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How do clinicians become teachers? A communities of practice perspective

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Abstract

There is widespread acceptance that clinical educators should be trained to teach, but faculty development for clinicians is undermined by poor attendance and inadequate learning transfer. As a result there has been growing interest in situating teacher development initiatives in clinical workplaces. The relationship between becoming a teacher and clinical workplace contexts is under theorised. In response, this qualitative research set out to explore how clinicians become teachers in relation to clinical communities and institutions. Using communities of practice (CoP) as a conceptual framework this research employed the sensitising concepts of regimes of competence and vertical (managerial) and horizontal (professional) planes of accountability to elucidate structural influences on teacher development. Fourteen hospital physicians completed developmental timelines and underwent semi-structured interviews, exploring their development as teachers. Despite having very different developmental pathways, participants’ descriptions of their teacher identities and practice that were remarkably congruent. Two types of CoP occupied the horizontal plane of accountability i.e. clinical teams (Firms) and communities of junior doctors (Fraternities). Participants reproduced teacher identities and practice that were congruent with CoPs’ regimes of competence in order to gain recognition and legitimacy. Participants also constructed their teacher identities in relation to institutions in the vertical plane of accountability (i.e. hospitals and medical schools). Institutions that valued teaching supported the development of teacher identities along institutionally defined lines. Where teaching was less valued, clinicians adapted their teacher identities and practices to suit institutional norms. Becoming a clinical educator entails continually negotiating one’s identity and practice between two potentially conflicting planes of accountability. Clinical CoPs are largely conservative and reproductive of teaching practice whereas accountability to institutions is potentially disruptive of teacher identity and practice.

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Notes

  1. "Firm" is a term used to describe clinical teams in UK settings. "Fraternity" is a term that was used by one of the participants in her interview to describe communities of junior doctors.

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Acknowledgments

This study was supported by an educational grant from the National Academy for Research on the Integration of Research on Teaching and Learning (NAIRTL) in Ireland. The authors would like to thank Professor Cees Van Der Vleuten and Dr Diana Dolmans of the School of Health Professions Education, Maastricht University for their support, suggestions and comments in the early stages of this research.

Author information

Authors and Affiliations

  1. Discipline of General Practice, NUI Galway, Galway, UK

    P. Cantillon & M. D’Eath

  2. School of Health Professionals Education, Maastricht University, Maastricht, Netherlands

    W. De Grave & T. Dornan

  3. Centre for Medical Education, Queens University, Belfast, UK

    T. Dornan

Authors
  1. P. Cantillon
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  2. M. D’Eath
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  3. W. De Grave
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  4. T. Dornan
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Corresponding author

Correspondence to P. Cantillon.

Appendices

Appendix 1: Topic guide

Being and becoming a teacher: topic guide

Demography + current practice

  • Why do you teach?

  • Can you describe the different teaching roles that you have at the moment?

  • Can you tell me about what you think good/poor clinical teaching is?

  • How do learners learn best in clinical settings in your opinion?

  • Tell me about your typical approach when teaching a small group of learners

  • Tell me about your typical approach when teaching one-to-one

Development

Persons (teacher encouraged to recall influential person narratives)

  • Why was this person important to your development as a teacher?

  • How did this person exert his/her influence on you (was it something she/he said, did or your observations of how she/he conducted him or herself?)

  • How might this person have influenced your thinking about teaching, learning or learners?

  • How might this person have influenced your current approach to teaching (and/or learners)?

  • How might this person have influenced how you think of yourself as a teacher?

Events (teacher encouraged to recall influential event narratives)

  • Tell me about educational events in which you were a learner or teacher that had a major influence on your current views about teaching and learning?

  • Why was this event important to your development as a teacher?

  • How did this event influence your thinking about teaching or learning or learners

  • Are there aspects of your current approach to teaching and to learners that have been informed by this event?

  • Did the event influence how you feel about yourself as a teacher?

Contexts (teacher encouraged to talk about learning in different contexts)

  • Tell me about your experiences of being a learner in an Irish context

  • Tell me about your experiences of clinical education in contexts outside of Ireland?

  • Can you think of ways in which exposure to overseas educational and clinical environments might have affected your thinking about being a teacher?

  • Can you think of ways in which spending time overseas might have influenced your current teaching practice?

  • How do you compare the learning and teaching environments in the overseas contexts with the learning and teaching environments that apply in the Irish context

  • Tell me about your experiences of teaching in this hospital

  • Tell me about your experiences of teaching the clinical curriculum issued by the medical school next door?

Appendix 2

The male predominance in the sample reflected the distribution of male and female consultants in the teaching hospital surveyed in the year 2011 (see Table 1).

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Cantillon, P., D’Eath, M., De Grave, W. et al. How do clinicians become teachers? A communities of practice perspective. Adv in Health Sci Educ 21, 991–1008 (2016). https://doi.org/10.1007/s10459-016-9674-9

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  • DOI: https://doi.org/10.1007/s10459-016-9674-9

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