Three ways of understanding development as a teacher


Terese Stenfors-Hayes
Karolinska Institutet
17177 Stockholm
Tel: 0044 8 52483737
Fax: +46 8 34 51 28


The demands on faculty in terms of teaching are increasing, but until recently there has been little discussion of how faculty perceive that development as a teacher can be achieved or what approaches they use or suggest themselves. The aim of this study is to explore how teachers in dentistry and medicine understand development as teachers. For this study, 20 teachers were interviewed. The interviews were analysed using a phenomenographic approach. Three different ways of understanding development were identified: 1) Development as a dental or medical clinician/expert as the teacher role is seen as a tacit part of the role of the clinician. 2) Experience and professional and personal maturation, related to personal and professional development and confidence in ones clinical role. 3) Knowledge in education and systematic teacher training as in this category, being a teacher is seen as a separate role from that of being a clinician. The differences in these three ways of understanding development as a teacher are shown in their different aims of development, what kind of knowledge that may be used and what methods they suggested. The way teachers understand what it means to develop as a teacher will affect their motivation for engaging in development activities, which activities they choose and their own aims of development. This means that awareness of teachers’ understanding of development is central when developing support or faculty development activities for teachers.


When becoming faculty members in dentistry or medicine, people have trained for many years to become researchers and clinicians, but only a few have had any training at all for being teachers. The demands placed on faculty members are increasing, however, deriving from things such as curriculum reforms, increased student diversity, the impact of technological advances, shifting disease patterns, patient demographics and the number of different roles faculty members take on (1–3). Until recently, there has been little discussion of how dental faculty can acquire the knowledge, skills and attitudes necessary for competent educators (4); however, in medicine such examples can be found. Dental and medical educators have also been claimed to be sceptical to educational research or not to recognise the potential gain in faculty development (2, 5). So how do faculty perceive that development as a teacher can be achieved? What approaches do they use or suggest themselves? The aim of this study is to explore teachers in dentistry and medicine’s understanding of development as teachers. In this study, teaching is used as a broad term to include all teaching activities undergraduate teachers take part in.

During the last three decades, teacher training activities have become more common and are today considered a necessary function of academic institutions (6). Training provided in the 1970s focused on skills practice and teaching techniques. Later on, becoming a better teacher was deemed as ‘more’ than mastering certain techniques and training included a focus on students’ preconceptions and the relationship between content and context. More recently, collaborative learning, the learning environment and reflective teaching practices have been included (1). Today the outcomes of staff development training may include changes in attitudes towards teaching, learner-centeredness, approaches to and awareness of teaching and learning processes, educational activities, increased motivation, self-awareness and reflective practices (3, 7–10). Staff development activities that are used today include the following: mentoring, reflective diaries, e-learning, self-assessment, student and peer feedback, role plays, auscultations, educational research and scholarship activities (for extensive lists of activities see (7, 10–12)). Good teaching has been found to have a positive impact on student outcomes, and the quality of teaching can be improved through the assistance of academic interventions such as courses, feedback, student assessments and work within the academic community (10). Research within medical schools show similar findings: in a survey with directors of faculty development units, the practices that were deemed most effective included workshops, simulated teaching opportunities, teaching scholars programmes and peer coaching (11). Staff development can also be initiated by a teacher community or an individual teacher (13). Teachers have also reported that they learn to teach from observing other teachers, by experimenting with new methods themselves and by reflecting upon these experiences (14); however, this may be a slow and painful process (1). Teachers’ own experiences as learners can also influence their development (15). The most important influence on how teachers teach has been found to be teachers’ conceptions of teaching (10).

Teachers’ conceptions of teaching have also been linked to development (16) and the way faculty understand teaching has been explored by several researchers (16–21). These studies all show a similarity in the focus towards either the transmission of information to students or the development of understanding in students. The aim of any staff development needs to be in line with the participants’ own understanding of teaching and development for them to be interested and find it worthwhile (22). For example, a teacher who believes that the best way to become a better teacher is to improve their content knowledge, would not prioritise learning about new teaching methods.

Teachers’ understanding of their own development and growth has previously been explored by Åkerlind and McKenzie (16, 23), although not in a dental or medical context. The qualitative differences identified in these studies focused primarily on either the teachers and their comfort, knowledge and skills, or on the students, their learning and development, and the relationship between teaching and learning. In a later study, Åkerlind (22) explored the way academics undertook their development as teachers and identified different approaches based on the teachers’ own experiences and examples. Each of the approaches represents an increasingly complex and inclusive view (24):

  • (A) Improved content knowledge to know what to teach
  • (B) Increased practical experience as a teacher to know how to teach
  • (C) Increased repertoire of teaching strategies to become more skilful as a teacher
  • (D)Increased understanding of which strategies work or do not work for the teacher to be more effective as a teacher
  • (E) Increased understanding of which strategies work or do not work for the students in order to become more effective in facilitating students learning

Previous studies also show that teaching is often seen as a marginalised task and even though an understanding of the importance of development exists, teachers may still not act accordingly in their own development (25). Therefore, this current study focuses on the way teachers understand development as a teacher in more general terms, rather then the way they have developed themselves. The aim of this study was to explore medical and dental teachers’ ways of understanding development as teachers.

Methods of data collection and analysis

To best suit the aims of this research, a qualitative research method with semi structured interviews was used. A wide selection of teachers with varying backgrounds and teaching experiences were deemed appropriate as respondents. The respondents comprised of ten dentists and ten medical doctors (MDs) teaching in the undergraduate programme in dentistry and medicine, respectively. In this study, the focus is on the respondents’ understanding of development as a teacher rather than on differences between dentistry and medicine. The two groups of respondents were used to widen the respondents’ backgrounds and experiences. The age of the respondents varied from people in their thirties to their sixties, men and women were included, and some respondents had received their degrees in other countries, within and outside of Europe. Some of the respondents had been teaching more or less daily for years, others hardly considered themselves teachers at all but did occasionally lecture and supervise students in the clinic. All MDs and five dentists had current experience of clinical supervision and classroom teaching. These respondents were primarily clinical supervisors. The other five dentists only taught in classrooms or lecture halls. Some respondents had participated in teacher training, usually for a couple of weeks, whilst others had no such training.

Data were gathered using semi-structured interviews focussing on the following domains:

  • (A) The meaning of development as a teacher
  • (B) Possible ways to develop as a teacher

As the point was to explore as many ways of understanding development as a teacher as possible, most questions followed from what the respondents said (26). The aim was to provide an opportunity for the respondent to reveal their understanding without the interviewer introducing new aspects. The respondents were asked to describe and provide examples from their own development as well. All interviews were made by the first author who had no previous link to the respondents but might have been a familiar face to some through her position as an educational developer at the university. The interviews were recorded and later transcribed to constitute the final material for the analysis.

Phenomenography as an analytical perspective

Phenomenography is a qualitative, empirical research approach designed to explore how people make sense of the world around them through experiences. The outcome of a phenomenographic study is categories describing the respondents’ differences in ways of understanding the research object. This means that the variations found are described and analysed with regard to qualities of their content (24, 27). The different categories are related and can be described in terms of the breadth of understanding of ‘development as a teacher’ that is considered. In phenomenography, all data are usually treated as one text to be able to capture the collective understanding (27). Therefore, focus is not on individual ways of experiencing a phenomenon, but rather on the variation of understanding and the relationship between these. The researcher furthermore needs to constantly adjust his/her thinking in the light of reflection, discussion and new perspectives (28). The analytic process of the data proceeded as follows:

  •  All transcripts were read and meaning units were identified.
  •  The units were compared and then grouped based on similarities in the way of expressing understanding of development.
  •  The meaning of each group was articulated and the categories labelled.

The analytic process was iterative, and the resulting categories were compared in terms of what they comprised and did not comprise. In the second part of the analysis, the various aspects of development that were found in the interviews were identified and labelled. A comparison of the identified categories based on these aspects was also made. This is presented in Table 1.

Table 1.   Five aspects of the identified three categories of understanding development as a teacher
Understanding of development as a teacherAim of developmentSource of knowledgeMethods of developmentThe use of feedback and reflectionRole of students and colleagues
Development is achieved by development as a dental or medical clinician/expert as the teacher role is seen as a tacit part of the role of the clinicianJob satisfactionThe field in which you are teachingWorking as a researcher/clinician and reading up on your fieldReflection regarding the role of the clinicianStudents’ questions may help you develop as a clinician by making you learn new facts
Development is achieved as above as well as by increased experience and is related to personal and professional development and confidence in ones clinical professional roleAs above and through:
Keeping oneself and students happy by activation and variation in the teaching technique and content
As above and through:
Colleagues and oneself
As above and through:
Role models such as good presenters
As above and through:
Based on own ideas and ‘common sense’
As above and through:
Provides feedback on whether they like the teaching or not
Development is achieved as above as well as through knowledge in education and systematic training as teaching is seen as a professionAs above and through:
Students learning
As above and through:
The field of teaching and learning
As above and through:
Structured feedback and teacher training
As above and through:
According to known or structured models. May be provided by educational developers
As above and through:
Partners in developing the teaching sessions

The first author performed the analysis, but during the process, the analysis was reviewed by co-authors who had read all the interview transcripts, and the analysis was discussed until negotiated consensus (29) was reached. To strengthen the face validity, the findings were reviewed by a dentist faculty member who was not one of the respondents of the study. The system of categories in a phenomenographic study cannot claim to form an exhaustive system; however, it should aim to be complete in the sense that nothing in the collective experience of the group of respondents should be left unspoken (27). Marton and Booth (27) suggest three quality criteria for phenomenographic findings: (i) each category is revealing something distinctive, (ii) the categories are logically related and (iii) the outcomes are parsimonious (no more categories than are necessary are presented).

Ways of understanding development as a teacher in dentistry and medicine

In this study, three ways of understanding development as a teacher were identified:

  • (A) By development as a dental or medical clinician/expert
  • (B) By experience and professional and personal maturation
  • (C) By knowledge in education and systematic teacher training

These three categories show an expansion of understanding development as ranging from a focus on content knowledge (category A) and the teacher to the learning process and the students, which includes awareness of the field of education. In the most inclusive category (C), teaching is seen more as a profession or role with its own knowledge base. In this last category, dental or medical knowledge and skills and a good presentation technique is still important, but a focus on the students’ learning is added as well as an understanding of how teacher training and things such as more structured feedback can support development. In the middle category (B), development as a teacher is related to personal development and confidence in one’s professional role. Apart from being a good dental or medical clinician, you should also be a good presenter, and peers, students and role models may help you to develop. In the first category (A), the teacher role can perhaps be described as a tacit feature of the role of the clinician as opposed to a profession in its own right. This understanding emphasises the role of the teacher as an expert similar to some apprenticeship models and lacks the breadth of awareness of understanding development as presented in the latter two categories. As described above, these categories of descriptions are hierarchical rather than exclusive in that a respondent expressing an understanding of development matching category C may also express an understanding matching category B and A, but not vice versa.

By development as a dental or medical clinician/expert

In this first category, focus is solely on the content of teaching. This means that developing as a teacher proceeds through developing as a clinician and improving content expertise.

I am teaching xxx and therefore I want to learn more about xxx to develop.

It is about knowing your job so that during the 30 minutes when you are seeing a patient you can give the student ten of those minutes.

One respondent suggests that teaching has been a way to develop his/her skills and knowledge as a dentist, as described in the following quote:

My inspiration was patients and the clinical issues, not students. But teaching turned out to be an efficient way to develop. To be able to teach you need to learn yourself first, so it was a good incentive.

The quotation below suggests that students can help the teacher develop by helping them to become more of an expert in their field, rather than by providing feedback on the teaching and learning process, as suggested in the latter categories.

You get some unusual questions from the students sometimes and then you need to look up the answers, this is quite stimulating.

Rather than reflecting upon the students’ learning or their own teaching, the focus of reflection is on the respondents’ work as clinicians and their role as dentists and doctors, which in turn is thought to lead to better teaching.

If you are interested in your subject in a certain way I also think you are a good teacher, you are interested in thinking why is it this way, why do I do it this way. I think you become a better teacher if you reflect a lot on how you do things (as a clinician).

Course evaluations are interpreted as feedback regarding whether the course and the teaching was good or bad and not as a tool for development. Some respondents believed that teaching is not to be discussed with peers or students. One suggested that if you were really bold you could ask about your own ratings as a teacher from the students’ lists, but this was perceived to be a sensitive issue. Another respondent did not know how he/she could obtain any feedback even if he/she wanted to:

Even if I wanted feedback, what could I do? Phone the students asking them what they think about me? It is not possible.

One respondent said that even if he/she knew from the course evaluations that subject expertise was not always what the students rated as most important, he/she still felt that it was.

By experience and professional and personal maturation

The understanding of development as a teacher as captured in this category includes the notion of it being more than just content expertise (category A), but is not extended to include the field of education (category C). Rather than focusing on students learning (as in category C), the focus is on keeping students happy, active and awake and on the teachers’ development and enjoyment of teaching. Indeed, some respondents claim that they develop their teaching mainly for their own sake, but nevertheless, this brings about an enthusiasm for their teaching which helps keep the students engaged.

You always want to do something better and differently. If I do the same thing over and over it gets so boring, and I know that if I do it for my own sake the students will notice and experience it and I will transfer more energy in the process.

Becoming a better teacher was sometimes described as becoming more confident, enjoying the job, finding it stimulating and developing on a personal level by, for example, increased self-knowledge. Increased confidence was often described as a consequence of increased experience. No suggested content for this experience was given; the focus was rather on ‘more hours of teaching’. Some emphasised the need to be true to themselves and have a personal style as a teacher; therefore, copying good lecturers might not always be the best option.

The following quotation illustrates how teaching is only a small part of the respondent’s job and therefore the respondent thinks that he/she should make the most of the skills he/she has and adjust the teaching accordingly. The focus in this quotation is on the method of teaching only, rather than the learning outcomes.

You have to see to your own abilities, if I am naturally a good speaker and can capture people’s attention, then great. But teachers are like everybody else, you are good at some things but not so good at others. But since it isn’t a full time job I think it is important that you get to do what you feel comfortable with.

Development as a dental or medical clinician was still described as influential not only in terms of expertise (as in category A) but also in terms of confidence.

If I develop as a professional I also develop as a teacher, my competence grows and I get more confident and this makes it easier for me to share my knowledge.

Some respondents mention how feedback from the students (or lack of positive feedback) might make them reflect on how they could improve their teaching. This feedback could be given face to face or in a course evaluation. No particular structure or suggested content of the feedback was given. These respondents also illustrated an understanding of development based on changes in teaching and learning activities to keep the students engaged, happy and awake such as information and communication technology such as websites and PowerPoint.

Teachers may also observe good presenters and reflect upon their techniques, try and understand what makes them successful and thereafter try to improve their own teaching by implementing something they picked up. Similar to feedback, reflection is based on ‘common sense’ rather than following a more systematic method or set criteria, which is the case in the latter category.

Through knowledge in education and systematic teacher training

This most inclusive category reflects an awareness and acceptance of the field of education and educational expertise.

You realise that education is something you should know some things about. The field of education exists and there is something in that knowledge base that you are missing but that would be useful to have.

In this category, formal teacher training is considered a way to develop as a teacher. One respondent believed that feedback from a teacher trainer on his/her own teaching would be most useful, or feedback from a peer based on criteria developed from knowledge of teaching and learning. A mentoring programme for teachers was also suggested. The second quotation below exemplifies how feedback on a lecture can include the students’ perspective.

I like skiing and am pretty good at it, but I know that a lesson with a professional ski instructor will make me even better. So I am very positive towards teacher training.

A colleague studied the students’ reactions during one of my lectures as part of her teacher training and then presented it to me, that was really, really good and meant a lot to me in terms of developing my teaching.

One respondent suggests that a better and closer relationship with students might help as it would mean that he/she would be able to see the teaching from their perspective more easily. Others emphasise how one should make the students part of the teaching session and work together with them rather than just receiving their feedback afterwards. This means that developing the teaching should be a shared task between teacher and student.

The quotation below shows that role models may lead to reflection and inspire development in areas beyond presentation technique alone. This quotation also illustrates the focus on the learner rather than him/her as the teacher.

My supervisor was amazing at helping people grow and to make them feel important.

The aim and focus of development in this third and most inclusive category is improved student learning. Some respondents emphasise that they want their students to enjoy coming to work each morning and at the same time learn.

After having participated in teacher training courses I understand the value of not just doing things for students or just showing them what to do. They don’t learn that way.

However, even if the main focus of this category is on the field of education and educational expertise, the respondents expressing this understanding of development may still also emphasise the need for continuous professional development as a dentist or MD. Confidence, enjoyment and increased experience are also still deemed important as well as a good presentation technique and being a clinical role model. The focus on content and the teacher him/herself is not lost, but rather complemented with an understanding of the importance of knowledge in education and the students’ perspective.

Comparison of findings

The findings of this study were presented above as three hierarchical categories. These three different ways of understanding development as a teacher appear to be based in particular on the following five aspects: (i) the perceived aim of development, (ii) knowledge sources available for development, (iii) which methods that are deemed suitable, (iv) how reflection and feedback is used, and (v) the role of peers and students. A description of how the responses in these five aspects differed between the three categories can be found in Table 1. All five aspects are inclusively hierarchical as is illustrated by the inclusion of the definitions of the aspects from the first category (A) in the description of the aspects in category B and C (and of the inclusion of B in C).

Discussion and conclusions

In this study, three ways of understanding development as a teacher in dentistry and medicine were identified:

  • (A) By development as a dental or medical clinician/expert
  • (B) By experience and professional and personal maturation
  • (C) By knowledge in education and systematic teacher training

These understandings are qualitatively different in terms of aspects such as the aim of development that they describe, the methods that are suggested and the role of peers and students (Table 1). The increased knowledge of how teachers understand development can be used to support the further development of teachers and of teaching and learning. In Åkerlind’s study (22), five approaches to development were identified, based on the respondents’ own examples and three different ways of understanding development. As the aim of this study was to explore the respondents’ understanding of the phenomenon rather than what they have or have not done, the respondents in this current study have not necessarily used the methods they described. Nevertheless, the pattern, ranging from a content focus to a learning focus, both in the way development was understood, the aim of development and in the approaches or methods used to achieve this, is similar to Åkerlind’s findings (16, 22).

During the interviews, the respondents in this study were also asked to describe their own development as teachers. Many respondents found this difficult and said that they had done nothing to actively support their development. Some claimed that they did not feel as if they had developed at all since they started teaching as they found it hard to prioritise this which matches previous research findings claiming that teaching is often described as a marginalised task because of competing priorities (15, 25, 30, 31). Teachers’ approaches to development and the priority it receives is influenced by pedagogical and institutional practices and Teaching and Learning Regimes (32). Teaching, for example, may be seen as the teacher’s own ‘private business’ (33–36). One respondent explained that at his department no feedback was provided to individuals, instead, the whole department was rated. Another teacher explained that some teachers find it insulting to have colleagues sitting in during their lectures. Even if teaching is prioritised, it may also be difficult to adjust to the new context and field of education. One respondent was selected to join a special teacher training course for excellent teachers but found it difficult to adjust to their language and ideas:

When you are not used to the way people talk…It was weird. A third of us just sat there shaking our heads, thinking this was such flummery. Time for reflection, that was what we picked up from there. It was fun to meet other groups of teachers, but me (a dentist) and the MDs, we were different, and we called ourselves autodidacts.

Teachers in dental and medical education have multiple roles as clincians and researchers besides being teachers (4). Their skills in these areas are developed by the interplay between theoretical studies and professional experience. The implied differences in the respondents’ understanding of development as a teacher indicate a difference in their approach and attitude towards the different professional roles. Formal training as a way of increasing teaching competence was found in this study to be only one of many ways to develop as a teacher, and the notions of what this formal training may include also differs as some focused exclusively on presentation skills. The respondents referred mainly to teacher training courses rather than any other method commonly used today, which suggests an unawareness of alternative faculty development activities.

The aim of this study was to explore the range of understanding of dental and medical teachers. Studies such as this one are always linked to the socio-historic moment in which the study was performed. The respondents in this study were all dentists or MDs, including more respondents or a wider range of professions might have provided a wider range of responses. However, the various teaching experiences and teacher training the respondents had suggest that a reasonable variation has been reached in the study. We have chosen not to compare the numbers of dentists and MDs in each category respectively, as this is not the primary aim with a phenomenographic approach (24). The analysis will not emphasise individual respondents’ understanding, but rather the collective understanding of the group (37). Responses from both dentists and MDs have been used to illustrate the three ways of understanding. The interviewer worked as an educational developer at a centre providing staff development courses. It is possible that awareness of this prompted the respondents to bring up such activities during the interviews. However, none of the respondents have participated in any such activities led by the interviewer.

Awareness of ones own understanding has been found essential in improving practices (9), and the findings of this paper may be used by individual teachers to reflect upon their own understanding. This study provides a new perspective by its dental and medical context and by focusing on teachers' understanding rather than what the teachers have actually done. When offering faculty development activities, these can either be tailored to the participants’ intentions and understandings or, as is commonly suggested today, focus on expanding this understanding to make a wider range of staff development aims and activities attractive (19, 21, 22, 38, 39). Either way, teachers’ understanding of what teaching and development means is central when developing support for teachers, and hence this study may be used by educationalists as well. This study has identified three different ways in which teachers understand development as teachers. These different understandings influence a wide range of things, such as the aim of development, the methods used and the role educational developers, colleagues (peers) and students play in the developmental process. It is likely that these approaches also are related to other aspects of teaching which can be explored in future studies.


The authors thank all teachers interviewed in this study and colleagues at LIME, Karolinska Institutet and Michael Ross at University of Edinburgh for valuable feedback on previous drafts of the paper. No conflicts of interests.


TS-H conducted the interviews, the analysis and wrote the paper. HH and LOD participated in planning the study, parts of the analysis and provided feedback on the paper.