Qualitative Study Research Articles

Workplace violence against medical students during clinical practice and its relevant factors: a mixed methods study

ABSTRACT Our study aims to describe the status of workplace violence against medical students during clinical practice, which consists of its prevalence, types, perpetrators, students’ responses and influences on them, reasons for workplace violence and to determine some relevant factors of this issue through both quantitative questionnaire and qualitative interview. A descriptive cross-sectional study with mixed methods was conducted on 320 students from the second-year to the sixth-year classes at Hanoi Medical University from August 2022 to February 2023. The questionnaire was based on the WHO questionnaire survey ‘Workplace violence in the health sector – country case studies research instruments – Geneva 2003’. 10 students from quantitative research who completed the questionnaire, experienced at least one type of workplace violence and consented to continue taking part in the research were chosen for in-depth interviews. The prevalence of students witnessing and/or experiencing workplace violence was 35.6% and 19.4% of the sample population had experienced at least one kind of workplace violence. Medical staff were the most common perpetrators. 86.8% of students who were exposed to workplace violence did not report the incidents for a variety of reasons. The major reasons leading to workplace violence related to patients, patients’ relatives and students, among which the first-ranked ones were the patients’ education level and their unsatisfied expectations. Some relevant factors to workplace violence against medical students were determined by quantitative analysis such as students’ grade (OR = 3.09) and region (OR = 3.31) and were explored additionally by qualitative interview such as the student management of the instructors, students’ personality, attitude and appearance as well as hospital environment. Based on the research findings, establishing prevention methods, which require action from both individuals (students, medical staff) and organizations (universities, hospitals) is recommended.

Physician experiences of team-based clinical microsystems: implications for the future of inpatient interprofessional communication.

Healthcare clinical microsystems are small, goal-oriented groups of healthcare professionals that work together on a regular basis to provide care to discrete patient populations. They often include team-based frameworks such as bedside interprofessional rounds, geographic colocation of healthcare team members, interprofessional staff leadership, and unit-level data sharing. In inpatient settings, microsystems improve interprofessional communication and collaboration. In this qualitative study, we examined physician experiences of clinical microsystems and the mechanisms underpinning interprofessional communication in this environment. We interviewed 51 resident and hospitalist physicians. Thematic analysis of physician experiences revealed three key themes: (a) Clinical microsystem effect on workflow, (b) Open forum and work relationships, and (c) Face-to-face vs technology-based communication. Physicians described strong interprofessional relationships based on frequent face-to-face communication. Familiarity with healthcare team members, often resulting from being co-located to the same units, created a comfortable work environment, advanced patient care, and accelerated workflow. Physicians preferred in-person communication with interprofessional colleagues over technology-based communicationand described how in-person interactions enriched subsequent technology-led interactions. As the use of technology-based communication grows in inpatient settings, decreasing face-to-face interactions and facilitating dispersed care, understanding and implementing optimal conditions for effective interprofessional communication is essential.

Experiences of loneliness and social isolation among young people with chronic physical conditions: A thematic synthesis of qualitative studies.

Young people with chronic health conditions are among the most at risk of having poor social connections, however, little is known about their experiences of loneliness and social isolation. We aimed to describe the perspectives and experiences of loneliness and social isolation among young people with chronic physical conditions. We searched MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL from inception to May 2023 for qualitative studies that described the perspectives of loneliness and social isolation in young people aged 10-24 years with chronic physical conditions. Findings from the included studies were analyzed using thematic synthesis. We included 35 studies across 12 countries involving 723 participants (56% female). Most studies (63%) were conducted in young people with cancer. Four major themes were identified: suffering from repercussions of disease (struggling with body image and physical changes, intensified disconnection while hospitalized); hindering relationships with peers and friends (missing out on formative experiences, feeling stuck behind, restrictive parental attitudes); grappling with social exclusion (facing concerns alone, bullying and ostracism); seeking social support and self-help (reliance on family, kindness and empathy from friends, developing rapport with healthcare professionals, discovering self in adversity). Symptoms, treatments, and hospitalizations limited young people's social participation and ability to maintain friendships, and this was compounded by social exclusion and bullying. Supportive friends, family, and healthcare professionals helped mitigate feelings of isolation. Interventions and strategies are needed to improve social support and foster meaningful connections. This can be achieved through education and awareness initiatives that promote inclusion in schools and the community, as well as efforts to enhance social support and continuity of care in hospitals.

School Social Workers' Responses to Racial Injustice During COVID-19: A Need for Anti-Racist Practice in K-12 Schools

ABSTRACT This qualitative study examines how school social workers (SSWers) responded to the U.S. racial injustices highlighted by the media during the first year of the COVID-19 pandemic. SSWers were interviewed during what some scholars dubbed a “moment of reckoning and crisis” following the murder of George Floyd and the subsequent nationwide demonstrations for justice that aimed to challenge racialized police violence (Villarreal Sosa 2022, p. 67). Seventeen SSWers in K–12 public schools from various school districts across three states (Minnesota, Colorado, and Nevada) completed two key informant interviews related to their experiences during the spring and fall semesters of 2020. A constructivist grounded theory approach, including three coding cycles, was used to analyze participant narratives. A substantive theory for understanding SSWers’ responses (or lack of responses) to racial injustices during this period emerged. The findings provide an initial understanding of how SSWers’ responded to racial injustice during this moment of crisis and some of the factors that impacted their responses. The most common responses to racial injustice during this moment of crisis included: 1) engaging in conversations about race and racism and 2) participating in learning opportunities about race, racism, and racial justice. Our theory highlights how (lack of) structural support influenced SSWers’ responses. Implications for school social work (SSW) practice, curriculum, and research are discussed.

Responding to the ongoing pandemic-related challenges of individuals with brain injury through the perspective of community-service in Canada: A qualitative study.

To investigate brain injury (BI) associations' perspectives regarding the impacts of the second year of the COVID-19 pandemic on individuals with BI and BI associations services across Canada. This qualitative descriptive study included 26 representatives of Canadian BI associations that participated in six online focus groups to discuss the effects of the second year of the pandemic on clients living with BI and on the provision of community services. Findings revealed three main themes: 1) ongoing pandemic-related challenges faced by clients living with BI, including worsening mental health and basic needs insecurities, difficulties faced by clients in adhering to safety measures, and ongoing technological issues; 2) ongoing adaptations to accommodate clients' needs, including offering tailored services, ensuring consistent and transparent safety measures, and providing hybrid services; and 3) developing a sustainable 'new normal' aligned with association mandates and resources by expanding networks and building resilience. The unfolding of the pandemic has brought increased challenges for people with BI and reinforced the need for adapted, clear, and accessible public health information to ensure the safety of vulnerable populations in times of crisis. It is essential to bolster community-based associations that provide direct care to people with BI.

What is effective physiotherapy for dementia and how do we get there: a qualitative study.

Dementia is a leading cause of disability. Physiotherapists play a crucial role in caring for people with dementia. However, previous research has found that physiotherapists have low knowledge and confidence working with people with dementia. To determine: 1) What are the components of effective physiotherapy care for people with dementia; and 2) What can be done to facilitate the provision of effective physiotherapy care. This was a qualitative study using an interpretive description approach. Sixteen physiotherapists experienced in dementia care participated in semi-structured interviews. Researchers analyzed data using thematic analysis. Two themes were created for each research objective. The themes explaining the components of effective physiotherapy care were: 1) engaging the person with dementia (subthemes: knowing the person with dementia; using knowledge to adapt the approach to successfully deliver physiotherapy treatments; optimizing the physical environment) and 2) collaborative care (subthemes: working with care partners; working as an interdisciplinary team). The themes describing how to facilitate provision of effective care were: 1) Physiotherapists require "greater opportunity for mentoring and education on dementia care" and 2) Physiotherapists must "advocate for the role of physiotherapy in dementia care." These findings provide important information regarding the components of effective dementia care for physiotherapists and will help guide clinical practice, inform future dementia education, research, and professional organization advocacy initiatives.

Teachers’ Understanding and Implementation of Authentic Assessment in the Integrated Curriculum for Grades 1 to 3: The Case of Nepal

This study explores the implementation and understanding of authentic assessment within Nepal’s integrated curriculum for grades 1-3, which emphasizes the development of soft skills alongside academic learning—utilizing a convergent mixed-methods design, including quantitative surveys of 280 teachers and qualitative interviews with eight teachers, conducted in December 2023. The findings identify significant gaps between the theoretical principles of authentic assessment and its practical application. While approximately two-thirds of teachers report familiarity with authentic assessment, many continue to rely on traditional methods such as rote memorization and paper-pencil tests. Key challenges include resource constraints, inadequate professional development, and time limitations. The findings underscore the need for enhanced teacher training, clear policy guidelines, and improved resources to better align assessment practices with the goals of the integrated curriculum, thereby fostering a more holistic educational experience that effectively nurtures academic competencies and soft skills in early-grade learners. Keywords: authentic assessment, integrated curriculum, soft skills, early grade education, Nepal

Qualitative examination of US and Israeli adults' perceptions of IQOS advertising messages: modified exposure and risk statements, US FDA endorsement, and health warnings.

IQOS, a leading heated tobacco product, is advertised as less harmful than cigarettes and received US Food and Drug Administration (FDA) authorization for 'reduced exposure' advertising claims. Perceptions of advertising messages, including reduced exposure/risk claims, FDA endorsements, and health warning labels (HWLs), are understudied. Qualitative interviews (N=84) from US and Israeli adults (2022) examined perceptions of advertising messages, specifically: 1) scientific claims that switching completely from cigarettes to IQOS reduces 1a) chemical exposure and 1b) tobacco-related disease risk; 2) FDA endorsement of IQOS as a 2a) better choice for adult smokers and 2b) fundamentally different product (heat-not-burn); and 3) promoting IQOS as cigarette alternatives with a HWL pertaining to cigarettes. For half of participants, referencing scientific studies or the FDA enhanced credibility; some believed this implied unbiased, rigorous research. Half were skeptical due to lack of research-related details. Half interpreted message 1 (switching) to mean any substitution could be beneficial; half interpreted it as complete substitution was necessary. Most did not perceive differences between message 1a (reduced exposure) vs. 1b (reduced risk). Some believed message 2a (FDA endorsement, not targeting youth) demonstrated IQOS' social responsibility. Some interpreted message 2b (fundamentally different product) as risk reduction; others perceived no difference. The majority paraphrased messages using the terms 'safer', 'healthier', or 'less harmful'. For message 3 (safer alternative), some did not think the HWL applied to IQOS; some believed it promoted IQOS. Regulators and researchers must monitor harm reduction advertising messaging and take actions to prevent consumer misinterpretations. Philip Morris International's IQOS received US Food and Drug Administration (FDA) authorization for 'reduced exposure' advertising claims, which are often misinterpreted, and has exploited FDA authorization to promote IQOS globally. This qualitative study showed that most participants perceived no difference between reduced risk vs. exposure messages in IQOS ads, half believed that references to scientific studies or FDA enhanced credibility, some believed certain messages demonstrated IQOS' social responsibility, and some perceived warnings in IQOS ads to promote IQOS. Product ads using harm reduction messages must be monitored to inform efforts to prevent potentially harmful misinterpretations and mitigate negative population-level impacts.

Use of Artificial Intelligence in the Banking Industry: A Case Study of Pakistan

This study investigates the adoption and impact of Artificial Intelligence (AI) in Pakistan’s banking sector, with a focus on Habib Bank Limited (HBL), Faysal Bank, and Bank Alfalah. The objective is to understand the extent to which AI technologies have transformed core activities within customer service, operations, fraud detection, and risk management in these banks. Data were collected from semi-structured interviews with ten respondents, selected based on their experience with AI implementation. This qualitative methodology allows for in-depth insights into the functionality and challenges associated with AI in banking. Results reveal that AI has notably improved operational efficiency by streamlining risk management and enabling real-time fraud detection. Additionally, AI-driven chatbots and virtual assistants have enhanced customer experiences by offering faster and more personalized services. Despite these benefits, the study identifies significant challenges, particularly regarding data privacy and regulatory compliance, as well as the need for human resources to adapt to AI-enabled tools. Key pressures in the industry include building capabilities to work alongside AI while addressing concerns over automation. To maximize the advantages of AI, the study emphasizes the need for comprehensive policies that balance technological adoption with ethical considerations, data security, and staff training. Strategic planning in Pakistan’s banking sector will be crucial to harnessing AI’s potential while managing its risks.

Enhancing Pronunciation Skills of Diploma Students at Bangladesh University of Business and Technology through Oral Drilling: A Comparative Study of Pre- and Post-Exposure to Accurate English Sounds among ESL Learners

The purpose of this study is to investigate the efficacy of oral drilling activities for improving phonetic skills at the diploma level at the Bangladesh University of Business and Technology. Data were gathered from 200 Bangladeshi students who were purposefully chosen, who speak Bangla as their first language, and who utilize English as a second or foreign language for academic purposes using qualitative methodology. A self-developed Likert-scale structured questionnaire was used to analyse students’ understanding of their learning experience, and pre- and post-usage pronunciation tests were conducted in conjunction with reading exercise tests for phonetic improvement. This study provides important insights into ESL pedagogy in Bangladesh and has the potential to shed light on ODA as a didactic approach used in EFL contexts, which offers more appropriate curriculum-based implications for oral practice that may improve the Pronunciation skills of students.

Navigating shared decision-making after the Life-Sustaining Treatment Decision Act: a qualitative study of in-depth interviews with terminal cancer patients, families, and healthcare professionals.

End-of-life decision-making, particularly relating to withholding life-sustaining treatment (LST), is a complex and emotionally charged process involving healthcare professionals, patients, and caregivers. This qualitative study explored the decision-making process in South Korea, where cultural norms and ethical considerations influence the dynamics of shared decision-making (SDM). In-depth interviews were conducted with healthcare professionals, patients, and caregivers using a grounded theory approach to elucidate the themes and processes underlying SDM for LST. This study used the "6C" framework, which could reflect the intricacies of the SDM process. The results suggest that healthcare professionals face emotional challenges and an ethical dilemma in disclosing prognoses and discussing LST withholding, often deferring such discussions until the condition of patients worsens. Cultural factors, such as collectivist values and societal taboos surrounding death, influence decision-making dynamics, highlighting the need for tailored interventions and cultural competence in healthcare settings. The proposed "6C" framework provides insights into addressing current challenges in SDM and emphasizes the importance of cultural norms and ethical obligations in end-of-life decision-making. Further research is warranted to examine the SDM process in diverse cultural contexts and develop interventions to enhance patient and family involvement in the decision-making process for LST.

"It was really helpful for me, and at the same time it was really tough": a qualitative study among Afghan peer refugee helpers in Greece.

Aid workers with a refugee background are increasingly engaged in the humanitarian field. These individuals, known as peer refugee helpers (PRHs), contribute to providing psychosocial support for other refugees. However, few studies have focused on the mental health and wellbeing of PRHs. This study aims to investigate the experiences of PRHs of Afghan origin in the humanitarian field in Greece. Seven focus group interviews took place in a hybrid format, online or in-person. PRHs of Afghan origin (N = 18), working for various Aid/Humanitarian Organizations (AOs), participated. Data was analyzed using template analysis. The analysis identified job resources reflected in the dimensions of sense of coherence (meaningfulness, manageability, comprehensibility) and job demands associated with role overload, role conflict, and role boundaries. Gender differences were noticeable. Specifically, female PRHs experienced empowerment, through accessing new opportunities often not available within Afghan communities. Female PRHs frequently reported going against traditional gender roles and faced negative reactions from their peers. Male PRHs reported feeling empowered through their engagement as a PRH, as it helped them fulfill their personal goals, such as becoming a good example within their families or communities. Recommendations for policymakers and AOs based on the study results include: (1) Offer training, supervision, and psychosocial support for PRHs to enhance work engagement and prevent emotional exhaustion; (2) Address gender differences ensuring the protection and support of female PRHs; (3) Adopt scalable psychosocial interventions to promote agency and a concrete way of engaging with beneficiaries; (4) Formalize job roles outlining responsibilities and expectations for PRHs.

Fraudulent Participation in Online Qualitative Studies: Practical Recommendations on an Emerging Phenomenon.

Fraudulent participation is defined in the following as participation in research by individuals who, for one reason or another, intentionally provide false responses. Qualitative studies are at an increased risk of fraudulent participation when online recruitment and participation are used, and monetary incentives offered. Fraudulent participation threatens data quality and subsequent evidence-based practice, yet validated guidance on how to tackle it is lacking. This paper offers a critical reflection thereon by three separate qualitative research groups that experienced fraudulent participation in collaboration with a patient representative, a bioethicist, a legal expert, a journal deputy editor, and a chief executive of a national charity. The Prevent FRaudulent Online STudy participation (P-FROST) recommendations provide advice on (1) Study set-up (including team members and study design), (2) Monetary incentives and recruitment, (3) Data collection (screening and interview considerations), and (4) Analysis, reporting, and support. The reflection which balances the diverse perspectives of patients, researchers, funders, ethics boards, and legal teams puts forward the P-FROST recommendations to identify and prevent fraudulent participation throughout the design, ethical approval, and implementation of online qualitative research.

Empirical Reality versus Theoretical Framework: Street-Level Bureaucrats' Behavior in Driver's License Services at Pinrang Police Resort, Indonesia

This study investigates the behavioral dynamics of street-level bureaucrats (SLBs) in the driver's license (SIM) service at the Pinrang Resort Police (Polres Pinrang) in Indonesia, juxtaposing empirical findings with Michael Lipsky's seminal theory of street-level bureaucracy. Employing a qualitative phenomenological methodology, the research seeks to elucidate the influence of working conditions on SLBs' behavioral patterns and the consequent impact on public service quality. Data were collected through semi-structured interviews with SLBs and service recipients, non-participant observations, and document analysis, then subjected to iterative thematic analysis using interactive model. The findings reveal notable divergences from Lipsky's theoretical propositions. SLBs at Polres Pinrang encounter reduced ambiguity in policy objectives and performance evaluation, attributable to effective communication channels, comprehensive standard operating procedures, and a robust performance appraisal system. Despite resource limitations and escalating service demands, SLBs exhibit adaptability in delivering responsive services through access rationing strategies, task routinization, and collaborative partnerships with interdepartmental units and community stakeholders. Contrary to the nonvoluntary client interactions posited by Lipsky, SLB-SIM applicant engagements are characterized by enhanced humanization and responsiveness. Nevertheless, Lipsky's theoretical insights maintain relevance in the broader landscape of public service provision. The study underscores the criticality of striking a balance between procedural adherence and client-centric responsiveness to optimize service quality.

Voters’ Perspectives on Elections (2011-2021): A Hermeneutic Study in Chadiza Constituency, Eastern Province, Zambia

The study explored voters’ experience during elections from 2011 to 2021 in Chadiza District of Eastern Province, Zambia. The objectives of the study were: to establish causes of electoral violence, to describe effects of electoral violence and to establish mitigation measures to ameliorating electoral violence in Chadiza Constituency. This was a thematic analysis and used qualitative research method with 35 participants. In using the Hermeneutic phenomenology, the authors desired not to depart from personal opinions, experiences and value as aid to analyse and interpret collected data. Data was collected through interviews and Focus Group Discussion using purposive sampling. The results of the study were discussed in referential to thematic areas that emerged during data analysis and they established that voting experiences in Chadiza were characterised by electoral violence. The factors that caused electoral violence and effects of electoral violence were revealed by the study. The collected data helped in formulation of sustainable electoral violence prevention measures. The study recommended that the Electoral Commission of Zambia ought to bridge the gap between Ideal and real elections by applying appropriate measures that would lead to cost effective elections that over rides or reduce elections nullifications.

Elder abuse in Flanders, Belgium: perspectives from home care nurses

ABSTRACT The present study focuses on elder abuse in the home care setting. The aim of this study was to explore home care nurses’ definition, general perspectives and experiences of elder abuse, and the barriers they experience to avoid elder abuse. Individual qualitative interviews were held with Flemish home care nurses (N = 17), employed by a Dutch home nursing organization. Data analysis was performed using reflexive thematic analysis. Results showed that (1) participants’ understanding of elder abuse was based on intuition and daily practice. (2) Participants highlighted several institutional barriers to avoid elder abuse. (3) The participating home care organizations did not have a standard protocol to report or handle elder abuse. Institutional structures, procedures and decisions should be critically reviewed as to how they lead to staff abusing older adults.

Russian Immigrant Families’ Child Care Selection in the United States

AbstractResearch on immigrant populations shows that child care choices are dependent on the population’s region of origin. While the Russian immigrant population in the United States comprises the largest group of immigrants from Eastern Europe and is likely to increase in the future, there is virtually no research on Russian immigrant families’ child care search and selection criteria. This qualitative study applies the theoretical model of Pungello and Kurtz-Costes (1999), which illustrates how factors such as parental demographic characteristics, environmental context, child characteristics, and parental beliefs play into families’ child care selection. The study draws from semi-structured interviews with 11 Russian immigrant families residing in the Mid-Atlantic region of the United States to examine their child care search processes and selection criteria. Results revealed that most parents found child care through friends’ recommendations, Internet search, and online reviews. Nine themes describing child care criteria valued by Russian immigrant families emerged from the analysis. Specifically, parents mentioned culture and personal beliefs, child characteristics, convenience, cost and subsidy, education and learning, program features, facilities and environment, teacher characteristics, and rating and reputation as the major factors in selecting child care. Understanding Russian immigrant parents’ child care information sources and selection criteria will allow for early care and education (ECE) providers to accommodate the needs of Russian immigrant population and for policymakers to facilitate access to ECE programs for these families.

Health service provider views on measuring patient involvement in healthcare: an interview study with researchers, clinicians, service managers, and policymakers.

There are several strategies used to assess involvement in their healthcare across service providers. However, there is no consensus on the most appropriate measurement tool to use when evaluating patient involvement initiatives. This qualitative study aimed to explore the perspectives of stakeholders from micro, meso, and macro levels within the Danish healthcare system on measuring patient involvement in their healthcare. This descriptive, explorative study employed semi-structured interviews with open-ended questions to elicit participants' views and experiences of patient involvement and measurement tools. A purposeful sample of participants was identified, to include decision makers, researchers, and health professionals (n = 20) with experiences of measuring patient involvement in healthcare at micro, meso, and macro levels across Danish organizations. Data underwent reflexive thematic analysis. Three main themes were identified: 1) Determining the purpose of patient involvement practices and measurement alignment; 2) Reflecting on the qualities, fit, and usefulness of measures; 3) Recognizing conflicting stakeholder paradigms. Despite the interest in and positive attitudes toward patient involvement innovations, views on the meaning and value of evaluating involvement varied; in part, this was attributable to challenges in selecting criteria, methods, and measures for evaluation. The findings indicate the need to integrate the perspectives of all key stakeholders in designing the evaluation of patient involvement initiatives. The application of a multiple stakeholder approach and co-production of a multidimensional evaluation may provide some common ground for selecting evaluation criteria and measurement tools in the healthcare setting. Danish Data Protection Agency (1-16-02-400-21) 15 October 2021.

Doctoral students’ reflections on generative artificial intelligence (GenAI) use in the literature review process

ABSTRACT Amidst discussions about the use of Generative AI (GenAI) for academic research, their potential for doctoral research or literature reviews is an area beginning to be explored. This qualitative study explores doctoral students’ perceptions of the value of GenAI tools in the literature review process. The analysis of 26 participants’ reflections on their exploration of three GenAI technologies revealed benefits and challenges for the literature review process. Participants highlighted the potential of these tools as complementary to traditional database searches presuming users possess prior information literacy and research skills. They also perceived several challenges such as inaccuracies, usability and privacy and emphasised the importance and indispensability of a human review. This study highlights the need for guidance and strategies for doctoral students on the appropriate and ethical integration of GenAI in literature reviews.

Factors affecting emergency medical dispatchers decision making in stroke calls - a qualitative study.

Emergency Medical Communication Centers (EMCC) have a key role in the prehospital chain-of-stroke-survival by recognizing stroke patients and reducing prehospital delay. However, studies on EMCC stroke recognition report both substantial undertriage and overtriage. Since mis-triage at the EMCC challenges the whole chain-of-stroke-survival, by occupying limited resources for non-stroke patients or failing to recognize the true stroke patients, there is a need to achieve a more comprehensive understanding of the dispatchers' routines and experiences. The aim of this study was to explore factors affecting EMCC dispatcher's decision-making in stroke calls. A qualitative exploratory study, based on individual semi-structured interviews of 15 medical dispatchers from EMCC Oslo, Norway. Interviews were conducted during August and October 2022 and analyzed using the principles of thematic analysis. We identified four themes: [1] Pronounced stroke symptoms are easy to identify [2]. Non-specific neurological symptoms raise suspicion of acute stroke but are difficult to differentiate from other medical conditions [3]. Consistent use of the Criteria Based Dispatch (CBD) protocol may increase EMCC overtriage [4]. Contextual conditions at EMCC can affect dispatchers' decision-making process and the ability for experiential learning. Medical dispatchers at the EMCC perceive vague and non-specific stroke symptoms, such as dizziness, confusion or altered behaviour, challenging to differentiate from symptoms of other less time-critical medical conditions. They also perceive the current CBD protocol in use as less supportive in assessing such symptoms. High workload and strict EMCC response time interval requirements hinder the gathering of essential patient information and the ability to seek guidance in cases of doubt, potentially exacerbating both EMCC undertriage and overtriage. The absence of feedback loops and other strategies for experiential learning in the EMCC hampers the medical dispatcher's ability to evaluate their own assessments and improve dispatch accuracy.