The lecturer-tutor in undergraduate medical education; navigating complexity as “a recruiter, a timetabler, an administrator, a counsellor”

Abstract

Abstract Introduction The importance of undergraduate medical education (UGME) tutors is highlighted in validated clinical environment evaluation tools and by the World Federation for Medical Education. These roles commonly involve competing clinical, educational and research commitments. We sought to obtain a rich description of these posts from doctors working in them. Methods We used a pragmatist, sequential explanatory mixed-methods design with a sampling frame of clinical lecturer/tutors in 5 Irish medical schools. Purposive sampling and third party participant contact were used for recruitment. Quantitative data collected from an online survey were used to inform a semi-structured interview question guide. Thematic analysis was conducted independently by both researchers. Quantitative and qualitative mixing occurred during data collection and data reporting. Findings 34 tutors completed the online survey with 7 volunteers for interview. Most (27; 79.4%) took the job to gain experience in educational practice. Major themes to emerge were the diverse interactions with students, balancing multiple identities, role-autonomy, perception by non-tutor colleagues, work-life balance and unpredictable work demands. Using a complexity theory lens, the tutor was defined by their relational interactions with numerous stakeholders, all in the context of an environment that changed regularly and in an unpredictable manner. We propose a complexity theory framework to improve tutor-led UGME. Conclusions The undergraduate tutor works within a complex adaptive system. An understanding of the system interactions recognises the non-linearity of the role but also acknowledges how the tutor can facilitate “co-evolution” and “emergence” within the system, thereby reducing role conflict, and improving educational delivery.