center has a group of professional pain specialists with relevant guidance capabilities.