45 A beliefs framework 2 overall belief orientation for each participant, using the final version of the new framework. The process and findings were discussed with the other members of the research team to enhance confirmability. Consensus was reached on the adaptation and refinement of the framework. Quality strategies Two other strategies were used to further confirm the quality of our results. First, we determined an inter-rater agreement of the participants’ belief orientations with the help of an independent research assistant. This assistant was trained in the analysis procedure, using the new framework and codebook, to enable determination of inter-rater agreement (confirmability by external rater). Because the final belief orientations were determined holistically, we decided that we would compare the outcome at the level of the overall belief orientation rather than at the level of text fragments. The inter-rater agreement was determined on eighteen interviews through calculation of Cohen’s Kappa. Second, we provide illustrative interview fragments in the results section, including two narratives of participants with contrasting educational belief orientations (thick description, adding to the transferability of the findings). We chose one educator holding the most teaching-centred belief orientation (Orientation I), and one holding the most learning-centred belief orientation (Orientation VI). RESULTS The new framework Although many beliefs described in the original Samuelowicz and Bain framework were also applicable in a medical education context, our data gave rise to new insights and allowed for refinements. The necessary adaptations in belief dimensions, including their constituent beliefs, and belief orientations will be described below.
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