1Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
چکیده
Introduction: Expertise is an experiential capability that cannot be acquired through formal education alone; rather, it develops through sustained reflection and iterative practice. Despite the importance of expert clinical faculty, the process of attaining this educational expertise has not been systematically conceptualized. This study was conducted to develop a paradigmatic model of the educational competency development process in clinical medical faculty and identify its dimensions, components, and interrelationships. Methods: This qualitative grounded theory study was conducted in 2024–2025 at Iran University of Medical Sciences using the Corbin and Strauss approach (2015). A total of 15 participants, including 13 clinical faculty members (with at least five years of teaching experience and recognized teaching competence) and 2 medical students, were initially recruited through purposive sampling. Snowball sampling was used solely as a recruitment technique to identify additional information-rich participants. As we collected and analyzed data, we used theoretical sampling. This helped us refine the categories and reach theoretical saturation. Data were collected through semi_structured, in-depth interviews lasting 30–50 minutes (mean: 45 minutes). All interviews were audio-recorded and transcribed verbatim. Data were analyzed concurrently with data collection using the constant comparative method, including open coding, category development, contextual analysis, and theoretical integration. Rigor was ensured through prolonged engagement with the data, member checking, peer debriefing, and the maintenance of an audit trail.
Results: Data analysis led to the emergence of the core category, “Gradual Transformation toward Expertise,” which explains how clinical faculty members evolve from expert clinicians into transformative educators. This process is dynamic, non-linear, and highly context-dependent. Five interrelated themes describe this developmental trajectory: 1) reflection and competence development, 2) experiential learning and clinical observation, 3) mentorship and knowledge transfer, 4) motivational and contextual influences, and 5) barriers and professional transformation. The process was shaped by six contextual factors: a) the complex and dynamic nature of clinical education; b) the need for continuous competency development; c) generational differences in teaching and learning styles; d) workload and competing clinical responsibilities; e) the necessity of integrating practical experience with scientific evidence; and f) an organizational culture that prioritizes treatment over education. Additionally, causal conditions such as multiple professional pressures and generational gaps further influenced the pace and direction of this transformation. Overall, the findings depict expertise development as a gradual, evolving process through which faculty members reconcile their clinical and educational roles to become effective and transformative clinical educators. Conclusion: Clinical teacher expertise develops through a dynamic interplay of individual effort, experiential learning, and environmental factors. This transformation requires personal commitment to lifelong learning and reflection, supported by organizational initiatives such as faculty development programs, mentoring, and aligned incentive systems. The proposed grounded theory provides a practical framework for designing professional development initiatives and fostering educational settings that enhance expertise in similar non-Western contexts.
Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative. USA: Lippincott Williams & Wilkins; 2011.
Charmaz K. Constructing grounded theory. UK; Sage; 2014.
Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory. UK: Sage publications; 2014.
Roy C. Key issues in nursing theory: Developments, challenges, and future directions. Nursing research. 2018;67(2):81-92.
Peyman H, Zarian A, Sadeghifar J, Alizadeh M, Yaghubi M, Yamani N, et al. Characteristics of a Capable University Teacher from the Students' Point of View. Iranian Journal of Medical Education. 2011;10(5):1131-9.
Ahmady S, Khani H. The situational analysis of teaching-learning in clinical education in Iran: a postmodern grounded theory study. BMC medical education. 2022;22(1):520.
Goldie J, Dowie A, Goldie A, Cotton P, Morrison J. What makes a good clinical student and teacher? An exploratory study. BMC medical education. 2015;15(1):40.
Cantillon P, Dornan T, De Grave W. Becoming a clinical teacher: identity formation in context. Acad Med. 2019;94(10):1610-8.
Persky AM, Robinson JD. Moving from novice to expertise and its implications for instruction. American Journal of Pharmaceutical Education. 2017;81(9):6065.
Mylopoulos M, Steenhof N, Kaushal A, Woods NN. Twelve tips for designing curricula that support the development of adaptive expertise. Med Teach. 2018;40(8):850-4.
Gauthier G, Lajoie SP. Do expert clinical teachers have a shared understanding of what constitutes a competent reasoning performance in case-based teaching? Instructional Science. 2014;42(4):579-94.
Shagrir L, Altan MZ. The expert teacher educator: Characteristics and professional identity. International journal of university teaching and faculty development. 2014;5(1):41.
Ericsson A, Pool R. Peak: Secrets from the new science of expertise. USA: Random House; 2016.
Aali A. Explaining the Models of the Development of Expertise in Teacher Education: the journey from acclimation to proficiency. Theory and practice in teacher education. 2019;5(7):9-22.
Singha S, Sikdar D. Professional development of teacher and professionalism in teacher education. International Journal of Applied Social Science. 2018;5(8):1320-32.
Grossoehme DH. Overview of qualitative research. Journal of health care chaplaincy. 2014;20(3):109-22.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007;19(6):349-57.
Greenhill J, Richards JN, Mahoney S, Campbell N, Walters L. Transformative learning in medical education: Context matters, a South Australian longitudinal study. Journal of Transformative Education. 2018;16(1):58-75.
Wald HS. Professional identity (trans) formation in medical education: reflection, relationship, resilience. Oxford University Press; 2015. pp. 701-6.
Benner B. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. AJN American Journal of Nursing. 1984;84(12):1480.
Salam A, Abdelhalim A, Begum H, Pasha M. Faculty Development in Medical Education: What, Why and How. Int J Hum Health Sci. 2023;7(1):3-8.
Schön DA. The reflective practitioner: How professionals think in action. UK: Routledge; 2017.
Kolb DA. Experiential learning: Experience as the source of learning and development. UK: FT press; 2014.
Nassar AK, Waheed A, Tuma F. Academic clinicians’ workload challenges and burnout analysis. Cureus. 2019;11(11):e6108.
Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Wang H, et al., editors. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2020. UK: Mayo Clinic Proceedings, Elsevier; 2022.
Dyrbye LN, West CP, Johnson PO, Cipriano PF, Beatty DE, Peterson C, et al. Burnout and satisfaction with work–life integration among nurses. Journal of occupational and environmental medicine. 2019;61(8):689-98.
Sabagh Z, Moshtari M. The unintended consequences of a quantitative, centralized faculty promotion system: empirical evidence from a developing country. Higher Education. 2025;90(6):1547-69.
Rahmanian M, Shafiei R, Shafa S, Taheri L, Kalani N. Barriers, Solutions, and Effective Motivational Factors for the Promotion of Clinical Faculty Members: A Qualitative Study. Development Strategies in Medical Education. 2023;10(2):180-93.
Battista A. Situated learning theory in health professions education research: a scoping review. Advances in health sciences education. 2020;25(2):483-509.
Khoshgoftar Z, Khaledian S, Khani H. Factors Influencing Faculty Participation in Medical Education Development Programs: A Qualitative Case Study. Journal of Medical Education and Curricular Development. 2025;12:23821205251384382.
