Medical educator identity: Embracing the teaching role

Integrating the teaching role into the career

Medical educator identity involves understanding oneself as a teacher and connecting the meaning attributed to education with daily activities and career choices. For those who have built careers centered on clinical practice and research, education is both an activity that supports existing roles and a distinct area in which to develop expertise. The process of embracing the teaching role involves teaching experience, colleagues’ responses, and the ways institutions recognize educational contributions.

Career entry and socialization through hospital teaching positions

A study of the experience of beginning an educational career in a hospital examined the Medical Education Registrar (MER) programme of the Queensland health authority in Australia (Bartle & Thistlethwaite, 2014). Introduced in 2008, the programme was designed to develop participants’ teaching and supervisory competencies and support educational projects over 12 months. Participants continued one or two sessions of clinical work in their specialty each week. The central organization supported 4 full-time positions annually from 2008–2012, after which hospitals and districts could fund the positions from their own education budgets. Of the 32 potential participants, 12 participated in the study: 10 incumbents in 2012 and 2 past graduates. The research team analyzed 15 semi-structured interviews using framework analysis and applied social cognitive career theory (SCCT) to connect self-efficacy, outcome expectations, and personal goals with environmental support. Five of the 8 participants interviewed at the beginning of the programme were interviewed again at completion. Retrospective interviews were conducted with the 2 past graduates.

The analysis identified six themes: motivation for career choice, personal goals and self-direction, role models, identity, supervisor and mentor support, and research requirements as a career barrier. Participants applied because they wanted to emulate good clinical teachers or improve on poor educational experiences. They recognized that teaching itself required learning. The educational project had no fixed format. Some set their own goals and performance criteria without a job description or initial guidance. One participant spent three months struggling to adjust to work that provided time to think and plan. Participants felt that autonomy had allowed them to pursue their preferred activities. Guidance and feedback from supervisors helped participants adjust the scope of their projects and make use of this autonomy.

Participants sought to maintain clinical activities to fulfill their patient care responsibilities and retain credibility as educators. After completing the position, they described themselves as surgeons interested in education or doctors who took on teaching roles. Research experience was limited, and evaluating the outcomes of educational programs beyond satisfaction or confidence proved difficult. Participants also preferred pathways that allowed them to improve hospital education as specialists to university careers requiring research records and doctoral degrees. The results are based on 12 participants from one organization and follow-up interviews with only some participants. They are limited to how participants described their roles and careers. The study proposed recognizing career pathways for clinical educators working without university affiliation and making explicit provision for early goal setting and support from supervisors with educational expertise.

Ways of integrating the teaching role among clinical practice, research, and education

A study conducted in 2012–2013 at a medical school in the Netherlands explored how 18 beginning teachers with five or fewer years of teaching experience integrated their roles (van Lankveld et al., 2017). Participants were purposively sampled from a 165-hour university teaching qualification course and a teacher community. They had an average of 1.3 years of teaching experience. All were responsible for undergraduate small-group teaching; 8 were from basic science departments, 2 from clinical departments, and 8 from education departments. The research team conducted two rounds of semi-structured interviews. Weekly diaries written over the intervening seven months informed the follow-up interviews. The analysis used figured worlds theory to examine recognized activities and collective narratives in clinical practice, research, and education. It used dialogical self theory to interpret negotiations among the I-positions of doctor, researcher, and teacher.

Half of the participants experienced strong tension as they integrated the teaching role into their identities. Medical degree holders encountered responses that valued education less than clinical practice. Participants from basic science departments described an atmosphere in which education was treated as a burden that interfered with research. Rewards centered on publication records. There were 8 participants who described education as supporting their goals as doctors and researchers, and 6 participants who maintained their existing identities without adopting the teacher position. Another 4 used narratives that favored education while distancing themselves from the competition, hierarchy, and working conditions of clinical practice or research. Three conferred status on the teaching role through a third position as a coordinator responsible for educational coordination and development. Another 4 adopted a meta-position that put the importance of occupational status in their lives into perspective. Individual participants could use multiple narratives. These five approaches describe a role in different situations rather than fixed types of people.

Participants expressed aspirations to become educational leaders even before taking on formal administrative positions. They viewed greater responsibility for coordinating and developing education as growth. The analysis identified opposition between I-positions and non-integration of the teacher position alongside the existing theoretical concepts of coalition, third position, and meta-position. The results must be interpreted in the context of participants’ voluntary involvement in faculty development and the research-centered promotion system. The study proposed support that connects positive teaching experiences, narratives from role models, teacher communities, teaching qualifications and awards, and reward and promotion structures that recognize educational contributions.

Role expansion and career stage tensions after post-graduate education

A study conducted at the Centre for Medical Education at the University of Dundee analyzed interview data from a three-phase mixed-methods study in 2013–2014 (Sethi et al., 2017). The 36 interview participants included 9 current students and 27 graduates from 2008–2012. All current students were international students, and the majority of graduates had studied remotely. The graduates’ study periods ranged from 2 to 9 years. Participants worked as clinical specialists, professors, department heads, deans, and project directors. The research team used constructivist grounded theory to analyze semi-structured interviews conducted by telephone, via Skype, and face-to-face. The relationship between identity and participation was interpreted through Communities of Practice.

Tensions shared by current students and graduates fell into six areas: balancing multiple identities, limited recognition of educator careers, unclear career pathways, practical application of theory, financial penalties, and continued growth and keeping knowledge up-to-date. Participants struggled to balance clinical practice, administration, and family life as their educational responsibilities increased. They worried that becoming full-time educators might reduce their credibility as clinicians. In institutions with unclear job descriptions or promotion criteria for educators, they were evaluated against criteria applied to clinicians and researchers. Applying what they had learned presented challenges, such as finding time to provide feedback during emergency department shifts or adapting professionalism education to national cultures. A post-graduate qualification provided a basis for recognizing educational expertise, while also prompting institutions to expect qualification holders to take responsibility for various areas of education. One participant took on continuing education duties outside their research field.

Most graduates aged 45 or older with extensive teaching experience reported having no fears. They explained that their qualification enabled them to perform a range of duties. One clinical tutor valued an arrangement that allocated about one-third of the job plan to education while also providing support for clinical practice and research. The research team used age and graduation year as indicators of experience and seniority when comparing participants. This sense of stability must be interpreted in relation to accumulated experience and current working arrangements. The study proposed including change management and the application of knowledge in context in post-graduate education. It also proposed linking mentoring for graduates, protected teaching time and financial support, specific job descriptions and career pathways, and further advanced education.

Measuring teacher identity through self-confidence, experience, and expectations

A study that reconstructed a questionnaire on university hospital physicians’ teacher identity examined the measurement properties of an existing 9-scale, 37-item instrument (Schindler et al., 2024). The institution surveyed was transitioning from a municipal maximum care hospital to a university hospital. Of 666 employed physicians, 147 participated in May 2020, yielding a 22% response rate. Some wording in the German questionnaire was modified to suit the hospital context, and responses ranged from 0 to 4. Respondents with teaching experience accounted for 68.3%, but 45.9% were not teaching at the time of the survey. The research team conducted confirmatory factor analysis for each scale, followed by item reduction, exploratory factor analysis with promax rotation, a theoretical review of item content, and confirmatory factor analysis of the reconstructed scales.

The existing structure was confirmed for “intrinsic satisfaction of teaching” and “responsibility for teaching”, with Cronbach’s α of .81 and .77, respectively. For the other scales, discrepancies between item content and respondents’ experiences informed the reconstruction. The mean score for reading medical education journals was 0.41 (SD=0.80), whereas the mean for the importance of developing teaching skills was 3.03 (SD=1.03). The final version consisted of 7 scales—“intrinsic satisfaction of teaching”, “responsibility for teaching”, “exchange of teaching experiences”, “identification and joy with the teacher role”, “teaching development”, “self-concept of teaching skills”, and “desired teaching rewards”—along with 4 single items. The α for “exchange of teaching experiences” was .75, “identification and joy with the teacher role” was .83, and “teaching development” was .86. With α=.53, “desired teaching rewards” was identified as needing further development. The research team proposed rewording some items about career advancement and experiences of rewards to address expectations.

“Exchange of teaching experiences” includes the frequency of conversations with colleagues, the usefulness of discussions, and the enjoyment of sharing ideas. Because the model for this scale has zero degrees of freedom, CFI=1.000 and SRMR=.000 need to be interpreted in light of item content and internal consistency. Because the German-language self-report questionnaire was administered in a single institution undergoing transition, its scores need to be interpreted in relation to respondents’ teaching experience and expectations for institutional change. Expanding the scope to include physicians without teaching experience raises a measurement challenge: distinguishing teaching already undertaken from anticipated future roles.

How teaching experience is recognized in promotion portfolios

A study of medical educator portfolios (MEP) examined how educational records are presented for professorial appointments and reappointments at the Faculty of Health in a large, research-intensive university in Denmark (Christensen et al., 2024). Portfolios (36 in total) were collected in the spring and summer of 2022 by inviting 91 professors appointed or reappointed between 2019–2022 to participate. The research team conducted a deductive content analysis using three themes and 16 sub-themes from the institutional guidelines as a pre-coding framework. The results were interpreted through the concept of cultural capital. Teaching capital refers to the total cultural capital an individual holds that can be recognized as legitimate teaching competence.

The institutional guidelines required descriptions and documentation of teaching activities, while reasons for educational choices and outcomes demonstrating educational quality were optional. All 36 portfolios contained descriptions and documentation of teaching activities, while 18 (50%) included reasons for educational choices and 15 (42%) included outcomes demonstrating educational quality. Educational records were primarily presented in tables listing the year, course name, teaching hours, number of students, and teacher roles. Reflections on personal pedagogical development appeared in 8 documents, as did reflections on the roles of teachers and students. Student evaluations appeared in 9 documents, ranging from attached quantitative survey results to accounts of how feedback informed changes to classes. Recommendations or evaluations from colleagues or educational leaders were included in 5.

The analysis interpreted the time and effort invested in lecturing and supervision as embodied cultural capital. Reflections, teaching philosophy, and student and colleague evaluations were interpreted as objectified cultural capital, and the professorship as institutionalized cultural capital. Guidelines that require documentation of teaching volume encourage applicants to present time invested as a qualification for promotion. Completing optional items was interpreted as an effort to gain recognition for educational quality and scholarly inquiry. The study proposed reconsidering the division between mandatory and optional items and developing clearer guidance on educational quality and reflection.

Reading notes

Examining faculty development outcomes from an HRD perspective can connect research on how learning from a program is applied to educational work with research on how those contributions lead to career recognition. The reward scale’s α=.53 was calculated from responses collected before the modifications, and the proposed expectation items await subsequent validation. The portfolio study analyzed document content against institutional guidelines. Its results are limited to the relationship between the evidence presented by appointed professors and institutional expectations.

References

• Bartle, E., & Thistlethwaite, J. (2014). Becoming a medical educator: motivation, socialisation and navigation. BMC Medical Education, 14(1), 110. https://doi.org/10.1186/1472-6920-14-110
• Christensen, M. K., Pedersen, I. M., & Wichmann-Hansen, G. (2024). “Teaching capital”– a sociological analysis of medical educator portfolios for promotion. Advances in Health Sciences Education, 29(5), 1769–1786. https://doi.org/10.1007/s10459-024-10333-3
• Schindler, A.-K., Schimmel, M., Oezsoy, M., & Rotthoff, T. (2024). Measuring teacher identity of physicians – a validation study of a questionnaire instrument. Medical Education Online, 29(1), 2333618. https://doi.org/10.1080/10872981.2024.2333618
• Sethi, A., Ajjawi, R., McAleer, S., & Schofield, S. (2017). Exploring the tensions of being and becoming a medical educator. BMC Medical Education, 17(1), 62. https://doi.org/10.1186/s12909-017-0894-3
• van Lankveld, T., Schoonenboom, J., Kusurkar, R. A., Volman, M., Beishuizen, J., & Croiset, G. (2017). Integrating the teaching role into one’s identity: A qualitative study of beginning undergraduate medical teachers. Advances in Health Sciences Education, 22(3), 601–622. https://doi.org/10.1007/s10459-016-9694-5