Table 1.

Key features of case study as presented by Shultz et al ²²

Feature	How the feature is reflected in the study
In depth	This mixed methods case study assessed a standardised patient instructor (SPI) training programme at the University of Michigan that provided training in female breast, pelvic, male genital and prostate examinations to Japanese family medicine residents. The SPI training programme was examined in depth, focusing on its perceived acceptability and impact.
Natural setting	The study was undertaken in the participants’ natural setting, the Department of Family Medicine of the University of Michigan and the Shizuoka Family Medicine Program. Individual interviews with Japanese residents, nurses and medical assistants were conducted in Japanese, enabling participants to express themselves spontaneously. Data were collected three times in the course of 3 years, 2010–2012. This allowed researchers to examine changes in the perceptions of the participants over time.
Focus on context	Interviews with the medical staff of the Shizuoka Family Medicine Program and Japanese residents allowed researchers to understand how Japanese sociocultural beliefs about gender, identity and sex played a role in patient care delivered by residents in Japan. They also allowed researchers to determine the extent to which a similar training programme in Japan would be feasible and sustainable.
Combination of methods	Qualitative and quantitative methods were used to investigate different components of the programme. Methods included: Post-training evaluations with trainers in the SPI programme and Japanese residents attending the programme. Semistructured follow-up interviews with the Japanese residents and nursing and medical staff of the Shizuoka Family Medicine Program. A web-based questionnaire distributed to Shizuoka Family Medicine residents. Qualitative data and quantitative data were analysed separately and brought together to analyse the extent of convergence. The combination of qualitative and quantitative methods allowed researchers to improve the accuracy of the findings and minimise the impact of the cultural bias of Japanese residents and medical staff on their perceptions about the SPI training programme.