Frequency distribution of emotions identified in respondents’ discourse, superimposed on Plutchik’s wheel of emotions with salient differences between students and faculty 

Contexts in source publication

Context 1

... basic emotions, other derivative emotions exist since com - binations can exist in varying degrees of intensity or levels of arousal (Figure 1). In the two-dimensional model, emotions in the blank spaces are mixtures of two of the basic emotions. The three-dimensional model describes relations between emotions, il - lustrating their relationships to the eight basic emo - tions at the core but also along diminishing levels of intensity as they radiate outwardly. The cone’s vertical dimension represents intensity, and the circle represents degrees of similarity among the emotions. Validity in qualitative research refers to the credibility of research procedures and whether the findings have relevance beyond the immediate context of the study. We incorporated a number of procedures to ensure the credibility of the research. Content validity of the focus group guide was dis - cussed with other researchers. Also, the participants were asked whether they understood the questions; any questions were then explained if needed. We ad - dressed the potential for observational bias by moni - toring intercoder agreement (Scott’s π ). Regarding credibility of researchers, the senior investigator had previously worked with qualitative methods applied to dental topics 24-27 and had undergone formal training in qualitative methods at courses, seminars, and workshops. The student investigator completed directed readings on qualitative methods; she discussed theoretical frameworks and underwent formal demonstration of methods through the men - toring and didactic components of a twelve-month student research fellowship. Regarding relevance of data, the transferability of findings refers to the ability to extrapolate from localized qualitative studies to other settings and is equivalent to the concept of generalizability in quantitative research. While we have presented detailed accounts of the methods and findings (so that other researchers can judge their applicability to other situations or to compare results), this investigation was a case study in one dental school. Future studies based on hypotheses generated by this research may provide an opportunity to fully ascertain the transferability of findings. Regarding reliability coding, we estab- lished the stability (intercoder variability) of coding emotions and concepts 28 in two interviews randomly selected and blindly recoded. The assessments were done using a coefficient recommended for content- analysis (Scott’s π ) that corrects expected chance agreement. 29 Stability coefficients for emotions and concepts coding ranged from 0.65 to 0.71. These were consid- ered acceptable since Scott’s π is a very conservative assessment. Five focus groups were conducted, with a total of forty students and faculty members. Twenty- five students took part in three groups (D2, D3, and D4 separately, out of a total 300 students in those three years), and fifteen faculty members participated in two groups (clinical and tenure streams, all ranks, out of a total of thirty-two faculty members involved in CRA/CRM and Comprehensive Care). No statistical contrasts were attempted. Al- though intrinsically qualitative, the findings will be reported in terms of frequencies of categories rather than quotes, as the thematic analysis pursued a pro - cess of identification of discrete categories within emotions and concepts. For example, a comment by a faculty member in group 1 that “I started here less than two years ago and I didn’t know I was allowed to swipe a CR form until our last faculty get-together” led to an emotion entry for annoyance. The following statement from faculty group 1 was listed as disap- proval: “So if you want this [CRA/CRM] system to work better, Preventive or the department that is responsible for these should have more manpower instead of making.” The following statement also from faculty group 1 was listed as disgust: “I don’t have time to teach and let them do all of the prep— that I don’t like—because I just have to let them finish by four [p.m.]. Now you are going to have me teach the [CRA/CRM] forms also and what else do you want me to do in that limited time.” Instances for concepts were accrued when information was semantically present and either already in the list inductively assembled or added to it (Table 1). For example, a comment from faculty group 1 that “Ev- eryone is pressed for time on the clinical floor. It’s better to throw it all in one separate appointment, it’s all in the comprehensive treatment plan, and it’s done” was assigned to Concept 6.2 (lack of time to do CRA). Another statement from a participant in the D4 group that “I think [CRA/CRM] is a great opportunity to provide some patient education and . . . provides that outlet” was added to Concept 3.3 (CRA/CRM allows to motivate/educate patients on dental priorities). Emotions classified using Plutchik’s model led to a total of 554 emotions identified in the discourses of students and faculty (Figure 2). Few basic emo - tions (i.e., emotions centrally located in Plutchik’s wheel) were identified: admiration and loathing had low frequencies; vigilance was higher. A few positive emotions used to discuss CRA/CRM experiences were more outwardly located in Plutchik’s wheel: interest, anticipation, optimism, and (to a lesser extent) trust, acceptance, and surprise. Emotions identified throughout the transcripts were more often mildly negative, in particular, annoyance, contempt, disgust, disapproval, and apprehension. Few frequency differences existed across stu - dents and faculty members in their emotions (278 identified in faculty members’ discourse; 276 in students’). After discounting emotions with very low occurrence, notable differences pertained to interest, vigilance, and surprise (higher among faculty mem - bers) and pensiveness, trust, and anticipation (higher among students) (Figure 2). A total of 535 concepts were assembled in seven groups (Table 1). Faculty members verbalized more numerous concepts than did students (300 vs. 235). Individual concepts with higher frequencies may be distinguished from the list in Table 1. Stu- dents and faculty members alike supported the CRA/ CRM overall notion as useful (concept 1.1) and important (1.2). Cumbersome (1.3) was also a term used. While students complained about the insuf - ficient faculty on clinic floor and long wait for CRA faculty (1.8, 1.9) (i.e., the Department of Preventive and Community Dentistry faculty) to review cases in the clinic and faculty members highlighted the lack of clear components to use system (1.10), the two types of respondents were about as likely to mention the lack of clear outcomes derived from using system (1.11). Faculty members were somewhat more likely to mention the need for CRA training programs for faculty (1.12) and for CRA/CRM applicable out- comes (1.13). Mixed perceptions about the CRA notion were voiced in different ways. Faculty members pointed out how the current version of the CRA system was desirable because of ethical implications (1.18) or legal liability (1.19), yet it failed to promote adher- ence by faculty (1.14) and compliance by students (1.15) or do justice to its importance in the eyes of faculty (1.16) or students (1.17). A minority of stu- dents and faculty stated the current system was poor use of time for students (1.6) and/or faculty (1.7) or even considered it useless (1.4 and 1.5). Faculty members offered more perspectives about the CRA form than students generally. The faculty participants said the form could be improved by having pre-filled segments (1.30.A) (e.g., through axiUm) or by initiating it in the screening visit (1.30.F) and highlighted the importance of the form’s role as a quick grasp of the CRA status (1.30.C), its role as gatekeeper before doing operative treatment (1.30.D), or allowing one to verify links between factors and events (1.30.E) in caries experience. Making the form shorter and/or easier (especially for students) was often stated (1.30.H through 1.30.K). A triage version to focus the complete form only on complex cases (1.30.M) was mentioned by students and faculty members. Both students and faculty members proposed in a few cases limiting the ...

Context 2

... Also, the participants were asked whether they understood the questions; any questions were then explained if needed. We ad - dressed the potential for observational bias by moni - toring intercoder agreement (Scott’s π ). Regarding credibility of researchers, the senior investigator had previously worked with qualitative methods applied to dental topics 24-27 and had undergone formal training in qualitative methods at courses, seminars, and workshops. The student investigator completed directed readings on qualitative methods; she discussed theoretical frameworks and underwent formal demonstration of methods through the men - toring and didactic components of a twelve-month student research fellowship. Regarding relevance of data, the transferability of findings refers to the ability to extrapolate from localized qualitative studies to other settings and is equivalent to the concept of generalizability in quantitative research. While we have presented detailed accounts of the methods and findings (so that other researchers can judge their applicability to other situations or to compare results), this investigation was a case study in one dental school. Future studies based on hypotheses generated by this research may provide an opportunity to fully ascertain the transferability of findings. Regarding reliability coding, we estab- lished the stability (intercoder variability) of coding emotions and concepts 28 in two interviews randomly selected and blindly recoded. The assessments were done using a coefficient recommended for content- analysis (Scott’s π ) that corrects expected chance agreement. 29 Stability coefficients for emotions and concepts coding ranged from 0.65 to 0.71. These were consid- ered acceptable since Scott’s π is a very conservative assessment. Five focus groups were conducted, with a total of forty students and faculty members. Twenty- five students took part in three groups (D2, D3, and D4 separately, out of a total 300 students in those three years), and fifteen faculty members participated in two groups (clinical and tenure streams, all ranks, out of a total of thirty-two faculty members involved in CRA/CRM and Comprehensive Care). No statistical contrasts were attempted. Al- though intrinsically qualitative, the findings will be reported in terms of frequencies of categories rather than quotes, as the thematic analysis pursued a pro - cess of identification of discrete categories within emotions and concepts. For example, a comment by a faculty member in group 1 that “I started here less than two years ago and I didn’t know I was allowed to swipe a CR form until our last faculty get-together” led to an emotion entry for annoyance. The following statement from faculty group 1 was listed as disap- proval: “So if you want this [CRA/CRM] system to work better, Preventive or the department that is responsible for these should have more manpower instead of making.” The following statement also from faculty group 1 was listed as disgust: “I don’t have time to teach and let them do all of the prep— that I don’t like—because I just have to let them finish by four [p.m.]. Now you are going to have me teach the [CRA/CRM] forms also and what else do you want me to do in that limited time.” Instances for concepts were accrued when information was semantically present and either already in the list inductively assembled or added to it (Table 1). For example, a comment from faculty group 1 that “Ev- eryone is pressed for time on the clinical floor. It’s better to throw it all in one separate appointment, it’s all in the comprehensive treatment plan, and it’s done” was assigned to Concept 6.2 (lack of time to do CRA). Another statement from a participant in the D4 group that “I think [CRA/CRM] is a great opportunity to provide some patient education and . . . provides that outlet” was added to Concept 3.3 (CRA/CRM allows to motivate/educate patients on dental priorities). Emotions classified using Plutchik’s model led to a total of 554 emotions identified in the discourses of students and faculty (Figure 2). Few basic emo - tions (i.e., emotions centrally located in Plutchik’s wheel) were identified: admiration and loathing had low frequencies; vigilance was higher. A few positive emotions used to discuss CRA/CRM experiences were more outwardly located in Plutchik’s wheel: interest, anticipation, optimism, and (to a lesser extent) trust, acceptance, and surprise. Emotions identified throughout the transcripts were more often mildly negative, in particular, annoyance, contempt, disgust, disapproval, and apprehension. Few frequency differences existed across stu - dents and faculty members in their emotions (278 identified in faculty members’ discourse; 276 in students’). After discounting emotions with very low occurrence, notable differences pertained to interest, vigilance, and surprise (higher among faculty mem - bers) and pensiveness, trust, and anticipation (higher among students) (Figure 2). A total of 535 concepts were assembled in seven groups (Table 1). Faculty members verbalized more numerous concepts than did students (300 vs. 235). Individual concepts with higher frequencies may be distinguished from the list in Table 1. Stu- dents and faculty members alike supported the CRA/ CRM overall notion as useful (concept 1.1) and important (1.2). Cumbersome (1.3) was also a term used. While students complained about the insuf - ficient faculty on clinic floor and long wait for CRA faculty (1.8, 1.9) (i.e., the Department of Preventive and Community Dentistry faculty) to review cases in the clinic and faculty members highlighted the lack of clear components to use system (1.10), the two types of respondents were about as likely to mention the lack of clear outcomes derived from using system (1.11). Faculty members were somewhat more likely to mention the need for CRA training programs for faculty (1.12) and for CRA/CRM applicable out- comes (1.13). Mixed perceptions about the CRA notion were voiced in different ways. Faculty members pointed out how the current version of the CRA system was desirable because of ethical implications (1.18) or legal liability (1.19), yet it failed to promote adher- ence by faculty (1.14) and compliance by students (1.15) or do justice to its importance in the eyes of faculty (1.16) or students (1.17). A minority of stu- dents and faculty stated the current system was poor use of time for students (1.6) and/or faculty (1.7) or even considered it useless (1.4 and 1.5). Faculty members offered more perspectives about the CRA form than students generally. The faculty participants said the form could be improved by having pre-filled segments (1.30.A) (e.g., through axiUm) or by initiating it in the screening visit (1.30.F) and highlighted the importance of the form’s role as a quick grasp of the CRA status (1.30.C), its role as gatekeeper before doing operative treatment (1.30.D), or allowing one to verify links between factors and events (1.30.E) in caries experience. Making the form shorter and/or easier (especially for students) was often stated (1.30.H through 1.30.K). A triage version to focus the complete form only on complex cases (1.30.M) was mentioned by students and faculty members. Both students and faculty members proposed in a few cases limiting the ...