83 Studying physician-related attributes of SDM frustration, or sadness. This approach was taken, to prevent participants from recognizing our distinct subjects of interest: doctors’ ratings on technical and SDM-related scenarios. [22] Furthermore, cases in which doctors deal with psychosocial or emotional problems are rated as more difficult and lead to less job satisfaction than other practice scenarios, making them a useful comparison to the two case vignette types. [19] The TECH cases covered bleeding due to uterine wall tear during caesarean section, ultrasound cornual pregnancy diagnosis, hemostasis difficulties during loop excision of the cervical transformation zone, and vacuum extraction during vaginal delivery. The SDM cases concerned preferences surrounding delivery (e.g., no oxytocin and no scalp electrode) that are not in line with clinical practice guidelines, wish for a ‘Woodruff’ operation that is not the first preferred medical and doctor’s option, and a patient that has a solid wish to continue estrogen suppletion, while it is medically safer to discontinue after ten years of usage. The EMO cases involved a delirious patient asking for euthanasia, an emotional trainee, and an angry spouse after a complication during a caesarean section. One gynecologist of the author team (FS) with experience in the design of vignettes prepared the vignettes. The other gynecologists from the author team reviewed and improved the vignettes (LS, JA, DB). All judged the tasks related to the cases described as feasible for all participants without evident differences in difficulty. We asked the study participants whether they approved of the constructed vignettes to represent their work and whether these vignettes were suitable for ranking. Almost all responded positively, confirming representativeness and suitability for ranking. Participants and setting For this study, we used a non-probability sample. Our study population consisted of gynecologists and gynecology trainees working within five non-academic training hospitals and one academic hospital in the Netherlands. We employed a convenience sample approach by selecting hospitals from two gynecology training regions. This decision was influenced by the fact that the majority of researchers involved in the study were affiliated with one of the two regions. This affiliation allowed us to have easier access to participants and anticipate higher participation rates from these areas. Gynecology training in the Netherlands takes six years. Trainees were included from year three of their training onwards and worked either in a non-academic or an academic hospital. We excluded trainees from junior years, as senior trainees were expected to be experienced beyond the novice level. Due to their rotation scheme, all trainees worked or had been working in a non-academic hospital and therefore had experience in the full breadth of a gynecologist’s work. Gynecologists working in academic hospitals were not invited to participate in the study. This decision was based on the fact that in the Netherlands, these gynecologists are often highly subspecialized, and as a result, they only encounter some, but not all, of the predesigned case scenarios in their clinical practice. Data collection and ranking procedure Contact data for gynecologists invited to participate were extracted from available lists from the national society in Obstetrics and Gynaecology (NVOG). They were all contacted through email or in person. Two researchers approached all eligible trainees, as both were involved 5
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