Junior Doctors’ Perception of Their Teaching Role and Responsibilities as Medical Teachers of Medical Students

doi:10.21203/rs.3.rs-5045878/v1

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Junior Doctors’ Perception of Their Teaching Role and Responsibilities as Medical Teachers of Medical Students

https://doi.org/10.21203/rs.3.rs-5045878/v1

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Background:

Junior doctors play a pivotal role in the education of medical students. This study aims to explore junior doctors' perceptions of their teaching responsibilities and experiences in delivering medical education.

Methods

A total of ten junior doctors, from Foundation Year 1 (FY1) to Core Medical Trainee 2 (CT2), were recruited from a teaching hospital in Southeast London. Semi-structured, face-to-face interviews were conducted, allowing participants to discuss specific aspects of their teaching roles. Interviews were audio-recorded with consent, transcribed, coded, and analysed thematically. The study received ethical approval from the Research Ethics Committee of King’s College Hospital, London, and Health Authority Approval. Participation was voluntary, following an invitation via email with an attached Participant Information Sheet. Potential participants were given the opportunity to ask questions directly or via email, and those who chose to participate provided written informed consent. Data confidentiality and participant anonymity were strictly maintained.

Result

Junior doctors perceive their teaching roles in three main capacities: as Information Providers, Student Assessors, and Leaders/Managers. An analysis based on five dimensions of teaching—planning, presentation, environment, evaluation, and pedagogy—highlights a critical need for faculty development, designated teaching time, and institutional support. Although junior doctors express a strong commitment to teaching, they encounter substantial barriers, including heavy clinical workloads and insufficient support, often relying on personal experience and observation to develop their teaching skills.

Conclusion

While the General Medical Council (GMC) expects junior doctors to engage in teaching medical students, this study reveals considerable variability in their perceptions and understanding of this role. These variations are predominantly influenced by the level of organizational support and the amount of teacher training provided. Despite the GMC’s recommendations, ongoing challenges continue to impede the delivery of high-quality teaching. The findings raise concerns regarding the practicality and attainability of the GMC's standards. The study further questions whether the responsibility for preparing junior doctors for their teaching roles should rest with NHS Trusts or Medical Colleges, emphasizing the need for clearer guidelines and enhanced support systems to improve teaching effectiveness.

Doctors have a professional obligation to engage in teaching, as highlighted by the General Medical Council (GMC) guidance on teaching medical students (GMC, 2006). Teaching is established as a core competency for doctors from the outset of their training in the UK, as outlined in the Foundation Programme Curriculum (Tomorrow's Doctors, 2009). The medical literature increasingly recognizes the growing involvement of junior doctors in teaching roles, which is shown to be beneficial for both junior doctors and medical students (Hinchliffe et al, 2021)). Several studies have demonstrated that teaching programs led by junior doctors are perceived by students to be of a comparable quality to those provided by senior faculty members (Hayden et.al,2021).

Furthermore, a study by Jones and Rai (2015) found that medical students viewed teaching programs led by junior doctors as effective, as they draw on their recent experiences as learners and are better able to identify and address the learning needs of medical students (Hayden et.al,2021). Bing-You and Sproul (1992) previously reported that junior doctors deliver approximately one-third of the teaching sessions for medical students, whereas only 19% of these sessions are conducted by consultants. Recent data suggests that the teaching load of junior doctors remains substantial. A study by Fagan et al. (2023) confirms that junior doctors continue to play a critical role in medical education, accounting for a significant proportion of teaching sessions. Specifically, Fagan et al. found that junior doctors are responsible for delivering over 30% of teaching sessions, reflecting the enduring importance of their contributions to medical education. The literature indicates an increasing demand for junior doctors to undertake the secondary role of teacher (Fagan et al, 2023). This trend may be attributed to several factors, including medical students’ appreciation of junior doctor-led teaching, a shortage of dedicated medical educators, the requirements set by the GMC, and the growing workload of consultants (Darragh et al., 2014).

Darragh et al. (2014) noted a decline in enthusiasm for teaching among consultants, largely due to a lack of recognition and increasing workload. This perspective is supported by Chapman et al. (2016), who observed that senior consultants are increasingly focused on service delivery priorities. Consequently, the responsibility for teaching medical students is progressively being transferred to junior doctors. Given this growing demand, providing support and development opportunities for junior doctors as teachers is crucial to ensuring the effectiveness of both the teaching and learning processes.

The GMC publications, "Tomorrow’s Doctors" (2009) and "Doctors as Teachers" (2006), emphasize the importance of developing teaching skills among doctors. These documents particularly highlight the need for adequate support and training to cultivate core competencies and practices essential for competent teaching. They stress that all doctors willing to teach, regardless of whether they are employed by medical schools, should receive organizational support, including from the NHS Trusts that employ them, to prepare them adequately for their teaching responsibilities.

In recognizing the role of junior doctors as medical educators, the GMC has set forth expectations for both the teachers and the organizations that employ them to fulfil this role effectively. These expectations include the provision of teacher training, "protected" time for teaching, recognition of teaching excellence through awards, access to teaching resources, and mechanisms for quality assessment and feedback. Such measures help to cultivate the necessary knowledge, skills, and interpersonal qualities required for effective teaching (Ralhan et al., 2012). It is important to acknowledge that most teachers do not begin their careers possessing a full complement of teaching skills; rather, teaching proficiency is developed through an ongoing process of refinement.

Understanding the roles and responsibilities inherent in teaching is essential for providing effective education. Therefore, educators must be able to identify their developmental needs to enhance the overall teaching process.

Study Design

This study employs a phenomenographic approach to investigate the diverse ways in which junior doctors experience and understand their role as medical teachers. Phenomenography is a qualitative research method designed to explore the variations in how individuals perceive and conceptualize phenomena (Marton,2000). Here, the focus is on junior doctors, typically in their fourth-year post-graduation, from Foundation Year 1 (F1) to Core Medical Trainee 2 (CT2). The aim is to capture the range of experiences and interpretations these junior doctors have regarding their teaching responsibilities. This approach aligns with Marton's (2000) definition of phenomenography, which seeks to elucidate the different ways people experience and understand their roles.

Participants

Participants were junior doctors with clinical experience ranging from 1 to 4 years post-graduation, specifically those in Foundation Year 1 to Core Medical Trainee 2. Recruitment was conducted via a voluntary response to an invitation email sent to all eligible junior doctors. The inclusion criteria were based on having a clinical experience and having engaged in teaching medical students. There were 15 participants who volunteered for this study to provide their valuable experience.

Data Collection

The primary method of data collection in a phenomenographic study is the semi-structured interview (Sin, 2010). This approach is inherently open-ended, allowing participants the freedom to focus on the dimensions or aspects of the phenomenon they find most relevant (Marton, 1986). I adopted this method to ensure that my data collection was reflective and descriptive. According to Sandberg (1997), the research focus should be on how participants reflect upon and describe their understanding of the phenomenon under study.

All interview questions were carefully crafted to ensure they aligned with the research questions of my study. As a novice interviewer, I was concerned about obtaining rich descriptions without extensive interviewing experience. To address this, I attended an interview skills workshop offered by my local hospital, which significantly enhanced my ability to conduct effective interviews and address potential issues.

A pilot interview was conducted to identify and rectify any issues related to the interview questions and my interviewing skills. This pilot session also helped me determine whether the questions would elicit the relevant information needed for the study.

During the interviews, I employed probing questions to elicit deeper responses when initial answers from junior doctors lacked clarity or detail. For example, I might ask, “You mentioned that time constraints are a challenge; could you elaborate on this?” I actively listened to participants to ensure their responses were clear and comprehensive, and used probing questions as necessary to seek further clarification or elaboration (Browne & Keeley,2018). Importantly, I avoided using leading or confusing questions.

I made a concerted effort to establish rapport with participants, aiming to create a safe and relaxed environment conducive to reflective and detailed responses. At the outset, I clearly explained the purpose of the study, the interview process, the use of audio recording, my role, and the ethical considerations and approval. Participants were also encouraged to ask any questions they might have. I stated at the beginning of each interview:

I am going to start the interview now. It will take approximately 30–45 minutes. My goal is to gain a deeper understanding of your unique experiences and perceptions related to teaching medical students. There are no right or wrong answers to these questions. Before we begin, do you have any questions for me?

The face-to-face interviews were conducted in a private room at the education centre of NHS Trust, as approved by the Ethics Research Committee. This setting allowed me to observe participants' facial expressions and body language, which can provide additional context for understanding their responses (Opdenakker, 2006). I used various non-verbal cues, such as silence, facial expressions, and gestures, along with verbal probes, to explore topics more deeply. All interviews were audio-recorded with participants’ consent, and I took supplementary notes on participants’ non-verbal communication, which cannot be captured by audio recording alone

Ethical Considerations

The study was approved by the Research Ethics Committee of King’s College Hospital, and Health Authority Approval was obtained prior to data collection. Participation was entirely voluntary, with potential participants receiving an invitation email that included a Participant Information Sheet. Interested individuals were encouraged to ask questions and seek clarification about the study. Those who chose to participate provided written informed consent, acknowledging their understanding of the study’s aims, the confidentiality of their data, and the anonymity of their contributions. Participants were also informed about the use of audio recording and note-taking during interviews.

Data Analysis

The transcribed interviews were analysed using phenomenographic analysis techniques. This involved identifying and categorizing variations in the participants’ descriptions of their teaching roles, as well as the meanings they attributed to these experiences. The analysis focused on capturing the different ways junior doctors perceive and experience their role as medical teachers, highlighting both commonalities and differences across participants.

This phenomenographic study provides valuable insights into the diverse experiences of junior doctors in their teaching roles, offering a nuanced understanding of their perceptions and conceptualizations. The findings will contribute to enhancing the support and development of junior doctors as effective medical educators.

Description of the Outcome Space (Variations)

The principal research question for this study was: “How do junior doctors perceive their role and responsibilities as teachers of medical students?” The sub-questions addressed were:

How do junior doctors perceive their preparedness to teach as being useful and effective?

What motivates them to teach medical students?

What kinds of challenges do they face as medical teachers?

To address these questions, the interview transcripts were meticulously examined. Data analysis revealed three broad categories that emerged from the interviews:

Information Provider

Student Assessor

Leader/Manager

These categories were analysed in detail to capture the variations in how junior doctors perceive their teaching role and responsibilities. To further elucidate their understanding of the purpose of teaching, the teaching dimensions proposed by Postareff & Lindblom-Ylanne (2008) were employed. These dimensions are:

a) Planning of Teaching

b) Presentation/Method of Teaching

c) Learning Environment
d) Evaluation of Learning/Assessment
e) Pedagogical Understanding

The table below summarizes the variations in the roles and responsibilities perceived by junior doctors as teachers for medical students. These variations were categorized according to the functions fulfilled in the five dimensions of teaching.

OUTCOME SPACE: VARIATIONS

TEACHING

DIMENSION

VARAITION 1: INFORMATION PROVIDER

VARAIATION 2: STUDENTS ASSESOR

VARIATION 3: LEADER/MANAGER

TEACHING PLAN

1) Learning objective is content/teacher focused.

2) Lack in assessment of prior –knowledge and expectation of learners.

1) Combination of content/ teacher and learner focused.

2) Good understanding of importance of assessment of learners’ need, prior knowledge and expectation while designing teaching.

1) Learning objective is learner focused.

2) Extremely good understanding of importance of assessment of learners’ need, prior knowledge and expectation while designing teaching.

PRESENTATION/ TEACHING METHOD

1) Knowledge is transmitted to learners.

2) Teaching is tailored to transmit knowledge only.

3) Didactic/ lecture style of teaching.

4) Prefer to teach only small groups.

1) Knowledge is either transmitted or constructed with learners.

2) Focused on teaching knowledge and skills.

3) Method of presentation is didactic/ lecture/ workshop etc. and use of various teaching method in order to enhance learning.

4) Prefer to teach small to large group.

1) Knowledge is constructed together with learners.

2) Teaching is focused towards the transmission of knowledge, skills, behaviour and professionalism.

3)Various ways or method of teaching included in order to enhance learning such as, simulation, workshop, seminars, interactive learning, lectures, practical demonstration.

4) Prefer to teach small to large groups.

LEARNING ENVIRONMENT

1) Less engagement and interaction during session.

2) Knowledge is transmitted mostly didactic.

3) No encouragement for students to be reflective and critical.

4) Learners learn from the teacher and teacher acts as subject/topic expertise.

5) Teaching is done mostly to build a portfolio.

1) More engagement and interaction during session.

2) Knowledge is constructed through both didactic and interaction.

3) Encourage students to be active and reflective.

4) Learners learn from teacher and teacher acts as an extreme expert.

5) Teaching is done both for fun and to build portfolio.

1) Extremely engaged and interactive sessions.

2) Knowledge is mostly constructed through interaction.

3) A lot of encouragement for students to be reflective and critical.

4) Learners learn from team and each other.

5) Teaching is done for fun and passion.

EVALUATION OF LEARNING/ ASSESSMENT PRACTICES

1) Evaluation of learning is not regularly used.

2) Feedback provided to learners as requested.

3) Less understanding of various forms and criteria in assessment and evaluation

4) No involvement in formative and summative OSCE as an examiner.

1) Regular use of evaluation of learning during teaching session.

2) Feedback provided to students to enhance the learning.

3) Detailed understanding of various forms and marking criteria of assessment and evaluation form.

4) Mostly involved in both formative and summative OSCE and contribution in developing scenario for formative OSCE locally.

1) Evaluation of learning is part of teaching sessions.

2) Feedback is provided regularly to learners as well as gained from learners to improve their own teaching practice.

3) Very good understanding of various evaluation forms and marking criteria of assessment.

4) Involved in organising formative OSCE locally and also participated in Summative OSCE as an examiner.

PEDAGOGICAL UNDERSTANDING & DEVELOPMENT

1) Less understanding of pedagogical/ educational theory.

2) Learn to teach from own experience as being students and observing role model teacher.

3) Less interest towards development of his/her teaching.

4)No training on how to teach and unaware of pedagogical skills

1) Understanding of pedagogy/ educational theory.

2) Training on how to teach such as “Train the Trainers”

3) Motivated to develop his/her own teaching.

4) Regularly reflects on own teaching practice and aware of need of development of pedagogical skills to enhance teaching and learning practice.

1) Greater understanding of pedagogy/ educational theory.

2) Training on how to teach such as “Train the trainers” and also some of them has gained the educational qualification in teaching practice such as PGCert in clinical education, diploma in clinical education.

3) Extremely involved in developing own teaching and proactively involved in team to organise, manage and enhance the teaching.

4) Critical and deep reflection of own teaching and ware of pedagogical skills development for effective provision of teaching.

Variation 1: Information Provider

The role of an “Information Provider” was predominantly expressed by Foundation Year One doctors and those with less than one year’s experience in teaching. This group demonstrated a “craft approach” to teaching, as described by Guzman (2009), where teaching is largely learned through practice and observation rather than through formal pedagogical training. Their teaching was characterized by a focus on content delivery, often through didactic lectures, with students being passive recipients of information. There was no evident element of an “Information Coach” role, where the teacher facilitates the students’ search for information.

This group exhibited a strong content-focused approach to teaching, where the primary goal was to transmit knowledge. Critical reflection on their own teaching practices was minimal, and pedagogical strategies were largely absent. The teaching skills employed were derived from their personal experiences as students rather than from formal pedagogical training. This group might benefit from additional teacher training and pedagogical education to develop into more learner-focused and reflective educators. Despite these limitations, members of this group showed a strong willingness to support students, motivated by the desire to update their own knowledge and to enhance their professional portfolios through teaching.

Statements from participants exemplify this perspective:

“Providing and sharing my knowledge and skills is certainly the main part of my role as I don’t have extensive experience in teaching.” (Candidate Number 2)

“I am aware that students’ expectations have changed, but as an F1 my knowledge is limited so I can only share what I know.” (Candidate Number 1)

“I am not an expert or experienced clinician to provide expert knowledge, but I would love to share my knowledge to help students pass their exams.” (Candidate Number 5)

Variation 2: Student Assessor

The role of the “Student Assessor” was primarily identified among those with over one year of teaching experience. These teachers focus on preparing students for Objective Structured Clinical Examinations (OSCEs). They have transitioned from a "craft approach" to a more professional continuum in their teaching practices. Many interviewees reported that their understanding of this role is informed by their own experiences as students, which highlights the significance of assessment for medical students and motivates them to assist in this area.

Teachers in this category generally possess a solid grasp of assessment principles, including OSCEs, Mini-CEX (Mini Clinical Examinations), and case-based discussions. They have often been involved in organizing formative OSCEs at the local level and participate as assessors in summative OSCEs conducted by the medical school. However, their involvement in high-stakes assessments is limited. The data suggest that these educators engage in some degree of critical analysis of their teaching and recognize areas requiring further development. Their teaching is frequently driven by the need to prepare students for exams, emphasizing skill and knowledge acquisition necessary for safe clinical practice.

Statements from participants illustrate this perspective:

“I have been asked to help in an OSCE a few times by the medical school, and I really enjoyed assessing medical students.” (Candidate Number 2)

“I love teaching in general, but I am more interested in helping medical students prepare for their exams, as they are always anxious about OSCEs and other assessments.” (Candidate Number 10)

Variation 3: Leader/Manager

The “Leader/Manager” role is typically seen among those with more than two years of teaching experience who consider education a crucial aspect of their job. These teachers manage their responsibilities on a personal level, including setting objectives, planning, organizing, communicating with teams, implementing plans, supporting and monitoring students' progress, and providing effective feedback. They view their role as integral to shaping the next generation of doctors, aiming to develop professionals capable of delivering safe and effective patient care.

Teachers in this category have transitioned from a “craft approach” to becoming expert educators through teaching courses, training, practice, and self-reflection. They perceive their role as evolving into a "Professional Continuum," where their focus extends beyond mere knowledge transmission to include creating diverse learning opportunities tailored to individual students' needs. Some interviewees emphasize the importance of developing safe and competent doctors rather than solely imparting knowledge. This group also recognizes the significance of interpersonal skills and personal attributes in organizing and delivering effective teaching. They adopt a learner-focused approach and often collaborate with other health professionals to enhance the educational experience for medical students.

Statements from participants highlight this role:

“My teaching role has expanded from one role to multiple roles as I gained more experience as a teacher. I used to think I was just teaching students, but now my view has changed. Each student that I teach means I am shaping a future consultant.” (Candidate Number 8)

These variations in teaching roles and responsibilities emerged from thematic analysis within the dimensions of teaching, illustrating how each role fulfils its function across the different teaching dimensions.

Description of Teaching Dimensions

Planning of Teaching

Planning was identified as a fundamental aspect of teaching by all participants. However, the methods and effectiveness of planning varied among the different groups. The “Information Provider” group, predominantly early-career doctors, reported challenges in assessing prior knowledge and setting clear learner expectations. Their sessions were generally content-focused, delivered through tutorials or lectures, and often lacked flexibility due to limited pedagogical training.

For example, one participant noted, “I do carefully prepare my sessions, and what I deliver is very detailed, so assessing prior knowledge is not my priority.” (Candidate Number 2).

Another added, “I find it very difficult to assess the students’ knowledge as I am not skilled in being flexible, but I understand this is a very important aspect of teaching.” (Candidate Number 1).

In contrast, the “Student Assessor” group, with more teaching experience, demonstrated a more adaptive approach. They tailored their planning to the needs of their learners, reflecting an understanding of the importance of assessing prior knowledge and adjusting teaching strategies accordingly. One participant stated, “I plan my lessons depending on who I am teaching. For Year 3 and 4 students, I know they would like to be spoon-fed. With Year 5 students, they have their own learning agenda, so I adjust my teaching to meet their needs.” (Candidate Number 5).

The “Leader/Manager” group, with extensive teaching experience, emphasized a learner-focused approach in their planning. They highlighted the importance of flexibility in lesson plans and prioritizing learner objectives over their own. As one participant explained, “Sometimes I don’t plan my sessions exactly; I let the learner know that their learning objectives are my objectives. I approach teaching with an open mind and use a variety of resources.” (Candidate Number 7).

Presentation/Teaching Method

The “Information Provider” group favoured didactic methods such as lectures and tutorials, with a preference for small group settings. They often relied on familiar methods such as PowerPoint presentations, sometimes due to comfort or lack of experience with alternative methods. For instance, one participant mentioned, “I am aware that new technology and new methods have adapted to meet students’ expectations, but I hesitate to use them as they are complex.” (Candidate Number 3). Another said, “I prefer teaching small groups. I am nervous when I have to teach large groups.” (Candidate Number 2).

Conversely, the “Student Assessor” group employed a variety of teaching methods to enhance learning. They adjusted their approach based on the group size and learner needs, using interactive workshops and lectures. This group showed a commitment to making sessions engaging, with one participant noting, “I always focus on making my sessions interesting and useful. It’s awful to see students sleeping during my sessions.” (Candidate Number 15).

The “Leader/Manager” group demonstrated proficiency with diverse teaching methods, including simulation, clinical skills sessions, group work, and lectures. They showed an understanding of how to adapt their methods to make content engaging and appropriate for different learner levels. As one participant remarked, “I like to make an effort in preparing my teaching so that learners enjoy my sessions. The method of presentation I select depends on the subject content and what I am teaching.” (Candidate Number 7).

Learning Environment

The “Information Provider” group often struggled with creating an engaging learning environment. They expressed a lack of experience in facilitating interactive sessions and were sometimes hesitant due to concerns about class management. Some participants tried to create a relaxed atmosphere through informal interactions, though their understanding of how to foster a supportive learning environment was limited. One participant said, “I like to start my session with some fun, so I share jokes or encourage them to contribute anecdotes to make everyone laugh.” (Candidate Number 3).

The “Student Assessor” group exhibited a better understanding of the importance of an engaging and interactive learning environment. They emphasized the role of interaction and discussions in reinforcing learning but acknowledged that it may not always be feasible with learners who have limited prior knowledge. One participant explained, “There is less energy in the classroom if the sessions aren’t interactive. I love to hear about their ideas and views. Even if their answers are limited, the discussion helps to fill in knowledge.” (Candidate Number 6). They also highlighted the significance of a safe learning environment where learners feel comfortable expressing their ideas and asking questions.

The “Leader/Manager” group showed a strong commitment to creating a positive learning environment and recognized the reciprocal nature of teaching and learning. They understood the importance of motivating and supporting learners while also valuing the opportunity to learn from their students. One participant noted, “There is fun in teaching when it’s led by the students. I don’t work hard in my teaching sessions as I make them very interactive. I always want students to take responsibility for their learning, and it’s the teacher’s role to create that environment.” (Candidate Number 12).

Evaluation of Learning/Assessment

The “Information Provider” group acknowledged the importance of evaluation and assessment but often lacked formal training in these areas. Their feedback practices were typically based on personal experience rather than structured training, resulting in challenges with providing effective feedback.

As one participant stated, “I do understand that learning is not meaningful without evaluation, but I have not been trained in how to provide feedback. I always struggle to give feedback, and I don’t want to upset students.” (Candidate Number 3). This group also noted a lack of involvement in high-stakes assessments such as OSCEs.

In contrast, the “Student Assessor” group demonstrated a thorough understanding of evaluation and assessment, including formative and summative assessments. They were trained in providing feedback and recognized its impact on learning. However, they did not mention the value of receiving feedback from students about their own teaching. One participant said, “I am involved both in summative and formative OSCEs organized by my medical school, and I like to support them as they are always looking for examiners.” (Candidate Number 11). This group also reported familiarity with various evaluation forms and marking criteria, though they sometimes struggled to keep up with changes.

The “Leader/Manager” group placed high value on evaluation and feedback, understanding its role in learner progress. They emphasized the importance of regular feedback and viewed student feedback as crucial for their own development as teachers. One participant noted, “I am focused on those students who are struggling. Regular feedback on their performance will help them improve in the areas where they are struggling.” (Candidate Number 10). This group showed a proactive approach to staying updated with changes in evaluation criteria and expressed a commitment to continuous improvement.

Pedagogical Understanding/Development

The “Information Provider” group exhibited limited emphasis on pedagogical development. They often relied on personal experience and observation of role models rather than formal training. One participant commented, “I would like to do a teaching course. I am sure this would be helpful to develop my feedback skills.” (Candidate Number 5). Some participants valued experience over formal pedagogy training, suggesting a gap in understanding the role of pedagogy in effective teaching.

The “Student Assessor” group had a better grasp of pedagogical principles and demonstrated a commitment to improving their teaching practices. They had completed some pedagogical training and recognized that expertise alone was insufficient for effective teaching. One participant noted, “In my view, anyone can teach if they have knowledge, but good teaching and learning only occur when the teacher understands how students learn.” (Candidate Number 8).

The “Leader/Manager” group showed a sophisticated understanding of pedagogy and its role in teaching. All members had undergone formal training, and some had completed advanced courses in clinical education. They demonstrated a proactive approach to their development, often seeking feedback from peers and engaging in self-reflection to enhance their teaching practices. As one participant shared, “I ask my colleagues to observe my teaching sometimes, so I know where to improve. I find this very useful.” (Candidate Number 10).

During interviews, some participants reported consistent challenges in their teaching roles, which were identified as “consensus themes.” These challenges are recognized as systemic factors that may influence the role and responsibilities of teaching and the overall teaching practice.

This study aimed to explore junior doctors' perceptions of their roles and responsibilities as teachers of medical students, focusing on their preparedness, motivations, challenges, and teaching practices. The data revealed three primary roles: "Information Provider," "Student Assessor," and "Leader/Manager," each characterized by distinct teaching approaches and dimensions.

Roles and Responsibilities

Information Provider

The findings indicate that junior doctors in this category primarily focus on delivering content through didactic lectures and tutorials. Their teaching approach is characterized by a "craft approach," wherein they rely heavily on their own experiences and the knowledge they acquired during their training. This group appears to emphasize knowledge transmission over pedagogical strategies, reflecting a limited engagement with teaching methods beyond traditional formats. This aligns with Guzman’s (2009) observation that novice educators often adopt a simplistic approach to teaching, lacking formal pedagogical training. The need for targeted teacher training and pedagogical education for these junior doctors is evident, as it could enhance their effectiveness and help them become more reflective and learner-focused educators.

Student Assessor

Teachers in this category have accumulated more teaching experience and are more involved in assessment activities such as OSCEs and formative evaluations. They have progressed from a craft approach to a more professional continuum in their teaching practice. This group demonstrates a greater awareness of the principles of assessment and the need to adapt their teaching based on student needs. However, despite their involvement in assessment, their role is primarily limited to formative evaluations rather than high-stakes assessments. This aligns with Sandberg’s (1997) view that experienced practitioners often develop a more nuanced understanding of teaching and assessment through their own experiences. The data also suggest that while they appreciate the importance of assessment, there is room for further development in understanding and applying different evaluation forms and criteria.

Leader/Manager

The most experienced junior doctors perceive their role as encompassing leadership and management responsibilities in addition to teaching. They exhibit a sophisticated understanding of pedagogy, employing a range of methods and focusing on creating a supportive learning environment. This group’s teaching is learner-centred and aims to develop students into competent professionals. They have transitioned from a craft approach to incorporating advanced pedagogical strategies, reflecting a deeper engagement with educational principles. This finding supports the views of Postareff & Lindblom-Ylanne (2008), who argue that experienced educators often engage in more reflective and adaptive teaching practices. The Leader/Manager group’s proactive approach to their own professional development and their use of varied teaching methods highlight the value of continuous pedagogical training and self-reflection.

Teaching Dimensions

Planning of Teaching

The study reveals significant variation in planning among the three groups. Information Providers often focus on content delivery without adequately assessing prior knowledge or adapting their sessions to learners’ needs. In contrast, Student Assessors and Leaders/Managers demonstrate a more flexible and learner-focused approach to planning. This variation highlights the importance of developing tailored lesson plans that account for the diverse needs of medical students, as emphasized by Marton (1997). The ability to adapt lesson plans based on student feedback and needs is crucial for effective teaching and learning.

Presentation/Teaching Method

Information Providers predominantly use didactic methods, reflecting a preference for traditional teaching formats. Student Assessors employ a mix of interactive and didactic methods, depending on the context and learner needs, while Leaders/Managers use a variety of methods, including simulations and group work. This diversity in teaching methods highlights the importance of employing varied pedagogical strategies to engage students effectively. The findings align with Postareff & Lindblom-Ylanne’s (2008) framework, which emphasizes the need for diverse teaching methods to accommodate different learning styles and contexts.

Learning Environment

Information Providers often struggle with creating an interactive and supportive learning environment, while Student Assessors and Leaders/Managers are more successful in fostering engagement and interaction. The importance of a positive learning environment in enhancing student learning is well-documented (Holbrook, 2023). Leaders/Managers particularly excel in creating a safe and stimulating environment, which facilitates deeper learning and reflection.

Evaluation of Learning/Assessment

The study highlights differing approaches to assessment among the groups. Information Providers acknowledge the importance of evaluation but often lack formal training in providing effective feedback. Student Assessors have a better grasp of assessment principles and are actively involved in formative evaluations, though they sometimes struggle with keeping up to date with assessment criteria. Leaders/Managers value regular feedback and are familiar with various evaluation forms, demonstrating a commitment to ongoing improvement. This variation suggests a need for comprehensive training in assessment and feedback for all junior doctors to enhance their teaching effectiveness.

Pedagogical Understanding/Development

The study reveals that Information Providers have limited pedagogical training and rely on their own experiences. In contrast, Student Assessors and Leaders/Managers show a more developed understanding of pedagogy and actively seek professional development opportunities. The emphasis on pedagogy and continuous improvement is crucial for effective teaching and aligns with Holbrook’s (2023) findings on the impact of pedagogical understanding on teaching quality.

The findings of this study provide valuable insights into the varying roles and practices of junior doctors as medical educators. The data highlights the need for targeted pedagogical training and support for junior doctors to enhance their teaching effectiveness and adapt to the evolving demands of medical education. Furthermore, it also raises the question of whether the medical schools are responsible to develop the doctors in their teaching role or will this responsibility lie to National Health Foundation Trust in the United Kingdom. By addressing the identified gaps in planning, teaching methods, and assessment, medical institutions can support junior doctors in becoming more effective and reflective educators, ultimately benefiting the learning experience of medical students.

Ethics approval and consent to participate- Kings college hospital/Kings College London; IRAS-239849
Consent for publication: Not applicable

Availability of data and material: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Competing interests: The author (Bandana Uprety) declare that I have no competing interests in this study.
Funding: Not applicable
Authors' contributions: The study is carried out by sole author. Author: Bandana Uprety, Senior Lecturer in Adult Nursing, University of Greenwich, London, United Kingdom
Acknowledgements: Not applicable
Authors' information (optional). Author: Bandana Uprety, Senior Lecturer in Adult Nursing, University of Greenwich, London, United Kingdom (2022-till now). I have worked from 2014- 2022 as a clinical skills and simulation educator at the postgraduate medical education centre providing the medical education to undergraduate and postgraduate medical doctors in the NHS Foundation Trust.
Author’s email: [email protected]
Corresponding Author: Not applicable.
Clinical Trail number: Not applicable

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Junior Doctors’ Perception of Their Teaching Role and Responsibilities as Medical Teachers of Medical Students

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Abstract

Background:

Methods

Result

Conclusion

Introduction

Method

Study Design

Participants

Data Collection

Ethical Considerations

Data Analysis

Results

Description of the Outcome Space (Variations)

Information Provider

Student Assessor

Leader/Manager

OUTCOME SPACE: VARIATIONS

Variation 2: Student Assessor

Variation 3: Leader/Manager

Description of Teaching Dimensions

Planning of Teaching

Presentation/Teaching Method

Learning Environment

Evaluation of Learning/Assessment

Pedagogical Understanding/Development

Discussion

Roles and Responsibilities

Teaching Dimensions

Conclusion

Declarations

References

Additional Declarations

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