The structured interview was designed as a cognitive task analysis, a technique which elicits practitioners’ thinking around parts of their work that require thought, planning and action. The interview was piloted and refined before implementation. Appendix 1 (available at includes the interview, links to the videos, an example mind map and the questionnaire. In phase 1 of the interview, the participant recalled a patient they tested for PE and explained their diagnostic approach and reasoning. In phase 2, the participant watched 2 videos of patients with possible PE symptoms in a simulation (the videos were chosen randomly from a selection of 4 videos). Participants were then asked to explain to the interviewer how they would test the patient (step by step) by drawing a mind map. In phase 3, they completed a questionnaire on their knowledge of the Wells score,8 age-adjusted d-dimer9 and the PERC rule.7 The interview finished with open-ended questions about barriers to using the diagnostic guidelines for PE (phase 4). All interviews were identical with the exception that participants from Hamilton reviewed an additional video of a patient with possible deep vein thrombosis. Our study analyzed only the PE-related cases. The interviews were conducted at each hospital in a private room. Our investigators trained the site research staff who did not have previous qualitative research experience and were either research assistants or undergraduate students with no previous relation to the participants. Interviews were audio-recorded and later transcribed.

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