Fernanda Claudio

Karen Moniz

Michelle Elizov

Peter Nugus

Tamara Carver

Canadian Medical Education Journal

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 110 Canadian Medical Education Journal     The role of professional culture in teacher identity formation: an ethnographic window onto becoming a clinical teacher  Le rôle de la culture professionnelle dans la construction de l’identité enseignante : une perspective ethnographique sur le devenir enseignant clinique Karen Moniz,1 Fernanda Claudio,1 Tamara Carver,1 Michelle Elizov,1 Peter Nugus1 1Institute of Health Sciences Education, McGill University, Québec, Canada Correspondence to: Peter Nugus, Institute of Health Sciences Education (IHSE), McGill University, email: peter.nugus@mcgill.ca     Published ahead of issue: Oct 21, 2025; published: Nov 6, 2025. CMEJ 2025, 16(5) Available at https://doi.org/10.36834/cmej.80934 © 2025 Moniz, Claudio, Carver, Elizov, Nugus; licensee Synergies Partners. This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License. (https://creativecommons.org/licenses/by-nc-nd/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is cited.   Introduction Formation of a teaching identity is associated with teaching excellence in the healthcare setting.1–3 Clinical teachers are at the nexus of both frontline healthcare delivery and education. Teaching identity among healthcare professionals is important to foster as it has a profound influence on the quality of education of future health care professionals, hence the future quality and safety of healthcare.4  Despite the importance of clinical teaching, the development of a teaching identity among health care professionals is strongly claimed to be under-supported and undervalued at the macro level of healthcare systems.5,6  One’s identity is strongly shaped by their professional culture. Professional cultures in healthcare promote the view that teaching is an “add-on activity” rather than fundamental to the future of healthcare.7 We know that professional cultures influence clinical teaching at the micro level of the individual and at the meso level of the healthcare unit.8 The “hidden curriculum” of clinical teaching is the culture of beliefs and behaviours that are not openly conveyed, yet reflect the value placed on clinical teaching.9 Less is known about how macro organizational culture interacts with individual and professional cultures in relation to the formation of teaching identities. This relationship is important because porous boundaries exist between micro, meso and macro levels allowing mutual influence.10–12 Therefore, this research seeks to answer the question: How do institutional cultures and socialization processes across micro, meso and macro levels shape teaching identities in health professions education?  Methods Focused on “live” cultures, ethnography is the methodology that will help explore how preceptors and trainees mutually engage with, discuss, challenge and negotiate role modelling of explicit or implicit teaching roles and teaching identity, within their health professional and organizational cultures. A systems-theory perspective provides conceptual guidance to account for multi-level interaction,13,14 making it possible to observe different levels of social life as they manifest though mutual engagement. A constructivist approach bridges systems theory and ethnography, based on the assumption that participants are likely to construct their knowledge of teacher identity through social interactions and experiences.15  Ethical approval for conducting the study was granted by both the university hosting the research and the university-affiliated acute tertiary-care level metropolitan hospital in Canada (AO1-EO7-24B/Pro00139507). Participants are being recruited through purposeful sampling16 among medicine, nursing, social work, and pharmacy faculty and students. Both observations and interviews will occur in Works-in-Progress CANADIAN MEDICAL EDUCATION JOURNAL 2025, 16(5)  111 the search for methodological congruence.17 Sixteen senior-trainee dyads are being observed over full shifts. Thirty-two semi-structured interviews will be conducted among the sixteen observed faculty, eight students, and an additional eight unobserved faculty. Thematic analysis will characterize the data collected, to guide a plausible account of the current relationship between professional culture and the associated socialization impacting the teaching identity in clinicians.18 Because clinical culture can transfer across settings, this study focuses on a single site to allow a deeper exploration of socialization, rather than a comparative analysis. However, we are open to exploring future collaboration with other institutions Summary  Ethnographic exploration of the social meanings of clinical teaching and analysis of a culture19 is expected to provide a much-needed broad sociocultural understanding of the meaning of a teaching identity in the clinical setting, with implications for future quality and safety of healthcare.20 Findings can be expected to deliver insights on how and to what degree teaching is fostered in clinical environments. In addition to informing faculty development, such knowledge could contribute to professional socialization in the context of health sciences education and be framed as recommendations for policy and institutional support for resourcing, recognizing and incentivizing teaching in the clinical context of health care communities of practice.  Acknowledgements: The authors wish to thank academic librarian Andrea Quaiattini at McGill University for her support during the initial stages of the literature review.  Conflicts of interest: All authors have no conflicts of interest. Authorship: All authors have each signed their own attestation statement that they meet the requirements of authors. The lead author, in addition to their own attestation as an author, has signed an attestation that all authors listed on this paper meet the requirements for authors. Edited by: Marcel D’Eon (editor-in-chief) References 1. Lieff S, Baker L, Mori B, Egan-Lee E, Chin K, Reeves S. Who am I? Key influences on the formation of academic identity within a faculty development program. Med Teach. 2012;34(3):e208-15. https://doi.org/10.3109/0142159X.2012.642827  2. Williams KN, Ramani S, Orlander JD. Improving bedside teaching: findings from a focus group study of learners. Acad Med. 2008;83(3):257–64. https://doi.org/10.1097/ACM.0b013e3181637f3e  3. Farnan JM, Petty LA, Georgitis E, et al. A systematic review: the effect of clinical supervision on patient and residency education outcomes. Acad Med. 2012;87(4):428–42. https://doi.org/10.1097/ACM.0b013e31824822cc  4. Cantillon P, D’Eath M, De Grave W, Dornan T. How do clinicians become teachers? A communities of practice perspective. Adv Health Sci Educ Theory Pract. 2016;21(5):991–1008. https://doi.org/10.1007/s10459-016-9674-9  5. Bullough Jr, RV. Theorizing teacher identity: Self-narratives and finding place in an audit society. Teach Dev. 2015;19(1):79–96. https://doi.org/10.1080/13664530.2014.978505  6. Steinert Y, O’Sullivan PS, Irby DM. Strengthening teachers’ professional identities through faculty development. Acad Med. 2019;94(7):963–8. https://doi.org/10.1097/ACM.0000000000002695  7. Sabel E, Archer J, Early careers working group at the academy of medical educator. “medical education is the ugly duckling of the medical world” and other challenges to medical educators’ identity construction: a qualitative study. Acad Med. 2014;89(11):1474–80. https://doi.org/10.1097/ACM.0000000000000420  8. Akkerman SF, Meijer PC. A dialogical approach to conceptualizing teacher identity. Teach Teach Educ. 2011;27(2):308–19. https://doi.org/10.1016/j.tate.2010.08.013  9. Cantillon P, Dornan T, De Grave W. Becoming a clinical teacher: identity formation in context. Acad Med. 2019;94(10):1610–8. https://doi.org/10.1097/ACM.0000000000002403  10. Nugus P, Carroll K, Hewett DG, et al. Integrated care in the emergency department: a complex adaptive systems perspective. Soc Sci Med. 2010;71(11):1997–2004. https://doi.org/10.1016/j.socscimed.2010.08.013  11. Cilliers P. Boundaries, hierarchies and networks in complex systems. Intern J Innov Manag. 2001;5(2):135–47. https://doi.org/10.1142/S1363919601000312  12. Levine RB, Cayea D, Shochet RB, Wright SM. Case study: a midclerkship crisis—lessons learned from advising a medical student with career indecision. Acad Med. 2010;85(4):654–9. https://doi.org/10.1097/ACM.0b013e3181d299b7  13. Letiche H. Making healthcare care: managing via simple guiding principles. Charlotte, NC: Information Age Publishing, Inc.; 2008. 14. Urry J. Social networks, travel and talk. Br J Sociol. 2003;54(2):155–75. https://doi.org/10.1080/0007131032000080186  15. Bunniss S, Kelly DR. Research paradigms in medical education research. Med Educ. 2010;44(4):358–66. https://doi.org/10.1111/j.1365-2923.2009.03611.x  16. Creswell JW. Research design (international student edition): qualitative, quantitative, and mixed methods approaches. Philippines: SAGE Publications; 2013.  17. Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545–7. https://doi.org/10.1188/14.ONF.545-547  18. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa  19. Coleman S, Simpson B. Glossary of terms. Ethnography. Royal Anthropological Institute; 2017. Available from: https://www.discoveranthropology.org.uk/about-anthropology/glossaryofterms.html.   [Accessed October 14, 2024] 20. Perrella A, Coret A, Reghr G, Farrell LM. Capturing the moments: an autoethnographic exploration of self-preservation in clerkship. Teach Learn Med. 2021;33(5):463–72. https://doi.org/10.1080/10401334.2021.1887739   

The role of professional culture in teacher identity formation: an ethnographic window onto becoming a clinical teacher

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The role of professional culture in teacher identity formation: an ethnographic window onto becoming a clinical teacher

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