Protean Career Paths in Medical Education

Abstract

Lee et al. (2024) explored how nine award-winning medical educators with leadership experience in South Korea developed their careers. Using interpretative phenomenological analysis and the protean career model, the authors examined how self-direction, intrinsic values, and organisational support shaped participants' careers and identities.

Background

Medical educators’ identities are often defined by their activities and roles, leaving some ambiguity about who they are professionally. Their work includes research, management, administration, and scholarly activities in medical education. Their roles may overlap with those of clinical teachers. Subsequent research added five roles to the 12 roles of medical teachers defined by Harden.

Previous research describes how medical educators experience conflicts between their clinician and educator identities throughout their careers. Clinician and researcher roles often take priority because they receive greater support and social capital. Previous studies have identified several factors that support professional development: understanding the possibilities of medical education, networking with other medical educators, mentoring, and enjoying teaching.

How do medical educators develop their professional identities and roles throughout their careers, and what challenges and opportunities do they encounter?

Theoretical background. Traditional approaches to career development view careers as unfolding within organisations. A protean career is self-directed and guided by goals that individuals set throughout their lives. It gives greater weight to psychological success than to objective success, such as salary and promotion. Protean career mechanisms comprise three components: orientation, process, and outcomes. Orientation consists of self-direction and intrinsic values. Process includes awareness, adaptability, and agency. Outcomes include subjective and objective career success and organisational commitment.

The protean career mechanism runs from orientation through process to outcomes, and participants' experiences aligned with the eight factors

Context. South Korea has 40 accredited medical schools. As of 2019, more than 500 medical educators among 11,111 full-time faculty members held membership in KAMC, KSME, and KIMEE. Medical educators in South Korea led several changes: expanding integrated curricula and problem-based learning, developing competency-based (outcome-based) curricula, implementing medical school accreditation in 1996, and introducing practical examinations.

Methods

The qualitative approach: IPA. Interpretative Phenomenological Analysis draws on phenomenology, hermeneutics, and an idiographic approach. Researchers interpret how participants make sense of their experiences.

Data collection. The research team used purposive sampling to select participants. The selection criteria were experience in medical education in South Korea, receipt of KAMC and KSME awards during 2017–2022 (the Myung-Gok Medical Education Award, Han-Gok Medical Education Academic Award, and Medical Education Innovation Award), and experience in leadership positions in medical education institutions. As of 2022, there were 19 Han-Gok Award recipients, 5 Myung-Gok Award recipients, and 5 Innovation Award recipients, with 3 receiving multiple awards. The team invited 9 recipients with leadership experience, and all participated. The team conducted interviews in May–June 2023: 4 in person and 5 online. Each interview lasted 1.5–2 hours and was transcribed verbatim. The study received approval from the Institutional Review Board of Severance Hospital, Yonsei University Health System (4-2023-0231).

Data analysis. The researchers read the data repeatedly to develop emergent themes, then organised them using protean career theory. To ensure reliability and validity, they used triangulation. The analysis involved 3 researchers, including a professor familiar with medical education in South Korea. They examined the context of the periods in which participants were active. They also collected career records, media articles, and published papers. The interviews were conducted in Korean. Translation took place at the final stage of analysis, followed by back-translation and review by a native speaker.

Results

Component	Element	Summary of participants’ experiences
Protean career orientation	Self-direction	Developed expertise through self-directed learning amid limited external support for faculty development
	Intrinsic work values	The value of educating doctors who care for patients and contribute to society guided career decisions
Protean career process	Awareness	Developed converging identities as clinicians and medical educators
	Adaptability	Changed education in response to social needs and changes in the healthcare environment
	Agency	Used strategies to initiate and implement change
Protean career outcomes	Subjective career success	Psychological satisfaction and fulfilment from students’ growth
	Organisational commitment	Organisational trust and support as conditions for sustaining careers
	Objective career success	Awards, leadership positions, and international academic networks

Self-direction. Participants placed the greatest importance on recognising key educational issues and independently learning relevant educational principles. One participant said they had not expected support. They had gathered materials independently and adjusted their schedule to attend academic conferences on education.

Intrinsic work values. Participants saw the value of medical education in educating good doctors who are humane and responsive to social needs. One participant said that defining the value of work in terms of “better lectures,” “popularity with students,” or “securing a job” could lead to burnout.

Awareness. One participant experienced conflict between their two professional roles and found motivation to continue their career by observing senior medical educators’ dedication. Another described the roles of clinician and medical educator as “100% the same.” The two identities converged, and work in each role reinforced the other.

Adaptability. Participants sought to examine medical education at a “global level” and anticipate “changes at least 10 years ahead.” As improvements to the national licensing examination, practical examinations such as OSCE and CPX, and computer-based methods emerged, participants independently learned the relevant educational philosophies, terminology, and theories.

Agency. Participants saw changes in faculty members’ “mindsets” as necessary for educational innovation. When faculty resisted changes, participants explained why the changes were necessary and prepared faculty members to experience success. They held monthly meetings with student representatives and briefings for all students at the beginning of each semester. Institutional changes introduced through accreditation processes helped communicate national and international standards and future directions. Legally established accreditation standards facilitated transitions when voluntary change was difficult.

Subjective career success. Participants described changes in students’ communication skills and attitudes after the students learned how to explain medications to older patients. They recalled students’ enjoyment of solving problems independently after the introduction of PBL. Participants experienced subjective career success as they passed on knowledge and skills and witnessed changes in students’ attitudes and behaviours.

Organisational commitment. Participants emphasised how strongly organisational trust and encouragement from the faculty community influenced early career success. They considered “small successes” and opportunities to build on them through participation in higher-level decision-making necessary to sustain their careers without burnout. Support took several forms: sponsorship to attend training programmes, fundraising, support for educational research, and opportunities to attend academic conferences.

Objective career success. All participants gained social recognition through awards and leadership positions. They organised an international medical education conference attended by more than 800 people from 57 countries. Drawing on South Korea’s experiences, they advised other countries on developing basic medical science education, improving clinical education, developing portfolios, assessing students, and designing and evaluating curricula. Participants regarded building networks as a form of objective career success.

Discussion

The authors argue that when medical educators’ roles are not clearly defined, individual goal setting and self-direction become more important. Drawing on previous research on protean career development, they describe how intrinsic values and self-direction together increase responsiveness to change.

Clinical experience served as cultural capital in their career development. The authors emphasise the need to understand change management principles and choose appropriate strategies to manage change in medical education. They argue that curriculum reform requires a shared vision and transparent engagement with faculty and students to build a sense of ownership.

Organisational commitment comprises normative, continuance, and affective commitment, with the affective component at its centre. The authors cite previous research showing a positive association between affective commitment and perceived organisational support and trust. They conclude that organisational support—including faculty development, educational facilities, formal career paths, university support, leadership, and the educational environment—is essential to medical educators’ career development.

Conclusion

South Korean medical education has limited structured career paths and faces rapid change. Medical educators developed individually driven careers guided by self-direction and intrinsic values. They formed their identities. The protean career model accounts for this self-directed approach while highlighting the need for organisational support. The authors identify the absence of structured career paths and career uncertainty as limitations of the model. They note difficulties in integrating it with traditional career structures in medical schools. They propose that future research examine the model’s explanatory scope by incorporating cases that do not fit it and critical perspectives. They also propose identifying practical ways to support early career medical educators.

Discussion of connections between career development theory and faculty development literature

Since the protean career concept was proposed by Hall, HRD researchers have examined it in empirical studies of career development. This study applies the model to medical educators as a professional group. Organisational commitment, treated as an outcome variable in individually driven careers, reflected experiences of “organisational trust” and “opportunities for small successes.” The study by Kim Dohwan (2023) described organisational and individual roles at each stage of career development in institutional terms.

The review by Hall (2004) traces how the protean career concept developed amid organisational restructuring and changing employment relationships. It places self-direction, core values, and subjective success at its centre. The study by Briscoe and Hall (2006) distinguishes values orientation and self-direction from psychological and physical mobility. It describes career orientations that combine these dimensions. This distinction allows values-driven, self-directed careers and organisational commitment to coexist.

The study by Sabel and Archer (2014) reported hierarchies and tensions between clinician/scientist identities and educator identities among medical educators in the United Kingdom. It also reported difficulties in developing a sense of emotional belonging to education. Among the South Korean participants, these two identities converged and reinforced each other.

The study by Hu et al. (2015) reported chance opportunities to enter medical education, ambiguous roles, and difficulties gaining recognition for educational work among medical educators in Australia and New Zealand. The authors described how tension between contributions to educational operations and rewards for scholarly achievements shaped careers.

The article by O’Sullivan and Irby (2011) conceptualised the relationships between faculty development programme communities and workplace communities. It identified networks, tasks, mentoring, and organisational culture as subjects for research. In BEME Guide No. 40, the review by Steinert et al. (2016) identified experiential learning, feedback and reflection, community building, longitudinal design, and institutional support as key features of faculty development.

References

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