How learning-centred beliefs relate to awareness of educational identity and mission: An exploratory study among medical educators

Which 'end' do you have in mind? Clinical supervisors' perceptions of Professional Identity Formation outcomes in GP residency

PURPOSE

Professional Identity Formation (PIF) is crucial for high-quality patient care and physician well-being. Few empirical studies examined PIF in residency from the perspective of supervisors. In GP residency, residents are supervised with an 'end in mind' that remains unexplored. To encourage supervisors to reflect on their teaching behaviours, this study investigated GP clinical supervisors' perceptions of PIF outcomes in GP residency.

METHODS

Applying qualitative description, focus group interviews were conducted between spring and autumn 2019. Using a semi-structured interview guide, supervisors' perceptions of PIF outcomes were explored. In an iterative coding process applying constant comparison, a thematic analysis was performed of focus group transcripts.

RESULTS

We conducted eight focus groups with 55 supervisors at four training institutes across the Netherlands. Half of the supervisors were female. GP supervisors tend to address the 'poor GP' when prompted to address the 'good GP'. PIF outcomes in GP residency should revolve around taking ownership in patient care, self-care and the persistence of GP as a profession.

CONCLUSION

PIF can be challenged by a lack of positive language. Supervisors' strong beliefs regarding ideals of the profession potentially compromise PIF when they do not resonate with residents' beliefs, resulting in poor educational alliance.

Situations that prompt teachers in problem-based curricula to reflect on their beliefs, identity and mission

Teachers have different perceptions of how to enhance student learning. Whereas some take a teacher-centred perspective, others lean more towards a student-centred approach. Many studies in higher education have invoked Korthagen's onion model (2014) to explain how teachers' perspectives can impact their teaching practices. Spanning six interrelated layers, this model contains both outer (environment, behaviour, competencies) and inner (beliefs, identity, and mission) aspects. Focusing essentially on teachers' outer aspects, previous studies have paid scant attention to how particular situations affect teachers' inner aspects and, consequently, how teachers perceive student-centred learning. In this descriptive qualitative study, we explored situations that encouraged or discouraged teachers to embrace student-centred beliefs, identities and missions. We held three focus-group discussions with 18 teachers from two Indonesian medical schools, performing a thematic analysis of the data thus obtained. We found that certain situations made teachers reflect on their inner aspects, which either favourably or adversely affected their acceptance of a student-centred learning approach. Teachers' outer aspects (i.e. their prior problem-based teaching and learning experiences, learning situations from their own training as well as clinical duties) strongly interacted with their inner aspects, thereby shaping their teaching perspectives. Understanding how specific situations can influence teachers' inner aspects might help institutions to design faculty development programmes that address teachers' specific educational needs.

Flipping the expert: faculty educator sensemaking during transition to an active learning-based curriculum

PURPOSE

Curricular change is becoming a standard feature of medical schools as they respond to learners' evolving needs. Implementing change is not always straightforward, however, especially when it directly shifts the expected roles of faculty educators. The authors investigated how faculty educators navigated a significant transition to the Active, Competency-Based, and Excellence-Driven (ACE) curriculum at one state medical school.

METHOD

The authors employed a qualitative descriptive design and conducted thematic analysis. From June 2018 to January 2019, the authors conducted individual, in-depth interviews with faculty educators and administrators involved in first-year medical student education. Data were analyzed inductively to identify the sensemaking process for faculty.

RESULTS

Twenty-one faculty educators participated in interviews averaging 58 min. Four phases were identified among educators as they moved through the change: (1) Making Sense of the Change; (2) Grieving the Lecturer Educator Role; (3) Risking an Active Learning Educator Role; and (4) Identifying the Rewards of Active Learning-based Teaching.

CONCLUSION

Faculty buy-in is an essential component of successful curricular change implementation. While most faculty in this study reported eventual enjoyment from the new interactional teaching that fostered critical thinking, navigating the change was not always smooth. This study suggests faculty development around curricular change should be tailored to address the varying faculty concerns relevant to the four phases that were identified. Effective and optimal faculty support during large-scale curricular change must take into account not just new skills but also the grief and risk faculty may experience as their roles shift.

Maturing through awareness: An exploratory study into the development of educational competencies, identity, and mission of medical educators

PURPOSE

Faculty development in learning-centred medical education aims to help faculty mature into facilitators of student learning, but it is often ineffective. It is unclear how to support educators' maturation sustainably. We explored how and why medical educators working in learning-centred education, more commonly referred to as student-centred education, mature over time.

METHODS

We performed a qualitative follow-up study and interviewed 21 senior physician-educators at two times, ten years apart. A hierarchical model, distinguishing four educator phenotypes, was employed to deductively examine educators' awareness of the workplace context, their educational competencies, identity, and 'mission,' i.e. their source of personal inspiration. Those educators who grew in awareness, as measured by advancing in educator phenotype, were re-interviewed to inductively explore factors they perceived to have guided their maturation.

RESULTS

A minority of the medical educators grew in awareness of their educational qualities over the 10-year study period. Regression in awareness did not occur. Maturation as an educator was perceived to be linked to maturation as a physician and to engaging in primarily informal learning opportunities.

CONCLUSIONS

Maturation of medical educators can take place, but is not guaranteed, and appears to proceed through a growth in awareness of, successively, educational competencies, identity, and mission. At all stages, maturation is motivated by the task, identity, and mission as a physician.