How community and organizational culture interact and affect senior clinical educator identity

Figures & data

Table 1. Demographics of senior clinical educators.

Demographics	Number (N)
Practice sites
Singapore General Hospital (SGH)	3
KK Women’s and Children’s Hospital (KKH)	2
Sengkang General Hospital (SKH)	2
Changi General Hospital (CGH)	2
SingHealth Polyclinics	1
National Dental Center	1
Specialty
Internal Medicine	4 (1 Endocrinology, 1 Rheumatology, 1 Gastroenterology, 1 Neurology)
Surgery	3 (1 Urology, 1 Paediatric Surgery, 1 General Surgery)
Pediatrics	2
Family Medicine	1
Dentistry	1
Gender
Male	6
Female	5
^aAcademic Titles
Professor	6
Associate Professor	5
^bFormal Educator Leadership positions	8
^cFormal Medical Educator training	0

^a Academic Titles: appointed faculty roles by the affiliated medical schools where the clinician teaches.

^b Formal Educator Leadership positions: Education Director in the hospital, programme directors, education coordination positions (e.g. undergraduate clinical lead, Associate Dean, Residency Programme director).

^c Formal Medical Educator training: certificate or higher degree in health professions education.

Figure 1. Strengthening and constraining factors toward the development of SCEs’ professional identity.

Table 2. Quotes related to the strengthening and constraining factors toward developing SCEs’ educator identity.

Domain	Themes	Quotes
Domain 1 Personal	Strengthening factors
	Interest and passion (N = 72)	‘… I have always been interested in teaching…I love the experience of sharing knowledge…teaching gives me joy… it is my passion.’ (Participant 3)
	Professional values and altruism (N = 45)	‘I feel that… almost more important than routine patient care, as a form of paying forward and it’s, it’s not a duty. It’s enjoyment.’ (Participant 4)
	Imagining the future trajectory of the impact of medical education (N = 25)	‘As a clinician treating patients, it benefits just like one patient or the number of patients that you have. that's that much you can do. then you ask yourself what happens when you step down. Will your patients continue to get the kind of care that you feel that you know patients should be given? It was then that I realized that actually, it is probably more impactful to focus on education. Because in education, you can really touch many people, and then hopefully try to encourage and nurture them, the younger doctors.’ (Participant 2)
	Self-actualization, and fulfilment (N = 15)	‘…when I train the young ones, I see them graduate, be a young doctor and be successful…. That is when I feel I have made a change for the better (Participant 5)
	Constraining Factors
	Competing roles (N = 53)	‘With the various roles, I think it is only fair to yourself and to everybody else that you decide that you have to actually step down or step back from certain activities (other roles), otherwise it's not sustainable.’ (Participant 2)
	Lack of time (N = 45)	‘It’s been a struggle because I’ve been torn…I felt that I had to give up definitely on some of my clinical sessions, in order to do a bit more of the administrative side of education and teaching, and … not helping out my clinical unit’ (Participant 4)
	Disappointment with organization (N = 15)	‘We tend to see the same few people keep teaching again…but teaching should be everyone’s role. Unless you (the organization) spread recognition, people (other clinicians) won’t think it is important and perceived as waste of time’ (Participant 3)
Domain 2 Relational	Strengthening factors Relationship with:
	Mentors (N = 53)	‘having good mentors is important, I've been extremely lucky so always. Very helpful mentors to look out for me to guide give tips that I can approach any time so that was truly very, very helpful.’ (Participant 5)
	Students (N = 43)	‘…teaching can be gratifying because you get the interaction with students, you get their energy, you tap off that’ (Participant 5)
	Patients (N = 40)	‘…education is not a standalone activity. It must start from, you know, what was the intent to improve on patient care and education is part of it, to teach is to learn twice.’ (Participant 6)
	Community of practice (N = 12)	‘I remember when I went to the AMEI fellows programme (faculty development programme), it was such a relief to actually interact with other colleagues from various other healthcare professions, and realize that everyone, each of one was actually facing the exact same sort of issues, even though we’re from different backgrounds- these are hard to come by.’ (Participant 4)
	Mixed Factors
	Role Models (N = 88)	‘You know, I’ve also certainly come across very brilliant teachers, whose joy comes from putting you down to make you feel stupid [laughs], and just to make fun of you, right, and so that, we’ve all come across all those (teachers) I’ve also worked with people that I’ve assisted for, you know, year after year, and they won’t let you do anything at all. And then, in the middle of the night, you call them, then they show you, then they say, ‘Why didn't you tell me earlier? You are disrupting for the longest time!’ [laughs](Participant 6) ‘A lot of our senior management in high positions hold academic titles, but how many of them commit their time to teach people? You are a role model and if you yourself cannot commit the time to teaching, how do you expect your juniors or those working under you, uh, to teach?’ (Participant 7) ‘…he (role model) has been always very gracious to share and will come in as in an advisor role for all the education administration that I do which he also handed the portfolio to me, he tapped me into his network, he was very generous in sharing that sort of resources and opportunities.’ (Participant 5) ‘some of my previous bosses, uh, pushed me a lot to, uh, teach, because it was an important priority for them. And I did have a lot of good role models that I work under, and I, I would guess they, they are like the stimulating factors who pushed me to go into more teaching. And when you see these role models, from which you learn a lot, it, it makes you want to continue the same.’ (Participant 7)
	Peers (N = 15)	‘Colleagues helped to cover for me when I’m not around.’ (Participant 1) (supportive peers) ‘…contractual basis makes it very hard because then erhm ‘If we don't reward, I don't teach.’ (Participant3) (peers who compare) ‘comparing educators and the researchers, right, scientists, the clinician-scientist track, they (peers) were saying it’s definitely not as glamorous as the scientist track.’ (Participant 4) (peers who compare)
	Constraining Factors
	Family (N = 6)	‘I could never… balance my work requirements from my family time…feedback I got (from my children) [laughs] many years later (was that), ‘Dad, it’s not enough, you know. There’s so many of us wanting to tell us, uh, tell you what we want, so we get interrupted.’. So, it’s one of my regrets.’ (Participant 8)
Domain 3 Organizational	Strengthening Factors
	Faculty development courses (N = 18)	‘… they have course for you now to teach you how to teach, there was none during my time… I attended a few conferences now and wished I knew some of methods (Scholarly teaching) earlier’ (Participant 9)
	Education Office (N = 8)	‘So, we work closely with the education office for the administration side of things, and it really helped. There are more facilities for teaching available as well nowadays’ (Participant 2)
	Physical Facilities (N = 5)	‘Nowadays it is not just the physical space which is important for teaching but also the IT support system, library…and importantly the faculty themselves’ (Participant 10)
	Mixed Factors
	Presence of formal educator career path (N = 75)	‘we work towards giving protected time for education….so that you can really focus and for our younger doctors and the lifestyle and the complexity of the society outside now is really is required for them to have that sort of work life balance or the work life harmony, that is very, very important otherwise you'll be burnt out. ‘(Participant 2)
	University support (N = 68)	‘Everything we (SCEs) do is on our own cost, I had to pay my own school fees… pay for my exam fees and so on. It’s on your own time after work. There’s no protected time. There’s no sponsorship. But now you do of course, and now you get sponsorship for master’s in education, which we go into. So, I think our young educators now are a bit more protected. They are given courses. They are given time to do all these things, which is good.’ (Participant 3)
	Leadership (N = 38)	‘my previous boss XXX was extremely supportive for education and all and I think he set certain expectations. like you asked about protected time, so he was the one that recognized the need for protected time put in the processes to make it happened which continued when the next person took over’ (Participant 5) ‘the pressure is just from the top and as much as we want to try to prioritize, somehow I feel when push comes to shove, right, service comes first, the clinicals, the patients and least priority will be education’ (Participant 4)
	Teaching environment (N = 38)	‘Because of Covid there’s no teacher’s day celebration but it doesn’t take much to send an email out at the very least, but it makes a difference to the teachers, the people to be recognized, or create a little name tag for teachers. So, I think recognition is the first part to making people realize that, yes, educators, do exist; educators are important, and the institution recognizes them.’ (Participant 3)
	Constraining Factors
	“Industrialization” of Medical Education (N = 30)	‘… the administrative burden has tremendously increase, and it is impeding and hampering.’ (Participant 1) (administrative work) ‘I don't really want to sound like I’m generalizing, but the younger generation tend(s) to become more contractual in – how they do things, like ‘If I do this, I must expect something in return.’ (Participant 3) (educators’ expectation in remuneration)
	Gender (N = 4)	‘if you're a woman and you want to do surgery, you must do that little bit extra otherwise they won't take you seriously, it is even harder to be a surgeon and teach at the same time’ (Participant 1) (gender bias)