Demand for postgraduate qualifications in medical education can be judged by the increase in providers worldwide over the last two decades. However, research into the impact of such courses on identity formation of healthcare professionals is limited. This study investigates the influence of such programmes on graduates’ educational identities, practices and career progression. Informed by constructivist grounded theory (CGT), semi-structured interviews were conducted with 27 graduates (2008-2012) from one postgraduate programme, who were at different stages in their careers worldwide. The audio data were transcribed and analysed using a CGT approach. Participants enrolled in award-bearing medical education courses for various intrinsic and extrinsic reasons. The findings from this study highlight their development as educators, and educational researchers, leaders and learners, as their self-efficacy in educational practices and engagement in scholarly activities increased. Graduates attributed career progression to the qualification, with many being promoted into senior positions. They also described substantial performance attainments in the workplace. The findings contribute to understanding the complexity and nuances of educational identity formation of healthcare professionals. A qualification in medical education encouraged transformational changes and epistemological development as an educator. Awareness of these findings will inform both those considering enrolment and those supporting them of potential benefits of these programmes.
Identity; Healthcare educators; Postgraduate qualifications; Communities of practice; Health professions education; Faculty development
In recent years, interest in the professionalisation of medical education has grown (Bleakley et al. [
Several higher education institutes offer awards such as a Postgraduate Certificate, Diploma or Master of Medical Education (Geraci et al. [
Provision of Master’s Level Programmes in Medical Education
1996 2005 2008 2012 2013 2014 2015 2017 Worldwide 7 21+ 40+ 76 103 121 124 126+ United Kingdom 2 8 17 20 25 31 31 31 References (Tekian and Harris 2012) (Cohen et al. 2005, Cusimano and David 1998) (Pugsley et al. 2008b, Riesenberg et al. 2009) (Tekian and Harri 2012) (Foundation for Advancement of International Medical Education and Research 2013) (Tekian and Artino 2013) (Foundation for Advancement of International Medical Education and Research 2015) (Foundation for Advancement of International Medical Education and Research 2017)
Steinert et al. ([
Until recently, the only studies published on postgraduate qualifications were UK scoping studies providing an overview of medical education programmes and the quality of Masters’ research (Pugsley et al. [
Professional identity is the perception of oneself as a professional i.e. who one is, one’s relationship with the profession, and how one’s behaviour aligns with the norms and culture of a profession, based on interpretation and reinterpretation of interactions within the professional community (Monrouxe and Rees [
We adopted Kelchterman’s ([
Self-image: The general principles governing one’s professional behaviour.
Self-esteem: Valuing and evaluating oneself as a professional, involving judgement of performance. Kelchtermans’ definitions of teachers’ self-image and self-esteem has links to teachers’ self-efficacy, which is an indicator of professional identity (Canrinus et al. [
Job motivation: Motives behind entering and staying in the profession. It also includes the commitment towards a profession and the factors affecting it.
Task perception: The understanding of one’s professional responsibilities i.e. how individuals define their professional work, relationships and behaviours.
The prospective dimension comprises one component, future perspectives. It focuses on how professionals see their role or career progress in the future. Additionally, it includes their evaluation of the job situation and opportunities for future development.
There is a need to look in-depth at the impact of award-bearing programmes on the identity formation of healthcare educators working in a diverse range of contexts worldwide, which may or may not be conducive for their newly learned educational practices. Understanding how participants learn the skills, attitudes and values needed to become active participants of the community, and develop an educational identity during the course, is necessary to tailor the support required in the transformation of beliefs and practices. Our overarching research question is:
How does a qualification in medical education influence graduates’ educational identities, practices and career pathways?
Given our interests in professional identity formation, participation and careers, theories we considered relevant were Communities of Practice theory (Wenger [
Communities of Practice (CoP) theory draws upon theories of situated experience and posits that the process of learning is closely interlinked with the construction of meaning and identity formation through shared practice (Wenger [
In education, CoP theory has been used to describe learning in virtual environments, institutions, higher research degrees and continuing professional development (Higgs et al. [
Social Cognitive Theory (SCT) considers the unique ways in which individuals acquire and maintain behaviour, while also considering the social context (Bandura [
One extension of SCT is Social Cognitive Career Theory (SCCT), which helps understand career-related interests and persistence in occupational pursuits (Lent et al. [
The Research Ethics Committee, University of Dundee granted the study ethical approval. The lead author (AS) is a dentist and medical educator, who had previously completed the Master of Medical Education at Dundee. He recruited participants and collected all the data. The other authors (SS, SM, RA) are academic medical educators with experience in qualitative research and were involved in the Dundee programme at the time of the study; therefore, data were de-identified before their involvement in the analysis. The insider research status of AS was beneficial in terms of ease of access, awareness of the context and work practices, familiarity with terminology used, and building rapport. This research did not seek to evaluate the programme, but instead utilised the context in order to shed light on an important educational phenomenon.
We used a constructivist grounded theory approach (Charmaz [
The Centre for Medical Education, University of Dundee, UK has 3438 graduates (1988-2017) at three levels: Postgraduate Certificate, Diploma and Masters. The Certificate and Diploma have a modular approach; a supervised research project completes the Masters. Students can study face-to-face, online distance or a combination of both, over a period of 1-6 years (previously nine). Entrants must have an educational or professional background in healthcare. About 90% are doctors, and 65% are UK-based.
The study sample frame was those graduating from the programmes between 2008-2012 who had consented to be invited to participate in this qualitative study during the previous survey study (Sethi et al. [
AS carried out individual interviews for focused two-way communication which encouraged rich descriptions of participants’ experiences (Dicicco-Bloom and Crabtree [
Interviews were conducted over a five-month period (Oct 2013-Feb 2014) via landline, Skype and face-to-face meetings depending upon individual circumstances. Interviews were audio-recorded and transcribed verbatim by AS using Express Scribe. During transcription, a single comma can result in changing the entire meaning of a sentence (Bleakley [
A constructivist grounded theory analysis (Charmaz [
The codes and associated data were categorised, and each theme compared across all the participants/groups. The participants were grouped based on qualification, year of graduation, age and nationality using query tool from ATLAS ti 7, in order to explore the effect of a particular demographic on the patterns of experience or behaviours. The data were interpreted from specific towards general concepts as a whole by searching for patterns, associations, concepts, and explanations (Skeat [
During the whole research process, spontaneous informal memos about codes or emerging ideas were added. These helped knit concepts together in new ways, which rely less on schematically ordering the concepts, and more on the feel for the data and abductive thinking that flits back and forth from the data to the abstracted concepts (Charmaz [
The participants (n = 27) were at different stages in their careers, from different countries, and predominantly distance-learners (Table 2). Their educational roles included dean, director, professor, project leader, lecturer, clinical registrar and PhD student.
We identified five themes associated with identity formation of healthcare educators: Motivations, Career Opportunities, Self-Efficacy, Development & Changes in Practices, and Performance Attainments. Motivations, career opportunities, self-efficacy and performance attainments related to Kelchterman’s ([
Healthcare professionals enrolling for medical education qualifications brought varied learning experiences based on personal and contextual factors. Multiple reasons for enrolment were identified, a desire to improve educational understanding and competency being the most common.
I was interested in education; I just wanted to know the theoretical aspects and to find out ways how I could improve my teaching’ (Female C#142)
For many participants, this intrinsic desire was associated with other extrinsic motivations, including: recommendations by colleagues and professional reviews, local requirement for educational reforms and academic positions, as part of their career pathway in medical education, and to enhance career prospects.
To basically pursue my plans of becoming a specialist medical educationalist (Male M#81)
The participants who enrolled for extrinsic reasons gradually developed an interest in medical education, and many continued from Certificate to Diploma and Masters. Participants wanting to enhance career prospects or satisfy professional reviewers later in their career only enrolled for the Certificate. However, most of the international participants enrolled for the Masters, typically due to governmental or faculty funding regulations.
Participants attributed their career progression to the qualification and this was associated with greater educational responsibilities. The Masters qualification acted as a stepping-stone for a PhD and an academic career in medical education.
Had an opportunity to take on an extra role that’s foundation programme director … the fact that I had a postgraduate medical education qualification helped me get that post … I don’t think previously, I had the knowledge or experience even to put myself forward for some of these posts (Male M#106)
Early career Masters’ graduates also reported a shift of career towards medical education rather than clinical practice. Their increasing self-efficacy encouraged further participation in medical education.
Once I did the qualification, I moved solely towards this field, before I was both the clinician and in medical education but now I am predominantly … studying medical education, working in medical education … when I initially joined the course, I never intended to do more than a Masters. (Female M#68)
Participants reported varying levels of self-efficacy based on their prior experiences. Irrespective of this level, they reported a further increase in self-efficacy after the qualification. The qualification enriched their understanding of core concepts in medical education and they reported better performance in various educational tasks, e.g., lesson planning, course evaluation and standard setting.
The process of doing the course has just made me more confident … so people give me things to do and then I find that I am very confident in doing them (Female M#73)
The data also suggested that participants’ self-efficacy was dynamic and continuously derived both from their performance attainments as students during the course and as professionals in the workplace. Strong self-efficacy in medical education contributed towards pursuing it as a career choice and also affected motivations towards related tasks.
I started with the certificate and … I was receiving very highly appreciating feedback from tutors, so I started to think that I had to continue … I took it very serious and I proceeded to Masters’ degree (Male M#30)
The analysis also highlighted the transformational changes and development of graduates as teachers, researchers, leaders and learners. Undertaking the qualification made them critically analyse their teaching, and they found evidence-based strategies helpful in becoming effective teachers. Participants gave many examples of their development as facilitator, assessor, planner, developer, mentor, feedback provider and role model.
[I’m] more into peer group and student-centred [teaching]… I would not have known how to facilitate [learning] … earlier on (Female C#142)
Participants also learned about various research paradigms and methods during the course. Masters graduates were able to implement their learning in the form of a research dissertation, with many continuing educational research after the qualification and reporting several publications.
I now do some education research and I have published three education papers in the last 18 months, that’s something I would have never done before (Male M#18)
Various leadership characteristics such as recognition/legitimacy, supportive behaviour and seeking constructive changes in their organisations were described. The graduates gave specific examples of educational changes, indicating impact of the qualification at organisational level.
I am certainly viewed as an educational leader in my current position … many other departments consult me (Male M#81)
The graduates developed as learners. They reported critically reflecting on their educational beliefs in order to improve their educational practices. They highlighted the essential role of evidence in educational decision-making and the need to continue to learn about education following graduation.
The biggest shift is about kinda standing back and critically thinking more, reflecting so if we are doing something … I’d be more inclined just to step back and say … Why are we doing it? Why we are doing it this way? … What’s the better evidence for suggesting this? Is this the right approach or not? (Male M#34)
Participants led various educational activities and innovations such as faculty development, curriculum reforms, course organisation and evaluations at institutional, national and international level. These activities resulted in substantial performance attainments including personal satisfaction, commendations, better external reviews and highly positive student/peer feedback. Some Masters’ graduates noted winning competitive grants for educational projects, while others reported obtaining course accreditation and registrations for their institutes. Participants were particularly pleased with their own students’ marked improvement in performance.
Since I have improved teaching and … changed the assessment practice … the pass rate has gone up and the students are getting through the course much more as they should in the time scale … we are not finding that the good students are suddenly failing something because the assessment is poor (Female M#89)
Performance attainments in the workplace fed back into participants’ learning experiences in an incremental iterative process. We use the term ‘incremental iterative process’ to convey the dynamic longitudinal nature of identity formation. This term has been used in software development, where the software is built in smaller sections, and the software is then used and built further based on learning derived from it in repeated cycles (Larman and Basili [
It became much easier to do the [study] modules … I kind of timed it you know having it with OSCEs was a good time to do the module on OSCE … it made much more contextual sense because you were doing the stuff as well as reading about it and you know writing it up … to be able to read around the kind of underlying theory about it at the same time. (Male M#34)
Their increasing self-efficacy and competency continuously encouraged further participation in scholarly medical education activities. The participants learned the language of the educational community, leading to an increased sense of belonging to a community of practice.
I think it has given me a better vocabulary with which to discuss issues with people (Female C#178)
During this interaction with the educational community, they not only learned from the community but also played an active role in its further development.
After my qualification and with the progress I made they decided to recruit new people for medical education and now it’s an effective centre … it plays a major role in running the curriculum … it’s going to be a department in the future (Male M#59)
However, graduates’ personal and contextual factors also influenced their self-efficacy in educational tasks and productivity in the workplace, sometimes reducing the impact of the qualification.
My thesis was around … curriculum development so I … can legitimately provide input into … curricula … [but] my role in my division has changed, where I do not have to deal with anything in curriculum development and it’s pretty lowered down in terms of what my division wants me to do (Male M#94)
Motivation, self-efficacy and taking part in legitimate educational activities, afforded by the programs, are influences for the development of self-image and a professional identity. Based on personal and contextual factors, participants described a mix of intrinsic and extrinsic motivations towards enrolling for a medical education qualification. Participants reported a positive impact of the postgraduate qualifications on their personal and professional development. This development encompassed increased knowledge, transformational changes in practices and recognition as educators by self and others. Through the qualification, there were opportunities to take on leadership positions and pursue higher career trajectories, with expanded responsibilities in medical education. As their educational roles developed, the graduates translated their learning to practice with various performance attainments. However, personal and contextual factors strongly influenced their performance attainments in the workplace. The attainments gave the graduates a sense of achievement and fed back into their learning experiences, resulting in further development of interest and self-efficacy, strengthening their self-image and sense of belonging to the educational community. This in turn led to increased participation in various medical education activities. During this continuous interaction with educational activities while doing the qualification and in the workplace, participants actively integrated personal beliefs and the norms and values of the community. The longer periods of professional training provided opportunities for further socialisation into the community and this in turn fostered their educational identity described in an iterative and incremental fashion.
Many of our participants demonstrated both intrinsic and extrinsic motivators for enrolling on the programmes. Intrinsic motivation for learning is theorised to promote self-regulation, which mediates better conceptual understanding with enhanced performance and achievements in learning tasks (Walker et al. [
Blackburn et al. ([
Lown et al. ([
The graduates also experienced transformational changes with development as teacher, researcher, leader and learner. Participants reported learning new teaching skills, becoming learner-centred and showed development in various roles of the teacher. They developed the capabilities of being an effective medical educator as identified in the literature such as knowledge of educational theory, role modelling, showing respect for learners and giving appropriate feedback (McLean [
The graduates reported shifts in leadership capacity and felt empowered to take on new challenges to effect institutional change and implement educational innovations. This ability to challenge the status quo shows successful internalisation and understanding of the intricate and nuanced ways in which educational practices occur and change. It also represents ways in which individuals preserve their newly formed identities (Ewick and Silbey [
The graduates reported that the qualification conferred legitimacy on their educational roles, giving them recognition as educational leaders, which itself further facilitated the implementation of educational changes. According to Northouse ([
Our participants reported developing collaborations, delivering seminars and gaining peer-reviewed educational publications. Hence, postgraduate programmes are not only a product of the professionalisation of medical education, but their graduates also contribute further towards professionalisation of the field. Unsurprisingly, only Masters’ graduates in our study reported developing as researchers. This may be due to applying the research paradigms and methods they have studied to an original research topic of interest to them, supported by one-to-one supervision. Absence of such supervision has been reported as a barrier to writing for publications in medical education (Simpson et al. [
The roles of a medical educator as a teacher, leader and researcher have been recognised by Bligh and Brice ([
The experience of involvement in the activities of the community and desire to become an integral part is known as the concept of belongingness (Levett-Jones et al. [
Career growth was directly attributed to the qualification, with graduates reporting new job opportunities, leadership positions and academic promotions with greater educational responsibilities. Academic promotions and career progress have also been reported by longitudinal programmes from the USA (Robins et al. [
Graduates reported leading various educational changes at institutional, national and international level, which resulted in performance attainments, which in turn increased their self-efficacy. The majority of our graduates were distance learners who were able to apply learning from the course to their day-to-day educational practices while doing the qualification. They could then reflect on their workplace experiences with reference to learning materials and support from their educators and colleagues. Productivity was also described by fellows from McGill University’s Teaching Scholars Program (Steinert and McLeod [
Our findings explain how the professional culture and practices are learnt alongside knowledge and skills, thus continuously shaping roles and identities. It highlights the roles of formal education and the workplace in the learning process. The participants seek to integrate their actions and thinking with their new community and become attuned to the ways of being in the practices which they employ within the workplace. This construction and co-construction of meaning during continuous interactions of the self with the educational and workplace communities results in professional identity formation (Rees [
Our findings are based on graduates self-reporting rather than observing behaviours, though it could be argued self-reporting is appropriate when looking at self-efficacy. Although graduates were from only one programme, they were dispersed across workplaces, contexts and geographically. Yin ([
This is the first qualitative study looking in-depth at the influence of postgraduate qualifications in medical education on the healthcare professionals worldwide. Such qualifications encourage transformational changes and development as a teacher, leader, researcher and learner. We offer a more nuanced understanding of the influences on educational identity formation of healthcare professionals. Future research should study a cohort longitudinally through the course and beyond to explore the influence of context on professional identity formation. This would facilitate exploration of programme design features associated with transformational changes.
The authors would like to thank all the participants for their time and the Khyber Medical University, Pakistan for funding AS’s PhD candidature.
AS conducted this research as part of his Ph.D. at the University of Dundee. All authors were involved in the design and conceptual framing of the study. AS secured ethics approval and collected and transcribed the data. All authors were involved in data analysis and contributed to the development of the model. All contributed to the writing of the paper and approved the final version.
The authors report no conflict of interest relevant to this article.
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By Ahsan Sethi; Susie Schofield; Sean McAleer and Rola Ajjawi