Development of complex pedagogical competencies and reflexivity in clinical teachers via distance learning: a mixed methods study

Figures & data

Figure 1. Mixed methods research design: a parallel, convergent study design to gain in-depth understanding of how distance learning can promote the development of complex pedagogical competencies. Interview pair I1-I3 (green) focused on a simulated recording of a supervision, interview pair I2-I4 focused on a participant’s personal situational recall of a supervision situation. Questionnaire pair Q1-Q4 (brown) generated data about participants’ self-assessed clinical supervision skills before and after partaking in the MOOC. Questionnaire pair Q2-Q3 (grey) investigated the interaction between participants and the learning tools developed in the MOOC (analysis out of scope of the present work). MOOC SCR: Massive open online course on the supervision of clinical reasoning, I: interview, Q: questionnaire, m: months.

Table 1. Dimensions of clinical supervisions and corresponding teacher actions explored with questionnaires Q1 and Q4.

Dimension	Teacher action
1.Role modeling	Active demonstration and description of clinical reasoning at work
2. Coaching	Observation of students and providing relevant and specific feedback on students’ performance
3. Articulation	Questioning students about their reasoning and encouraging them to ask questions
4. Exploration	Encouraging students to formulate and pursue learning goals
5. Learning environment	Creating a safe, respectful and constructive learning environment by showing interest in student’s learning and making students feel respected
6. Professional identity development	Demonstrating self-perception as clinician and as teacher through explicit emphasis on teaching practices, usage of pedagogic terminology, etc.

Table 2. Sociodemographic characteristics of MOOC participants to the quantitative arm of the study. *: ambulatory and hospital settings. MOOC: Massive open online course, Q: questionnaire, NA: non-applicable.

	Total MOOC registrations (03/2019–10/2021)	Participants to Q1	Participants to Q1 & Q4 (sample for quantitative study)
N	3734	405/3734 (1.85%)	48/405 (11.85%)
Age	NA	<30 years old: 21.98% 30–39 years old: 31.85% 40–49 years old: 25.19% > 49 years old: 2.99%	<30 years old: 2.83% 30–39 years old: 39.58% 40–49 years old: 22.92% > 49 years old: 16.67%
Profession	NA	General internal medicine*: 2.74% Specialized medicine: 29.88% Nursing sciences: 12.10% Physiotherapy: 2.25% Other: 17.04%	General internal medicine*: 18.75% Specialized medicine: 35.45% Nursing sciences: 1.42% Physiotherapy: 16.67% Other: 18.75%
Profession in a setting allowing the supervision of medical students	NA	Yes: 85.93% No: 14.07%	Yes: 85.42% No: 14.58%
Currently supervising a medical student	NA	Yes: 85.19% No: 14.81%	Yes: 91.67% No: 8.33%

Table 3. Mean scores for all questionnaire items in Q1 and Q4. Statistically significant increases are highlighted in yellow. Q: questionnaire, NS: non-significant, m: mean, std: standard deviation.

	Questionnaire dimensions and corresponding items	Q1 m (std)	Q4 m (std)	P-value paired t-test
Modelling		3.138	3.38
1	I consistently demonstrate how to perform clinical tasks	3.06 (0.76)	3.19 (0.64)	NS (P=.38)
2	I create sufficient opportunity for my students to observe me	2.71 (0.77)	3.2 (0.72)	P<.001
3	I serve as a role model as to the kind of health care professional the students would like to become	3.13 (0.73)	3.5 (0.58)	P=.004
4	I encourage them to ask me questions to increase their understanding	3.65 (0.67)	3.63 (0.53)	NS (P=.84)
Coaching		3.214	3.46
5	I give relevant feedback during or immediately after observing my students’ patients encounters	3.27 (0.71)	3.44 (0.58)	NS (P=.18)
6	I adjust my teaching activities to their level of experience	3.29 (0.61)	3.54 (0.54)	P=.02
7	I provide sufficient opportunities for students/trainees to perform activities independently	3.15 (0.74)	3.5 (0.54)	P=.001
8	I observe them on several occasions during their patients encounters	3.21 (0.92)	3.42 (0.65)	NS (P=.11)
9	I help them to become conscious of their knowledge and skills gaps	3.15 (0.74)	3.40 (0.54)	P=.03
Articulation		3.115	3.4
10	I ask my students/trainees to provide a rationale for their actions	3.23 (0.69)	3.52 (0.62)	P=.03
11	I ask questions aimed at increasing their understanding	3.44 (0.65)	3.65 (0.53)	NS (P=.09)
12	I stimulate them to explore their strengths and weaknesses	2.96 (0.82)	3.3 (0.62)	P=.008
13	I clearly explain the different key steps of an activity/process	2.83 (0.91)	3.13 (0.64)	NS (P=.06)
Exploration		3.115	3.475
14	I encourage them to formulate learning goals	2.88 (0.91)	3.35 (0.60)	P=.001
15	I encourage my students/trainees to pursue their learning goals	3.35 (0.81)	3.60 (0.49)	NS (P=.05)
Learning environment		3.82	3.83
16	I take care to create a learning environment in which they feel safe	3.73 (0.45)	3.77 (0.42)	NS (P=.62)
17	I am genuinely interested in my students/trainees	3.85 (0.36)	3.83 (0.38)	NS (P=.74)
18	I am respectful towards my students/trainees	3.88 (0.33)	3.88 (0.33)	NS (P=1.0)
Professional identity development		3.06	3.37
19	I feel that I am mastering the pedagogical concepts or teaching methods and techniques	2.56 (0.92)	3.06 (0.67)	P<.001
20	I contribute to establish pedagogical standards and processes in my service/department	2.98 (0.91)	3.00 (0.85)	NS (P=.85)
21	I feel that I can change things in our teaching methods	3.42 (0.74)	3.65 (0.56)	P=.03
22	I identify my student/trainee’s difficulties or knowledge gaps and I am able to explicitly formulate his/her difficulties	2.71 (0.77)	3.27 (0.57)	P<.001
23	I identify and focus on the needs of my student/trainee during my supervisions	3.04 (0.80)	3.46 (0.54)	P<.001
24	I identify both as a health professional and as a teacher	3.65 (0.56)	3.8 (0.39)	NS (P=.07)

Table 4. Comparison of proportions of respondents agreeing and disagreeing with each item’s statement in Q1 and Q4 using McNemar’s test for paired data. Na: McNemar’s test non-applicable since one proportion equal to 0. Q: questionnaire, NS: non-significant.

	Proportion of respondents agreeing with the statement (%)		Proportion of respondents disagreeing with the statement (%)
Questionnaire dimensions and corresponding items	Q1	Q4	Q1	Q4	P-value McNemar test for paired nominal data
Modelling
1	36	42	12	6	NS (P=.109)
2	25	41	23	7	P<.001
3	42	46	6	2	P=.046
4	43	47	5	1	NS (P=.102)
Coaching
5	43	46	5	2	NS (P=.180)
6	44	47	4	1	NS (P=.180)
7	40	47	8	1	P=.008
8	36	44	12	4	P=.005
9	42	47	6	1	P=.025
Articulation
10	41	47	7	1	P=.034
11	44	47	4	1	NS (P=.180)
12	35	44	13	4	P=.013
13	32	41	16	7	P=.039
Exploration
14	29	45	19	3	P<.001
15	42	48	6	0	Na
Learning environment
16	48	48	0	0	NS (P=1.00)
17	48	48	0	0	NS (P=1.00)
18	48	48	0	0	NS (P=1.00)
Professional identity development
19	27	39	21	9	P=.005
20	34	37	14	11	NS (P=.366)
21	43	46	5	2	NS (P=.180)
22	29	45	19	3	P<.001
23	36	47	12	1	P=.002
24	46	48	2	0	Na

Table 5. Sociodemographic characteristics of MOOC participants to the qualitative arm of the study. MOOC: massive open online course, F: female, M: male, I: interview.

Participant	Gender	Age at study start (years)	Practical/clinical experience at study start (years)	Experience in supervision at study start (years)	Experience in supervision at study start (max level of trainees)	Participation in qualitative arm of this study
01	F	36	5	3	Junior interns	I1, I2, I3, I4
02	M	38	10	3	Senior interns	I1
03	M	38	8	4	Junior interns	I1
04	F	32	2	1	Junior interns	I1, I2, I3, I4
05	M	33	2	1	Externals	I1, I2, I3, I4
06	M	30	3	2	Junior interns	I1
07	M	40	10	4	Senior interns	I1
08	F	34	6	4	Junior interns	I1, I2, I3

Data availability statement

The data sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.