Experiences of Clinical Lecturers in Providing a Supportive Learning Atmosphere Required for the Development of the Medical Students' Professional Identity

Extended Abstract

Background
Clinical environments create unpredictable conditions that affect the professional excellence of the learners. Proper and efficient medical education is impossible if clinical education is neglected and its quality is not improved. In a clinical education environment, it is important to create an atmosphere where the learners can learn the necessary professional skills and participate in the teaching/learning processes without fear and with mental and physical peace. Effective learning is influenced by contextual factors, including the atmosphere in which the learning takes place. Several quantitative studies have investigated this category in Iran, but further in-depth analyses are still required to explore it. The present qualitative study was conducted in Tabriz University of Medical Science, Iran, In an attempt to investigate the effects of background factors on clinical teaching atmosphere for undergraduate medical students. This study mainly aimed to explain the lived experiences of the clinical lecturers in providing a supportive learning atmosphere for developing the professional identity of the medical students.

Methods

This qualitative study was conducted using a conventional content analysis approach. The data were collected by conducting semi-structured interviews with 19 clinical instructors and students of medical sciences, which continued until data saturation was reached. However, the follow-up interviews did not yield any new data beyond what was previously collected. In addition, to complement the categories, medical students at various stages of training were also interviewed. During the interview sessions, the interviewees were briefed on the study's objectives, methodology, and voluntary participation. Afterwards, informed consent was obtained from all interviewees, and permission was received to record their interviews. The interviews were guided by the topics that emerged from the interaction between the interviewer and the interviewee. The interviews were transcribed verbatim at the end of each session and were independently read and re-read by two researchers (research members: H & B). This process continued until the researchers were fully immersed in the interviews. A first-level coding was then conducted for each interview, focusing on both the manifest and implied content. This involved identifying and highlighting the units of analysis, sentences, and paragraphs. A code was assigned to each meaningful unit. The codes were then classified into subcategories and categories based on their scope and attributes. As the data analysis progressed, the codes and their categorizations were regularly reviewed, and any disagreements were resolved through discussion. MAXQDA 10 software was used for data management. To maintain the study's trustworthiness, four criteria of credibility, confirmability, dependability, and transferability were fulfilled. To enhance the study's credibility, the interviewer attempted to build trust with the interviewees by establishing effective communication. In terms of triangulation, interviews were conducted with instructors from various clinical fields, medical personnel, and students from different educational levels. The methodology and extracted codes were reviewed by expert instructors who teach qualitative studies and experts in medical education. Furthermore, data immersion was achieved through long-term engagement with the data. The data collection, data analysis, decision-making for coding and classification, as well as other steps were documented to ensure data confirmability. As for dependability, the extracted codes were reviewed by a panel of researchers. They were either confirmed or disconfirmed, leading to the selection of other codes. To enhance the transferability of the findings, an external researcher with expertise in qualitative studies was invited to analyze the steps and data collection processes. The researcher was also asked to comment on the systematic implementation of the study steps. To implement maximum variance sampling, interviews were conducted with instructors from various universities, clinical fields, age groups, genders, and positions.

Results

Semi-structured interviews were conducted to interview with 27 individuals (i.e., 19 clinical teachers and 8 undergraduate medical students) in order to discover and explain the experiences of clinical teachers regarding the professional excellence of undergraduate medical students by creating a supportive atmosphere in clinical education. The clinical teachers included two faculty members from the Department of Surgery, three individuals from the Department of Psychiatry, two individuals from the Department of Social Medicine, four individuals from the Department of Internal Medicine, three individuals from the Department of Nursing, two individuals from the Department of Bacteriology, and three individuals from the Department of Emergency Medicine.

Three main categories were extracted after analyzing the data. First category was "Clinical Professor as an architect of a learning environment" with three sub-categories including "matching the atmosphere of clinical education with theory education", "organization of educational programs according to existing clinical cases”, and “repetition of important training to institutionalize learning". The second category was "creating a supportive atmosphere" with three sub-categories including "creating an educational atmosphere free of tension and stimulating”, “creating growth and excellence opportunities for students”, and “respecting the principles and moral values and human interactions in the clinical education process”. The third category was "a holistic view of the education process and students' needs" with two sub-categories including "the need to pay attention to the physical and psychological needs of learners in clinical education” and “the necessity of paying attention to the differences of learners”.

Conclusion

One of the factors contributing to the quality and effectiveness of educational programs is the atmosphere that influences the context of clinical education and the learning experiences created in the educational environment. By providing a supportive atmosphere, paying attention to various human dimensions, respecting the principles of professional behavior and obligations, and giving special consideration to the needs of the students, clinical teachers can offer students suitable learning opportunities to develop their professional identity and to gain an understanding and appreciation of professional values. Clinical teachers, as professional advisers and role models, can also assist students in enhancing their metacognitive skills and achieving the highest level of professional competence. To create such a conducive learning environment, it is essential to educate graduates with professional qualifications and be responsive to the needs of society. Clinical instructors who are knowledgeable and familiar with ethical and professional principles may have taken advantage of every opportunity to teach these principles to students and instill the professional values of the medical field in them. Clinical instructors, as professional and ethical advisors and role models, may also bridge the gap between pre-clinical education and clinical education by fostering a supportive learning environment. They help students enhance their metacognitive skills and achieve the highest level of professional competence. In order to cultivate such a conducive learning environment, it was deemed essential to equip graduates with professional qualifications and address the demands of society.