BackgroundAlthough studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. AimTo evaluate the presence of ICE and its relation to medication prescription. Design of studyCross-sectional study. SettingThirty-six GP teaching practices affiliated with the University of Ghent, in Flanders, Belgium. MethodParticipants were all patients consulting on 30 May 2005, and their doctors. Reasons for an encounter (consultation or home visit) with new and follow-up contacts, the identification of ICE, and the prescription of medication were recorded by 36 trainee GPs undergoing observational training. The study included 613 consultations. ResultsOne, two, or three of the ICE components were expressed in 38.5%, 24.4%, and 20.1% (n = 236, 150, 123) of contacts respectively. On the other hand, in 17.0% (104/613) of all contacts, and in 22% (77/350) of the new contact reasons, no ICE was voiced, and the GPs operated without knowing this information about the patients. Mean number of ICE components per doctor and per contact was 1.54 (standard deviation = 0.54). A logistic regression analysis of the 350 new contacts showed that the presence of concerns (P = 0.037, odds ratio [OR] 1.73, 95% confidence interval [CI] = 1.03 to 2.9), and expectations (P = 0.009, OR = 2.0, 95% CI = 1.2 to 3.4) was associated with not prescribing new medication (dichotomised into the categories present/absent); however, other patient, doctor, and student variables were not significantly associated with medication prescription. ConclusionAn association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.

Background: Consolidating a standard for reporting qualitative research remains a challenging endeavor, given the variety of different paradigms that steer qualitative research as well as the broad range of designs, and techniques for data collection and analysis that one could opt for when conducting qualitative research. Method: A total of 18 experts in qualitative research participated in an argument Delphi approach to explore the arguments that would plead for or against the development and use of reporting guidelines (RGs) for qualitative research and to generate opinions on what may need to be considered in the further development or further refinement of RGs for qualitative research.Findings: The potential to increase quality and accountability of qualitative research was identified as one of the core benefits of RGs for different target groups, including students. Experts in our pilot study seem to resist a fixed, extensive list of criteria. They emphasize the importance of flexibility in developing and applying such criteria. Clear-cut RGs may restrict the publication of reports on unusual, innovative, or emerging research approaches.Conclusions: RGs should not be used as a substitute for proper training in qualitative research methods and should not be applied rigidly. Experts feel more comfortable with RGs that allow for an adaptation of criteria, to create a better fit for purpose. The variety in viewpoints between experts for the majority of the topics will most likely complicate future consolidation processes. Design specific RGs should be considered to allow developers to stay true to their own epistemological principles and those of their potential users.

The 54 participants' conceptions mainly related to their beliefs about who was responsible for (a) preparing for transfer of learning, (b) being at the workplace and connecting back to classroom-based learning, and (c) reflecting on transfer of learning and continuing the process. A continuum was recognized between those who held medical teachers/workplace supervisors responsible and those who held students responsible. Insights: There appears to be a variety of conceptions about who is responsible for enabling the transfer process. These conceptions may influence learning and instructional activities. Hence, it may be necessary to make these beliefs explicit in order to better align stakeholders' conceptions. To this end, the conceptual framework created in this study may be a useful tool.

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The 2 instruments have convergent validity, but the drawbacks of the CG, which has fewer items to be scored, include lower inter-rater reliability and score variance within trainees.

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