Boundary Spanning Behavior of Clinician-Teachers in the Classroom. An Observation Study

Abstract

INTRODUCTION: Clinician-teachers are engaged in both clinical practice and education. They positively influence student learning by connecting clinical practice and education. Most research into clinician-teacher's dual role was performed in the clinical settings where practice and teaching are intertwined. The benefits of clinician-teachers' dual role in the classroom-setting have been underexplored, whilst a large part of medical education is classroom-based. Using boundary work theory as a lens, this study aimed to illuminate clinician-teachers' observable boundary spanning behavior integrating the clinical practice and medical education in the classroom. METHODS: A qualitative observation study of classroom-teaching within postgraduate general practitioner specialty training at three Dutch medical institutes was conducted. Video recordings and transcripts of classroom teaching were analyzed using a structured observation schedule. Boundary spanning behavior was categorized into: boundary bridging, boundary making and boundary maintenance. Distinctions were made between verbal- and non-verbal behavior. RESULTS: All three categories of boundary spanning behavior were observed. Clinician-teachers demonstrated boundary bridging by integrating their own clinical experiences, by normalizing students' reported clinical experiences, by encouraging students' sharing of clinical experiences and by encouraging students to apply theory in practice. Clinician-teachers demonstrated boundary making by accentuating discontinuities between clinical practice and educational information, and boundary maintenance by allowing transient differences to exist between the two settings for didactic reasons. DISCUSSION: This observational study contributes to an understanding of how clinician-teachers use their experience as a clinician in classroom-teaching. These insights may contribute to faculty development fostering boundary-spanning teaching practices.