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Honoring Thyself in the Transition to Online Teaching

Maggio, Lauren A., PhD; Daley, Barbara J., PhD, RN; Pratt, Daniel D., PhD; Torre, Dario M., PhD, MPH, MD

doi: 10.1097/ACM.0000000000002285

Increasingly, health professions education (HPE) faculty are choosing or being required to transition their face-to-face teaching to online teaching. For many faculty, the online learning environment may represent a new context with unfamiliar technology, changing expectations, and unknown challenges. In this context, faculty members may find themselves teaching in ways that are dissonant with the existing assumptions, beliefs, and views that are central to their pedagogical or teaching identity. This “identity dissonance” may lead to dissatisfaction and frustration for faculty members and potentially suboptimal learning experiences for students. In this Perspective, the authors propose that faculty consider using Pratt’s five teaching perspectives as a conceptual framework to recognize and mitigate potential identity dissonance as they transition to teaching online. Derived and refined through several years of research, these teaching perspectives are based on interrelated sets of intentions and beliefs that give direction and justification to faculty members’ actions. They have been used in higher education to improve faculty satisfaction, self-reflection capabilities, and faculty development. The authors, therefore, believe that these teaching perspectives hold the potential to help HPE faculty enhance their teaching and retain their primary teaching identify, even as they shift to online teaching. Doing so may ensure that the components of teaching they enjoy and draw self-efficacy from are still central to their teaching experience. Pratt’s teaching perspectives also provide a conceptual framework for creating future faculty development initiatives and conducting research to better understand and improve the experience of transitioning to online teaching.

L.A. Maggio is associate professor of medicine and associate director of distributed learning and technology, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID:

B.J. Daley is professor of adult and continuing education, Department of Administrative Leadership, School of Education, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin: ORCID:

D.D. Pratt is senior scholar, Centre for Health Education Scholarship, and professor emeritus of education, University of British Columbia, Vancouver, British Columbia, Canada.

D.M. Torre is associate professor of medicine and associate director of evaluation and long-term outcomes, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Funding/Support: No funding was received for this work.

Other disclosures: Daniel D. Pratt is the author of the book Five Perspectives on Teaching: Mapping a Plurality of the Good.

Ethical approval: Reported as not applicable.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.

Correspondence should be addressed to Lauren A. Maggio, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4799; telephone: (301) 295-1273; e-mail:; Twitter: @laurenmaggio.

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

Increasingly, health professions education (HPE) faculty are choosing or being required to transition their face-to-face (F2F) teaching to online teaching, either partially or completely. For many of these faculty members, the online teaching/learning environment presents a new context with unfamiliar technology, changing expectations, and unknown challenges—all of which may erode or chafe against their current teaching or pedagogical identity. Although some faculty receive instructional design assistance and technology training to support the change, these approaches do not address the potential effect that negotiating this transition may have on their pedagogical identities. In this Perspective, we aim to raise awareness of these challenges and encourage faculty to use Pratt’s perspectives on teaching1 as a conceptual framework for reflecting on and managing the shift from F2F to online teaching. But first, to ground our study in the personal, we begin with two brief narratives from hypothetical faculty members who shifted from F2F to online teaching.

Chris has worked with medical students in both the classroom and clinical setting. Chris states, “For eight years, I’ve enjoyed teaching students how to share information with patients as a module in our doctoring course. I was recently tasked with moving my module online. Having only taught in person, I read about best technology practices and met with instructional design colleagues. However, in preparing to transition my content online, I forgot a key component: myself. For example, I did not consider how this transition would impact my approach and identity as a teacher or my relationship with my learners who would no longer be in the room with me.” In making this transition Chris questioned how his students could learn to interact with and teach patients by taking an online course.

Erin, a clinician educator, has been teaching medical students and residents for many years. Erin’s institution has decided to offer online modules for clerkship students who are studying at distant clinical sites. Erin states, “Transitioning to teaching in an online environment is a big change for me. My strength as a teacher is how I work individually with learners to develop their critical thinking. I believe we need to help learners understand how they develop their cognitive structures and how they construct a knowledge base for advanced practice. This necessitates in-depth discussion and analysis between teacher and learner. I’m worried that I’ll have to change who I am as a teacher and how I teach to adapt to this online environment.”

Erin and Chris have both articulated important, valid concerns that faculty face as they move their teaching online. These concerns are increasingly relevant as more and more HPE faculty choose to or are tasked with transitioning their F2F courses to teaching online. Here we define online teaching as Wittich and colleagues have defined it: “the use of internet technologies to enhance knowledge and performance.”2 Transitions from F2F to online teaching can vary greatly in scope, which may influence the level of concern a faculty member experiences. University of Pennsylvania faculty moved the resident nephrology journal club completely online.3 In comparison, Stanford University faculty took a blended learning approach, migrating the first-year microbiology content online while maintaining in-person classwork for applying key concepts.4 Blended learning is the fusion and integration of F2F and online learning that combines the properties of both modalities to enhance the capabilities of each separately.5

An important component of the transition to online teaching, whether the teaching will be totally online or blended, is understanding that the learning process is situated in a particular context (e.g., online discussion forum, lecture hall, community clinic). The context in which learning occurs affects all elements of the educational process for faculty members and learners alike. In the online context, faculty may find themselves teaching in ways that feel incongruent with the existing assumptions, beliefs, and views that are central to their pedagogical identity.6 This incongruence, known as “identity dissonance” in medical students and faculty members, has been linked to frustration and low self-worth.7,8 Further, faculty may inadvertently transmit this dissonance to their learners, which can impact the overall learning process.7,9 Thus, it is important to anticipate both the personal and professional challenges that may accompany a shift to online teaching, especially if mandated.

Numerous resources, including faculty development, are available (albeit variably across institutions) to support faculty as they migrate their teaching online. A national faculty development survey identified a variety of training offerings for online learning, many of which focused on technology (e.g., course management systems, wikis).10 Importantly, none of these trainings addressed implications for faculty members’ pedagogical identity, and the survey did not include medical schools.10 We are unaware of faculty development initiatives supporting online teaching in HPE that incorporate faculty members’ identity.

Recently, Carnegie Mellon University sought to understand why, despite producing leading research related to online teaching, its own faculty had largely failed to adopt the findings.11 To understand this conundrum, anthropologist Lauren Herckis spent over a year observing, interviewing, surveying, and documenting faculty members. She focused specifically on their resistance to adopting online teaching and observed that two factors were common across her project. First, faculty members clung to images of professors who, in their perspective, were effective teachers—that is, images of what, for them, constituted “good teaching.” Secondly, an even stronger source of resistance among faculty was the need to retain their personal identity as a teacher. They did not want to risk what had worked in the past by trying new ways of teaching. Adopting new teaching approaches seemed to run against faculty members’ pedagogical identities, which were formed by images of former effective teachers and of themselves as successful teachers. As such, these pedagogical identities can be a source of dissonance, and even resistance, for faculty moving from one form of teaching to another.

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Pedagogical Identity

Teaching is a socially constructed role that is written and authorized by society (or a professional community) well before it is enacted by any particular person. A person enacts the role and is judged according to how acceptable a performance s/he gives in terms of the expected norms of what it means to be “teacher” in a particular context. Each context (cultural, social, professional, or technological) imposes conditions on the role of teacher. These preconditions shape preconceptions of acceptable and unacceptable ways of being a teacher. As a result, much of what a person does, as a teacher, is judged on the basis of how well that person adapts to preconceptions of “teaching” within a particular context. To be a good teacher in one context is not necessarily the same as in another context.

Across time, individual teachers develop a socially acceptable set of norms about what works and does not work for them and their learners in particular contexts. Significant variation may occur within those acceptable norms, allowing individual teachers to develop their own pedagogical identity. That identity, while fitting the social and cultural norms of the community, is also a personal pedagogical identity. It is this identity, considered in light of Pratt’s teaching perspectives,1 that we draw attention to in the context of faculty moving from F2F teaching to online teaching.

We believe critical self-reflection guided by Pratt’s teaching perspectives will enable faculty to recognize and mitigate potential identity dissonance as they transition to teaching online. Understanding these teaching perspectives may help faculty transitioning to online teaching (especially if the transition is mandated) retain their pedagogical identity. Considering these perspectives may help ensure that the components of teaching that faculty particularly enjoy and draw self-efficacy from remain central to their teaching. This approach recognizes that the reluctance some faculty members feel about teaching online is much more than simple resistance to change but, rather, a fundamental need to incorporate their pedagogical identity into a new context.

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Teaching Perspectives

As described earlier, Erin and Chris share concerns about how their beliefs about teaching and learning will be affected when they begin teaching online. Although multiple factors contribute to teaching beliefs, including personal experiences with online learning, self-efficacy in using technology, and exposure to peers’ online teaching, the paragraphs below describe five qualitatively different teaching perspectives that can help faculty begin to understand Erin and Chris’s views. Each teaching perspective is based on an interrelated set of intentions and beliefs that give direction and justification to a teacher’s actions. They are derived from studying 254 teachers of adults, many of whom were medical professionals.1,12

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The primary responsibility and commitment for teachers who predominantly identify with the transmission perspective is to present content accurately and efficiently. Transmission teachers use big questions and/or key concepts to orient learners as they guide them through tasks leading to content mastery. Along the way, these teachers explain how or why the content is important, clarify misunderstandings, adjust the pace of delivery, answer questions, provide timely feedback, and link content back to key concepts. They set high standards for achievement and develop objective means of assessing learning. Effective transmission teachers are passionate about their subject. For many learners, these teachers were the reason they became interested in a particular subject or specialty.

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Apprenticeship teachers are usually experienced practitioners of what they teach and committed to engaging learners in authentic tasks and relationships in the workplace. Effective apprenticeship teachers take time to reveal the inner workings of their skilled performance and translate those internal considerations into meaningful language that is accessible to learners. They also provide opportunities for learners to participate in authentic work through ordered sets of tasks, usually proceeding from simple to complex and allowing for different points of entry depending on the learner’s capability. Through apprenticeship teaching, teachers seek to socialize learners into a specific community. Effective apprenticeship teachers know what their learners can do independently and where they need guidance; they engage each learner within his or her zone of proximal development.13 As the learners become more competent, the teacher provides less direction and offers greater responsibility. Chris uses an apprenticeship perspective to assist medical students in teaching patients about their medical conditions.

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Developmental teachers must understand and activate learners’ prior knowledge and beliefs as they relate to the form of reasoning to be learned. Their primary commitment is to developing learners’ reasoning or thinking by fostering the growth of complex and sophisticated cognitive structures. Two skills are essential to developing those cognitive structures: (1) using questions that challenge learners to move from relatively simple to more complex forms of reasoning, and (2) “parking” or delaying the provision of solutions and answers to allow learners time to construct their own understanding. Questions, problems, cases, and examples form bridges that these teachers use to transport learners from simpler ways of thinking and reasoning to new, more complex and sophisticated forms of reasoning. Effective developmental teachers adapt their knowledge to learners’ levels of understanding and ways of thinking, particularly in early stages of learning. Erin uses a developmental perspective to assist students in developing their thinking skills.

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Nurturing teachers believe that learners are more motivated and productive when expectations are clear and accompanied by a balance of intellectual challenge and emotional support. Their primary commitment is to developing a trusting learner–teacher relationship. They believe that learning is diminished when the learner’s self-concept is threatened. Effective nurturing teachers, therefore, create a learning environment that provides conditions in which learners feel a sense of control over their education, work collaboratively with others, believe their work will be considered fairly and honestly, and receive feedback in advance of high-stakes assessment of their efforts. Nurturing teachers do not lower their standards, nor do they excuse learners from doing what is required; rather, they help learners set challenging, but achievable goals; acknowledge effort as well as achievement; and recognize individual growth as well as absolute achievement. Both Chris and Erin identify strongly with the nurturing perspective in addition to their respective dominant perspectives.

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Social reform

The primary commitment of the social reform teacher is to critique and change the status quo. Social reform teachers question existing practices and encourage students to consider how they are positioned and constructed within particular discourses and practices. Effective social reform teachers help learners analyze and deconstruct common practices, looking for ways in which those practices perpetuate conditions that are unacceptable for practical or ethical reasons. These teachers interrogate discourses and artifacts of practice, observing what is said and what is unsaid; what is included and what is excluded; and who is represented and who is omitted. They encourage their students to adopt a critical view to take action to improve their own lives and the lives of others. Critical deconstruction, though central to this view, is not an end in itself; the goal is not just to learn about the world but, rather, to improve it.

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The Teaching Perspective Inventory

Teachers, including HPE faculty, can determine their dominant and “backup” teaching perspectives by completing the Teaching Perspectives Inventory (TPI). The TPI measures teachers’ self-reported actions, intentions, and beliefs across the five contrasting perspectives and provides respondents with a profile of their pedagogical identity.14 Over 400,000 people in over 100 countries have taken the TPI since it became available online in 2000. Development information and reliability and validity measures are reported by Collins and Pratt.12

No particular teaching perspective is universally better than any other; each holds the potential for good or poor teaching, depending on its alignment with specific goals, values, learners, and contexts. However, because they represent contrasting and sometimes competing views of teaching and learning, individual teachers value some perspectives more than others. For example, of the 400,000+ people who have taken the TPI, the majority hold a single perspective as their dominant view of teaching, as well as one or two additional backup perspectives, which allows them to accommodate changes in circumstances.1,12 As noted above, Chris and Erin each have a dominant perspective. Chris leans more toward an apprenticeship perspective and Erin toward a developmental perspective; both also demonstrate elements of the nurturing perspective.

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Teaching perspectives and transitioning to teaching online

As HPE faculty transition to teaching online, they may ask themselves not only how they can be effective online but also how they might teach in a way that honors the skills, abilities, and dominant teaching perspective that they have developed over their careers. In Table 1, we align each of the teaching perspectives with examples of teaching cardiac auscultation both in F2F and online settings, and list potential concerns that might arise as faculty transition to the online setting. We have articulated these concerns to foster an analysis of what instructors view as important in their teaching.

Table 1

Table 1

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Discussion and Implications

As when experiencing any significant shift, faculty transitioning their teaching to an online context may find it helpful to engage in a process of self-reflection—either as a solitary process or as a component of a faculty development initiative. Reflecting on the different dimensions of their teaching, including their dominant teaching perspective, may nurture growth. The transition to online teaching can act as the “disorienting dilemma” nudging faculty to examine and, if desired, transform their frames of reference to build new pedagogical understandings and strategies.15 For example, for Chris the transition to online teaching may be disorienting; he may feel that teaching in the new context clashes with aspects of his dominant apprenticeship perspective and even with his strong backup nurturing perspective. Chris may wonder how he will establish relationships with learners online.

Our hope is that having an awareness and understanding of these teaching perspectives will foster among faculty a process of critically assessing their values and beliefs about teaching, lead to an exploration of new roles and strategies, and, ultimately, build competence and self-efficacy in a new educational context. Discovering new approaches to teaching that do not undermine a person’s pedagogical identity may be the reflective lens by which faculty can view, adapt, and eventually enhance their teaching in the context of an online or blended teaching approach.

Additionally, understanding the teaching perspectives can assist faculty to think critically about how they might leverage online technologies to facilitate the use of their dominant perspective. Erin, for example, could use voice technologies to have students record themselves thinking aloud. The students could share their recordings via an online platform that Erin could access. This technology would provide a way for Erin to monitor the development of her students’ clinical reasoning skills, thus preserving her educational commitments and pedagogical identity.

Although identifying and honoring their dominant perspectives is important for faculty, external forces (learner needs, content, technology) may at times require them to adopt components of other perspectives. For example, Chris’s dominant perspective is apprenticeship teaching. However, if his institution lacks the technology infrastructure to support this perspective, he may need to consider shifting to an alternate perspective. In adopting alternate perspectives, faculty members should reflect on which elements of their dominant perspective are essential to their pedagogical identity and consider how to best retain those elements.

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Faculty development

The quality of online education has been generally criticized.16 One pillar of providing quality online education—specifically, enhancing learners’ satisfaction with the instructors—is faculty development.17 Yet, few faculty development programs in HPE focus on helping faculty either adapt their teaching perspectives to the online space or to mitigate the potential discomfort that may result from identity dissonance.

Thus, we suggest that those who develop faculty development initiatives consider integrating the TPI and teaching perspectives into their training programs (see Table 2). Although we know of no faculty development programs in HPE that have used the TPI as a tool to explore teaching perspectives and mitigate identity dissonance, a few programs have used the TPI in other faculty development initiatives. For example, at the University of British Columbia, faculty developers have used the TPI as a tool for participants to examine the underlying values and assumptions of their teaching philosophies. The training resulted in positive changes in participants’ perception of teaching.18 Additionally, faculty developers at the University of California, Davis used the TPI with medical and veterinary faculty who indicated that they were satisfied with the training and reported changes in their teaching, including enhanced personal reflection.19 We propose that integrating the TPI and five teaching perspectives will improve the overall quality of online teaching, which, as noted, has been criticized.16,20,21 Furthermore, faculty developers might consider delivering Internet-based training that not only highlights approaches to online teaching based on the five perspectives but also, itself, role models good online teaching practices.

Table 2

Table 2

Faculty development that integrates the teaching perspectives would require time for participants to reflect before, while, and after they transition their teaching to an online context. Such programs could play a critical role in helping faculty identify their dominant teaching perspectives and develop approaches to integrate these perspectives into online environments. In this way, faculty development programs could help curriculum developers and others begin to identify, respect, and normalize the unease that faculty members feel as they transition not just their content but also their pedagogical identity to online contexts.

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Future research

As many health professions schools offer more online teaching, the need to study this transition, to support teaching and learning and to disseminate related findings in a scholarly manner, also increases.20 Potential areas of research include using the TPI to investigate faculty members’ teaching perspectives and assessing how these perspectives are applied in the online context. Researchers might consider also taking an inventory of the perspectives of HPE faculty regarding teaching in the F2F environment and, then, investigating whether faculty modified their teaching on the basis of their teaching perspectives in the online space. Additionally, identifying critical moments that either facilitate or disrupt the transition to the online context is important.

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As HPE faculty move their teaching online, they may find themselves teaching in ways that are dissonant with their assumptions and beliefs about teaching. This identity dissonance may lead to dissatisfaction and frustration for the faculty and potentially suboptimal learning experiences for students. We hope that this Perspective will raise faculty members’ awareness of potential discomfort when transitioning to teaching online and position them to “honor thyself” by retaining components of teaching that they enjoy and from which they draw satisfaction and self-efficacy.

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