Pedagogical and professional compromises by medical teachers in hospitals

Following research about workplace constraints reducing the effectiveness of teaching and the motivation to teach, this study sought to understand how medical teachers in hospitals respond to the institutional context for their teaching of medical students.

Through purposive sampling, younger and older male and female teachers in a range of medical and surgical paediatrics subspecialties participated in this qualitative study. We drew on ethnographic methods in interviews so that answers to the questions came from the teachers' own emphases. The systematic coding and categorising procedures used in the inductive analysis of the interview transcripts reflect the constant comparison approach of grounded theory, locating features, patterns and conceptual categories.

We identified four main concepts: teachers' goals and motivations; their approaches to teaching; teachers' preferences; and, finally, as discussed in this article, the teachers' perceptions of contextual and institutional pressures in hospital-based medical teaching and related compromises. The teachers perceive constraints resulting from the various mismatches that they experience, a loss of autonomy, and the paucity of acknowledgement and resources. They suggest that the compromises they make in response are both pedagogical and institutional.

We conclude that professional development is not enough to address these issues: the conditions for medical teaching and teachers in hospitals require workplace responses to enable a more productive connection between the students, curriculum and pedagogy. In particular, teachers' responsibilities in teaching and curriculum development need to be acknowledged, and practising teachers need to be supported and included in the education mission.