Determinants of student-teacher relationship in health professions education- a multi-method study

Abstract

Background

Student-teacher relationship (STR) in health professions education impacts students’ academic performance, professional development, and mental well-being. Understanding the determinants of these relationships is essential for fostering an effective and supportive learning environment, particularly in the emotionally demanding context of health education.

Methods

This study used a multi-method approach, combining quantitative surveys to measure perceptions of student-teacher relationships with qualitative interviews to explore underlying factors influencing these interactions. Data were collected from students and faculty across diverse health professions programs and analyzed using statistical and thematic analysis techniques.

Results

A total of 333 students participated in the quantitative survey, with the majority being medical students (38.4%). Ten faculty and students participated in the qualitative study. The majority were female students (68.2%), and from the 2nd year of study. Students identified personal qualities of being impressive and inspiring teachers, who are warm, compassionate, and demonstrate trustworthy, well-intentioned, and reliable behavior, as the factors instilling confidence in them. Reliability was the most important factor identified for strong STR, with 75.8% of medical and 68.8% of pharmacy students sharing the opinion. STR can affect teachers’ performance, students’ attendance in class, as well as their academic achievements. Students appreciated qualities in their teachers. The views about teacher qualities, STR, teachers’ actions, and their effect on teachers and attendance had diverse responses from students. They agreed on most points, while displaying significant differences among different years, colleges, and different grade point average categories on others.

Conclusion

This bidirectional relationship affects students in terms of attendance, discipline, and academic achievement, and teachers in self-confidence and performance as an educator. Health professional students consider teacher characteristics like a friendly approach, reliability, and trustworthiness important for STR, and motivation to learn. Both teachers and students agree that technology should be appropriately used to benefit STR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08040-7.

Introduction

Education is a cornerstone of both individual growth and societal development. Within this context, the student-teacher relationship (STR) is a key focus in pedagogy and psychology, reflecting broader educational practices and values [1]. Baumeister and Leary’s (1995) “belongingness hypothesis” [2], which highlights the human need for enduring interpersonal connections, provides a critical framework for understanding STR in higher education.

Strong STR fosters positive learning environments, supports students’ personal development, and significantly influences academic outcomes. It also reduces dropout rates, particularly in the first year of university, by enhancing educational, social integration, and student satisfaction [3]. Positive STRs benefit students who are considered at risk, and educators, who report increased positive emotions from such relationships [4].

A relational approach to teaching underscores the importance of STR in promoting teaching excellence [5, 6], as highlighted in discussions on the Scholarship of Teaching and Learning (SoTL) [7, 8]. However, national surveys such as the NSS (UK), NSSE (USA), and CES (Australia) often overlook STR, focusing instead on general teaching quality.

The first year of any program is critical, as most dropout decisions are made during this period [9]. In the healthcare profession, the student-teacher relationship is vital in shaping clinical skills, decision-making abilities, and professional identity of future practitioners. For example, during clinical rotations, a nursing or medical student relies heavily on their instructor to demonstrate procedures such as inserting Intravenous (IV) lines, interpreting lab results, or conducting patient assessments. A supportive teacher provides constructive feedback, ensures patient safety while allowing the student hands-on experience, and models empathy and professionalism in patient interactions. This mentorship also helps students navigate high-stress environments like emergency rooms or intensive care units, where clear communication and emotional resilience are essential [10]. Furthermore, strong relationships with educators can positively influence students’ career choices, specialty interests, and lifelong learning habits, which are the key components of success in the rapidly evolving healthcare field.

Research has examined the emotional dimensions of STR [11], with recent models identifying three key relational factors: affiliation/warmth, attachment/security, and assertion/power/status [12]. A quantitative questionnaire based on these dimensions was employed in the current study. To sum it up, a strong STR is essential for improving teaching quality and student performance in higher education. Ongoing research and attention to relational dynamics are crucial for fostering effective educational experiences.

Background

Man is a social animal with a natural urge to cultivate and maintain lasting, positive relationships with people around them. To attain such relationships, there must be frequent, effective, and pleasant interactions in a safe, stable, cordial, and sustainable context in which mutual respect and concern are expressed. Before delving into the topic further, we will list some common traits of Gen Z, the college-going students of this era:

• A)They are born in the age of technology, so they have a short attention span, and they expect quick answers.
• B)They generally don’t taste failure in childhood (e.g., getting prizes even if they lost a race), so they have less resilience.
• C)They expect the same support from the teachers in the university that they received in school, and do not anticipate the challenges of college life.

In this situation, they desperately look up to the teachers for support to succeed. At this point, higher education teachers have a pivotal role in shaping students’ personalities and careers, but the effort should be mutual. During the initial interactions, the teacher sets the rules and boundaries of the relationship and encourages or discourages its further development [13].

Interaction, care, sensitivity, and emotional responsiveness on the part of teachers support students’ positive self-evaluations, helping students feel more valuable, confident, and thus more likely to achieve goals [14]. Furthermore, students’ perceptions of teachers in relational dimensions, such as fairness and high expectations, predicted students’ goals, academic motivation, and ultimately academic performance [15]. In the educational context, STR plays a critical role in student outcomes, with benefits [14–16]. Despite being the center of interest, the issue of the relationship between university teachers and students in higher education needs further development as the constantly changing modern academic environment calls for new approaches to teaching and learning [17]. Interaction of representatives of different generations, having different worldviews, beliefs, and values, is likely to provoke conflicts. The gap between the average age of a university teacher and a student may be around 23 years and can cause differences in students’ and teachers’ expectations for interactions during the education process [18]. A university teacher is expected to have the ability to handle obstacles emerging in teacher-student classroom communication and adjust to constantly changing conditions. Just as positive STRs may increase student motivation, they may also increase teacher motivation, effort, engagement, happiness, and confidence, resulting in greater use of complex, high-impact teaching practices.

According to Guzzardo et al. (2021), faculty can play a significant role in counter-balancing structural inequities and contextual challenges by building relationships with students, engaging them in learning, and serving as a conduit to helpful campus resources [19]. Difficult or unsupportive relationships with faculty may serve as an additional hurdle for students feeling overburdened. Guzzardo et al. mention creating “pedagogical space”, which means that the teacher should be flexible enough to adapt the course to the needs of the students so that they feel supported. An example can be accepting written answers instead of verbal participation, as some students may have anxiety disorders.

A beneficial student-teacher relationship contributes to students’ personal growth and boosts their self-confidence [20]. The student-teacher relationship is a crucial factor for students’ long-term welfare. Teachers have a potential role in the academic performance of students, and the teacher-class relationship has been considered an important element [21]. Student-teacher relationships can have positive or negative effects on the academic output and students’ lives, which are indirectly affected by the teachers’ behavior [22].

If a strained relationship has been observed between a teacher and the class, students are less motivated and less encouraged to study [23]. A smooth STR motivates the students to participate in discussion and classroom activities, which affects the academic performance of students [24]. Teachers play an important role in students’ lives, and teachers’ behavior has much influence on the lives of students; teachers’ relationships with their students can make or break the mental health and personality of students [25].

Problem statement

STRs in higher education, especially in the healthcare profession, are taken for granted, assuming both parties are mature adults. But it plays a pivotal role in determining students’ future choices. The learning environment is inherently complex and diverse, and nurturing positive student-teacher relationships can be particularly challenging. Factors such as large class sizes, diverse student populations, varying teaching styles, and the increased use of technology in learning environments further complicate these dynamics. Consequently, there is a pressing need to investigate the multifaceted nature of STR in healthcare education and to identify the key determinants that influence their quality and effectiveness.

Exploring the student-teacher relationships in healthcare education will help bridge the gap regarding the impact on students’ and teachers’ engagement and well-being. By identifying and analyzing the critical factors that shape these relationships, the study seeks to provide actionable insights that can enhance educational practices and policies, ultimately contributing to students’ improved academic and personal development.

Aims and objectives

• Research questions

  1. What behaviors or practices are associated with positive and negative student-teacher relationships?
  2. In what ways do students’ and teachers’ perceptions of STR differ?
  3. What feasible steps can be taken to improve the quality of these relationships?

• Aim: To explore key factors influencing STR and identify strategies to enhance positive engagement and mutual respect.

Objectives

1. To identify specific behaviors, attitudes, and contextual factors responsible for positive or negative student-teacher relationships.

2. To assess the perceived impact of STR on the emotional and mental well-being of students and teachers.

3. To explore the perceptions of students and faculty regarding the qualities and behaviors of teachers that foster positive student-teacher relationships in health professions education.

4. To investigate the perceived impact of student-teacher relationships on the emotional and mental well-being of both students and faculty.

5. To identify the role of technology and institutional policy in enhancing student-teacher relationships in the context of healthcare education.

6. To propose practical, context-specific strategies for a safe and respectful learning environment.

Methodology

The qualitative interviews and quantitative questionnaire surveys were conducted at RAK Medical and Health Sciences University, Ras Al Khaimah, UAE, through a multi-method study. The questionnaires were prepared from existing literature, finalized in phases involving non-participating faculty members and students. The final version was validated among a pilot group of faculty and students with an internal validity of > 0.7 (Cronbach’s alpha) for each item. Ethical approval was obtained from the Research and Ethics Committee of the university with the number RAKMHSU-REC-232-2022/23-F-GE. Written consent was obtained from all the participants before administering the questionnaire for the survey. The study was conducted over a period of 6 months from November 2023 to April 2024. Quantitative data provided an insight into the perception of students across GPA, gender, year of study, and discipline. Qualitative interviews explored personal experiences and contextual factors shaping these relationships. The validation method is mentioned in the supplementary file. This integration is intended to triangulate findings to validate interpretations for a better understanding.

Participants

This study included students from different colleges of RAK Medical and Health Sciences University (RAK College of Medical Sciences, RAK College of Dental Sciences, RAK College of Pharmacy, and RAK College of Nursing). For the quantitative survey, the sample size was calculated using the Sample Size Calculator software available at Calculator.net. In this study, the significance level (α) for p-values was set at 5%; population proportion at 50%, population size at 1200 [approximate number of students], and confidence intervals (CI) at 95%. This calculation provided the minimum required sample size (n = 292) that needed to be recruited to generate adequately sized subgroups to ensure the statistical robustness of analyses. A consecutive non-probability sampling was done, and we included all participants who consented to be a part of the study. The students were assessed for both quantitative and qualitative surveys, but the TAs and faculty were only included in the latter.

For the qualitative study, the sample was deliberately selected to reflect maximum variation in key demographics (e.g., gender, nationality), academic standing (GPA), level of study, and professional role (faculty, students, TAs). Faculty members and TAs were chosen to represent diverse disciplines (core subjects), ranks (seniority), and countries. The faculty list was stratified to include faculty from all the colleges and grouped according to nationality and disciplines. The list was narrowed down to include faculty from South Asian and the Middle East (the major nationalities). They were approached for consent for the interview, and were included if they consented. This was to ensure inclusion across disciplines, cultures, and varying levels of experience for a broader perspective on the issue.

Students were grouped according to year of study, GPA, and nationality. It was narrowed down to include South Asian and Middle Eastern nationality, and GPA (> 3 and < 3). The students in each group were approached for consent and were included if they consented.

Tool for survey

The structured, validated questionnaires were used for a quantitative and qualitative survey. The researchers followed the guidelines for developing a questionnaire [26]. They developed two structured self-administered questionnaires for data collection from various sources [27–31]. The initial version of the questionnaire (V1) had 58 items. The questions were discussed among the investigators and put into five sections. We invited faculty members (N = 10), who were not involved in the research, from the institution to screen the questionnaire for general readability and content. The second version (V2) had 48 questions, modified based on the suggestions of the faculty. We then invited the faculty members again (n = 10) and 10 other participants to test the questionnaire for general readability and comprehension. The reliability of the items was calculated using Cronbach’s alpha, which was considered acceptable if the value was >0.7. It was validated among pilot groups of 20 students and 10 teachers for content, general readability, and comprehension. The final version (V3) of the questionnaire had 44 items spread across five sections using a four-point Likert scale, and demographic data. The questionnaire consisted of the following details:

1. Demographic data of students & faculty [College, Nationality, Position (for faculty only), year of study, and GPA in the last summative assessment (for students only)]

2. Items related to students’ and teachers’ expectations of and behavior toward each other for the survey.

The items on the questionnaire (V3) for the quantitative study had an internal consistency between 0.78 and 0.81 among a pilot group of 30 faculty and students.

The questions for a qualitative study were developed from the literature search and agreed upon through discussion among the investigators. Five faculty members were then given the questions to check for clarity and understanding.

All participants reviewed and approved their interview transcripts for the qualitative study.

Statistical analysis

The filled forms were collected, and the data were entered into Microsoft Excel. All categorical variables were presented with frequencies and percentages. The agreement of students on Motivation to learn and the student-teacher relationship was assessed by Kappa statistics. The association of relative importance of factors between different college students, between students of different years, between genders, and between students with GPA < = 3 and > 3 scores was tested using the Chi-square test. A p-value < 0.05 was kept statistically significant. SPSS v28 (Statistical Package for Social Sciences Version 28) was used for quantitative data analysis.

For the qualitative research, interviews were conducted using the developed questionnaire with open-ended questions. The answers of the participants were recorded using the Microsoft Voice-to-Text converter. The text was shown to the participants at the end of the interview for confirmation and approval. The recorded text was used for analysis. Thematic analysis was used for the data obtained from the interviews using Braun and Clarke’s six-phase framework for thematic analysis [32]. This is a widely adopted and flexible method for identifying, analyzing, and reporting patterns (themes) within qualitative data, involving steps like familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report [32]. Coding was inductive and data-driven. Each transcript was coded by at least two researchers independently. Discrepancies were discussed and resolved by consensus.

Results

Quantitative survey

A total of 333 students from different colleges participated in the study (Table 1). The majority of the participants were Medical students [128 (38.4%)], followed by Nursing [105 (31.5%)], Dental [68 (20.4%)], and Pharmacy students [32 (9.6%)].

Table 1.

General characteristics of study participants (Students)

Variable	Category	Frequency	Percent
College	Medical	128	38.4
	Dental	68	20.4
	Nursing	105	31.5
	Pharmacy	32	9.6
Year of study	1 st year	66	19.8
	2nd year	90	27.0
	3rd year	65	19.5
	4th year	68	20.4
	5th year	44	13.2
Gender	Male	106	31.8
	Female	227	68.2
GPA	<=3	155	46.5
	> 3	178	53.5

Maximum participation was from the 2nd year, and the least from the 5th year. A very high number of females participated [227 (68.2%)] in the survey compared to males [106 (31.8%)]. More than half [178 (53.5%)] had good academic scores with a GPA of more than 3. Questions were asked regarding the Qualities, Approaches, and Behaviors of their teachers that they think motivate them to learn. There were significant differences of opinion among students of different colleges (Table 2).

Table 2.

Students’ motivation to learn depending on teacher characteristics

Factors		College				Total	Chi-square, P-value
		Medical	Dental	Nursing	Pharmacy
Impressive [Quality]	Very Important	37 (28.9%)	25 (36.8%)	50 (47.6%)	12 (37.5%)	124 (37.2%)	22.093, 0.009
	Important	41 (32.0%)	22 (32.4%)	23 (21.9%)	6 (18.8%)	92 (27.6%)
	Slightly important	25 (19.5%)	17 (25.0%)	19 (18.1%)	4 (12.5%)	65 (19.5%)
	Not important	25 (19.5%)	4 (5.9%)	13 (12.4%)	10 (31.3%)	52 (15.6%)
Inspiring [Quality]	Very Important	54 (42.2%)	34 (50.0%)	55 (52.4%)	17 (53.1%)	160 (48.0%)	21.596, 0.010
	Important	25 (19.5%)	22 (32.4%)	27 (25.7%)	3 (9.4%)	77 (23.1%)
	Slightly important	21 (16.4%)	8 (11.8%)	14 (13.3%)	4 (12.5%)	47 (14.1%)
	Not important	28 (21.9%)	4 (5.9%)	9 (8.6%)	8 (25.0%)	49 (14.7%)
Warm [Approach/Attitude]	Very Important	51 (39.8%)	32 (47.1%)	52 (49.5%)	13 (40.6%)	148 (44.4%)	22.952, 0.006
	Important	31 (24.2%)	22 (32.4%)	36 (34.3%)	6 (18.8%)	95 (28.5%)
	Slightly important	21 (16.4%)	9 (13.2%)	8 (7.6%)	10 (31.3%)	48 (14.4%)
	Not important	25 (19.5%)	5 (7.4%)	9 (8.6%)	3 (9.4%)	42 (12.6%)
Compassionate [Approach/Attitude]	Very Important	56 (43.8%)	32 (47.1%)	56 (53.3%)	10 (31.3%)	154 (46.2%)	18.400, 0.031
	Important	29 (22.7%)	22 (32.4%)	29 (27.6%)	11 (34.4%)	91 (27.3%)
	Slightly important	14 (10.9%)	9 (13.2%)	9 (8.6%)	7 (21.9%)	39 (11.7%)
	Not important	29 (22.7%)	5 (7.4%)	11 (10.5%)	4 (12.5%)	49 (14.7%)
Trustworthy [Behavior]	Very Important	57 (44.5%)	35 (51.5%)	59 (56.2%)	18 (56.3%)	169 (50.8%)	20.304, 0.016
	Important	23 (18.0%)	22 (32.4%)	17 (16.2%)	3 (9.4%)	65 (19.5%)
	Slightly important	19 (14.8%)	5 (7.4%)	17 (16.2%)	4 (12.5%)	45 (13.5%)
	Not important	29 (22.7%)	6 (8.8%)	12 (11.4%)	7 (21.9%)	54 (16.2%)
Well-intentioned [Behavior]	Very Important	62 (48.4%)	34 (50.0%)	54 (51.4%)	17 (53.1%)	167 (50.2%)	21.506, 0.011
	Important	20 (15.6%)	24 (35.3%)	26 (24.8%)	4 (12.5%)	74 (22.2%)
	Slightly important	18 (14.1%)	5 (7.4%)	12 (11.4%)	2 (6.3%)	37 (11.1%)
	Not important	28 (21.9%)	5 (7.4%)	13 (12.4%)	9 (28.1%)	55 (16.5%)
Reliable [Behavior]	Very Important	68 (53.1%)	33 (48.5%)	59 (56.2%)	18 (56.3%)	178 (53.5%)	22.014, 0.009
	Important	13 (10.2%)	21 (30.9%)	22 (21.0%)	3 (9.4%)	59 (17.7%)
	Slightly important	15 (11.7%)	8 (11.8%)	9 (8.6%)	5 (15.6%)	37 (11.1%)
	Not important	32 (25.0%)	6 (8.8%)	15 (14.3%)	6 (18.8%)	59 (17.7%)
Instilling confidence [Behavior]	Very Important	66 (51.6%)	34 (50.0%)	56 (53.3%)	17 (53.1%)	173 (52.0%)	19.275, 0.023
	Important	16 (12.5%)	22 (32.4%)	23 (21.9%)	3 (9.4%)	64 (19.2%)
	Slightly important	17 (13.3%)	6 (8.8%)	13 (12.4%)	5 (15.6%)	41 (12.3%)
	Not important	29 (22.7%)	6 (8.8%)	13 (12.4%)	7 (21.9%)	55 (16.5%)

The proportion of students perceiving a characteristic of a teacher as very important factor for motivation to learn was compared across colleges. Most of the nursing students [50 (47.6%)] believed that impression (well dressed, good personality) does matter a lot for the motivation to learn; however, dental college students [4 (5.9%)] considered it least important (p < 0.05). There was a significant association observed between Inspiring, Friendly, Compassionate, Trustworthy, Well-intentioned, Reliable, and Instilling confidence factors among students of different courses (p < 0.05) (Table 2).

There was a set of questions asked to students on their views on teachers’ characteristics that enable a strong student-teacher relationship. Students had mixed opinions about the qualities, attitudes, and behavior. Most students regarded being friendly, having a positive attitude towards students, and being reliable are the most important contributors to strong STR. Reliability was the most important factor, with 75.8% of medical and 68.8% of pharmacy students sharing the opinion that the reliability of the teachers is a very important aspect. This was statistically different from the other two colleges (nursing and dental) (p < 0.05). There was no statistically significant difference between the students of different colleges about other attributes of the teachers (Supplementary Table 1). When the factors for motivation to learn and strong STR were compared among students of different colleges, there was no statistically significant difference in any of the attributes [kappa value 0.186–0.383] (Supplementary Table 2).

In Sect. 3 of the questionnaire, students of different colleges were asked about their views on teachers. The proportion of students agreeing to all of their teachers’ actions in a certain scenario was compared across colleges. The results show that the highest proportion of pharmacy students believed that teachers answered the students’ questions during the lecture, and teachers treat all students with respect, while medical students expressed positive views on teachers also helping them outside the class (Table 3). A marginal number of students from Nursing 22 (21%) believed “only some of them receive respect” (p < 0.05). The views differed significantly among the students of different colleges with regards to teachers helping them outside the class, and treating students with respect (p < 0.05). There were differences of opinion regarding teachers accepting students’ criticism of their opinions willingly, although it was not statistically significant (p = 0.08).

Table 3.

Students’ views about the teacher’s actions

Factors		College N (Percentage)				Total	Chi-square, P-value
		Medical	Dental	Nursing	Pharmacy
Following their decisions is obligatory for students	All of them	58 (45.3%)	28 (41.2%)	51 (48.6%)	17 (53.1%)	154 (46.2%)	12.367, 0.193
	Most of them	50 (39.1%)	30 (44.1%)	37 (35.2%)	9 (28.1%)	126 (37.8%)
	Some of them	20 (15.6%)	10 (14.7%)	15 (14.3%)	4 (12.5%)	49 (14.7%)
	None of them	0 (0.0%)	0 (0.0%)	2 (1.9%)	2 (6.3%)	4 (1.2%)
They treat students with respect	All of them	65 (50.8%)	35 (51.5%)	54 (51.4%)	20 (62.5%)	174 (52.3%)	19.078, 0.025
	Most of them	45 (35.2%)	24 (35.3%)	28 (26.7%)	5 (15.6%)	102 (30.6%)
	Some of them	18 (14.1%)	9 (13.2%)	22 (21.0%)	5 (15.6%)	54 (16.2%)
	None of them	0 (0.0%)	0 (0.0%)	1 (1.0%)	2 (6.3%)	3 (0.9%)
They answer the student’s questions during the lecture	All of them	75 (58.6%)	33 (48.5%)	57 (54.3%)	24 (75.0%)	189 (56.8%)	13.431, 0.144
	Most of them	41 (32.0%)	27 (39.7%)	33 (31.4%)	3 (9.4%)	104 (31.2%)
	Some of them	12 (9.4%)	7 (10.3%)	14 (13.3%)	4 (12.5%)	37 (11.1%)
	None of them	0 (0.0%)	1 (1.5%)	1 (1.0%)	1 (3.1%)	3 (0.9%)
They help students outside the class	All of them	76 (59.4%)	29 (42.6%)	56 (53.3%)	19 (59.4%)	180 (54.1%)	22.017, 0.009
	Most of them	34 (26.6%)	25 (36.8%)	32 (30.5%)	6 (18.8%)	97 (29.1%)
	Some of them	17 (13.3%)	14 (20.6%)	16 (15.2%)	4 (12.5%)	51 (15.3%)
	None of them	1 (0.8%)	0 (0.0%)	1 (1.0%)	3 (9.4%)	5 (1.5%)
They accept students’ criticism of their opinions willingly	All of them	51 (39.8%)	22 (32.4%)	52 (49.5%)	19 (59.4%)	144 (43.2%)	15.146, 0.087
	Most of them	38 (29.7%)	20 (29.4%)	30 (28.6%)	5 (15.6%)	93 (27.9%)
	Some of them	35 (27.3%)	25 (36.8%)	22 (21.0%)	6 (18.8%)	88 (26.4%)
	None of them	4 (3.1%)	1 (1.5%)	1 (1.0%)	2 (6.3%)	8 (2.4%)

The views of the students on attendance, discipline in the class, and its effect on STR, reflected mixed views. The proportion of students strongly agreeing to statements on attendance, discipline in the class, & its effect on STR was compared across colleges. Most of the students favored disciplinary actions for students causing disruption during the class, with only few disagreeing or strongly disagreeing (Table 4). There was statistically significant differences in views of the students regarding whether it is proper action to expel the students or ignore the action, for the students causing class disruption (p < 0.05). The majority of the nursing students strongly believe that, if there is a disruption in the class, the most proper action by the teacher is to expel the student (p < 0.05). The majority of students either agreed or strongly agreed that STR can positively or negatively affect academic achievements (95.5%). However, the difference was not statistically significant (p > 0.05) (Table 4).

Table 4.

Students’ views on attendance, discipline in class, and the effect of relationship compared between colleges

Factors		College N (Percentage)				Total	Chi-square, P-value
		Medical	Dental	Nursing	Pharmacy
In your opinion, your attendance is affected by the student-teacher relationship	Strongly agree	47 (36.7%)	27 (39.7%)	41 (39.0%)	13 (40.6%)	128 (38.4%)	4.283, 0.892
	Agree	43 (33.6%)	23 (33.8%)	40 (38.1%)	10 (31.3%)	116 (34.8%)
	Disagree	27 (21.1%)	16 (23.5%)	18 (17.1%)	6 (18.8%)	67 (20.1%)
	Strongly disagree	11 (8.6%)	2 (2.9%)	6 (5.7%)	3 (9.4%)	22 (6.6%)
Teacher’s performance is affected by students’ attendance or absence	Strongly agree	42 (32.8%)	25 (36.8%)	38 (36.2%)	13 (40.6%)	118 (35.4%)	12.295, 0.197
	Agree	45 (35.2%)	29 (42.6%)	45 (42.9%)	8 (25.0%)	127 (38.1%)
	Disagree	34 (26.6%)	13 (19.1%)	19 (18.1%)	7 (21.9%)	73 (21.9%)
	Strongly disagree	7 (5.5%)	1 (1.5%)	3 (2.9%)	4 (12.5%)	15 (4.5%)
In your opinion, if there is a disruption in the class, the most proper action by the teacher is to expel the student	Strongly agree	36 (28.1%)	21 (30.9%)	37 (35.2%)	11 (34.4%)	105 (31.5%)	19.172, 0.024
	Agree	33 (25.8%)	20 (29.4%)	42 (40.0%)	7 (21.9%)	102 (30.6%)
	Disagree	37 (28.9%)	21 (30.9%)	23 (21.9%)	10 (31.3%)	91 (27.3%)
	Strongly disagree	22 (17.2%)	6 (8.8%)	3 (2.9%)	4 (12.5%)	35 (10.5%)
In your opinion, if there is a disruption in the class, the most proper action by the teacher is to reprimand the student	Strongly agree	31 (24.2%)	15 (22.1%)	34 (32.4%)	12 (37.5%)	92 (27.6%)	11.938, 0.217
	Agree	68 (53.1%)	34 (50.0%)	53 (50.5%)	12 (37.5%)	167 (50.2%)
	Disagree	23 (18.0%)	14 (20.6%)	16 (15.2%)	4 (12.5%)	57 (17.1%)
	Strongly disagree	6 (4.7%)	5 (7.4%)	2 (1.9%)	4 (12.5%)	17 (5.1%)
In your opinion, if there is a disruption in the class, the most proper action by the teacher is to Ignore it	Strongly agree	31 (24.2%)	21 (30.9%)	32 (30.5%)	6 (18.8%)	90 (27.0%)	23.379, 0.005
	Agree	22 (17.2%)	22 (32.4%)	36 (34.3%)	9 (28.1%)	89 (26.7%)
	Disagree	43 (33.6%)	19 (27.9%)	19 (18.1%)	7 (21.9%)	88 (26.4%)
	Strongly disagree	32 (25.0%)	6 (8.8%)	18 (17.1%)	10 (31.3%)	66 (19.8%)
Do you think the student-teacher relationship can positively or negatively affect academic achievement?	Strongly agree	87 (68.0%)	39 (57.4%)	56 (53.3%)	17 (53.1%)	199 (59.8%)	12.724, 0.176
	Agree	38 (29.7%)	28 (41.2%)	41 (39.0%)	12 (37.5%)	119 (35.7%)
	Disagree	1 (0.8%)	1 (1.5%)	6 (5.7%)	2 (6.3%)	10 (3.0%)
	Strongly disagree	2 (1.6%)	0 (0.0%)	2 (1.9%)	1 (3.1%)	5 (1.5%)

A teacher’s teaching methods, students’ opinions and trust also affect STR. A major proportion of students across colleges in general think that teachers who use references for the lecture are good teachers, and they trust the advice of their teachers (> 90%) (Table 5). Students are more interested in attending lectures for teachers who use interactive teaching rather than spoon-feeding (68.2%). The students also report either very good or good relationships with their teachers, with only 2.1% (n = 7) reporting bad or very bad relationships. However, the nursing and pharmacy students have significantly better (very good Good) relationships with their teachers (p = 0.01) (Table 5).

Table 5.

Students’ views on different aspects of the student-teacher relationship compared between colleges

Factors		College N (Percentages)				Total	Chi-square, P-value
		Medical	Dental	Nursing	Pharmacy
In your opinion, the teacher who uses references for the lecture (book, handout, etc.) is	A good teacher	123 (96.1%)	65 (95.6%)	105 (100.0%)	29 (90.6%)	322 (96.7%)	7.687, 0.053
	A bad teacher	5 (3.9%)	3 (4.4%)	0 (0.0%)	3 (9.4%)	11 (3.3%)
Did the opinions of the previous students affect your view of the teacher?	Yes	75 (58.6%)	45 (66.2%)	70 (66.7%)	18 (56.3%)	208 (62.5%)	2.535, 0.469
	No	53 (41.4%)	23 (33.8%)	35 (33.3%)	14 (43.8%)	125 (37.5%)
In general, do you trust the teacher’s advice?	Yes	120 (93.8%)	63 (92.6%)	99 (94.3%)	30 (93.8%)	312 (93.7%)	0.189, 0.979
	No	8 (6.3%)	5 (7.4%)	6 (5.7%)	2 (6.3%)	21 (6.3%)
I am interested in attending lectures from the teacher who uses the method of	Spoon feeding	34 (26.6%)	21 (30.9%)	43 (41.0%)	8 (25.0%)	106 (31.8%)	6.380, 0.095
	Interactive teaching	94 (73.4%)	47 (69.1%)	62 (59.0%)	24 (75.0%)	227 (68.2%)
How do you evaluate the current relationship between you and your teachers?	Very good	41 (32.0%)	24 (35.3%)	55 (52.4%)	17 (53.1%)	137 (41.1%)	20.192, 0.017
	Good	85 (66.4%)	41 (60.3%)	49 (46.7%)	14 (43.8%)	189 (56.8%)
	Bad	2 (1.6%)	1 (1.5%)	1 (1.0%)	0 (0.0%)	4 (1.2%)
	Very bad	0 (0.0%)	2 (2.9%)	0 (0.0%)	1 (3.1%)	3 (0.9%)

Table 6 shows the relative perceived importance of teachers’ characteristics influencing students’ motivation to learn. Students perceiving a particular characteristic as very important were compared. When compared year-wise, there were statistically significant differences between different years of students in the factors they consider that motivate them to learn. We found that the major proportion of students from the second year rated high for exciting, inspiring, friendly, and compassionate as very important, with the highest proportions of 57.8%, 60.0%, 63.3%, and 57.8% respectively. The importance of this factor declined in the later years, especially in the 5th year at 31.8%, 31.8%, 40.9% and 38.6%. The students of 1 st and 2nd years showed higher values for positivity (62.1% and 63.3%), caring (57.6% and 56.7%), and trustworthiness (60.6% and 61.1%), and it showed a notable decline in 5th year students-40.9% in all aspects.

Table 6.

Teachers characteristics influencing students’ motivation to learn

Factors		Year of study N (Percentages)					Total	Chi-square, P-value
		1 st year	2nd year	3rd year	4th year	5th year
Exciting	Very Important	31 (47.0%)	52 (57.8%)	26 (40.0%)	24 (35.3%)	14 (31.8%)	147 (44.1%)	29.606, 0.003
	Important	10 (15.2%)	20 (22.2%)	23 (35.4%)	29 (42.6%)	12 (27.3%)	94 (28.2%)
	Slightly important	12 (18.2%)	9 (10.0%)	6 (9.2%)	9 (13.2%)	6 (13.6%)	42 (12.6%)
	Not important	13 (19.7%)	9 (10.0%)	10 (15.4%)	6 (8.8%)	12 (27.3%)	50 (15.0%)
Inspiring	Very Important	35 (53.0%)	54 (60.0%)	25 (38.5%)	32 (47.1%)	14 (31.8%)	160 (48.0%)	36.025, < 0.001
	Important	8 (12.1%)	19 (21.1%)	23 (35.4%)	17 (25.0%)	10 (22.7%)	77 (23.1%)
	Slightly important	9 (13.6%)	8 (8.9%)	7 (10.8%)	16 (23.5%)	7 (15.9%)	47 (14.1%)
	Not important	14 (21.2%)	9 (10.0%)	10 (15.4%)	3 (4.4%)	13 (29.5%)	49 (14.7%)
Friendly	Very Important	38 (57.6%)	57 (63.3%)	30 (46.2%)	33 (48.5%)	18 (40.9%)	176 (52.9%)	25.059, 0.015
	Important	8 (12.1%)	13 (14.4%)	15 (23.1%)	19 (27.9%)	5 (11.4%)	60 (18.0%)
	Slightly important	6 (9.1%)	11 (12.2%)	10 (15.4%)	8 (11.8%)	6 (13.6%)	41 (12.3%)
	Not important	14 (21.2%)	9 (10.0%)	10 (15.4%)	8 (11.8%)	15 (34.1%)	56 (16.8%)
Compassionate	Very Important	34 (51.5%)	52 (57.8%)	22 (33.8%)	29 (42.6%)	17 (38.6%)	154 (46.2%)	36.015, < 0.001
	Important	10 (15.2%)	22 (24.4%)	27 (41.5%)	26 (38.2%)	6 (13.6%)	91 (27.3%)
	Slightly important	10 (15.2%)	7 (7.8%)	9 (13.8%)	6 (8.8%)	7 (15.9%)	39 (11.7%)
	Not important	12 (18.2%)	9 (10.0%)	7 (10.8%)	7 (10.3%)	14 (31.8%)	49 (14.7%)
Positivity towards students	Very Important	41 (62.1%)	57 (63.3%)	30 (46.2%)	35 (51.5%)	18 (40.9%)	181 (54.4%)	32.904, 0.001
	Important	4 (6.1%)	17 (18.9%)	20 (30.8%)	17 (25.0%)	5 (11.4%)	63 (18.9%)
	Slightly important	6 (9.1%)	7 (7.8%)	8 (12.3%)	7 (10.3%)	6 (13.6%)	34 (10.2%)
	Not important	15 (22.7%)	9 (10.0%)	7 (10.8%)	9 (13.2%)	15 (34.1%)	55 (16.5%)
Caring	Very Important	38 (57.6%)	51 (56.7%)	23 (35.4%)	30 (44.1%)	18 (40.9%)	160 (48.0%)	39.475, < 0.001
	Important	6 (9.1%)	21 (23.3%)	24 (36.9%)	25 (36.8%)	5 (11.4%)	81 (24.3%)
	Slightly important	7 (10.6%)	10 (11.1%)	9 (13.8%)	6 (8.8%)	6 (13.6%)	38 (11.4%)
	Not important	15 (22.7%)	8 (8.9%)	9 (13.8%)	7 (10.3%)	15 (34.1%)	54 (16.2%)
Trustworthy	Very Important	40 (60.6%)	55 (61.1%)	27 (41.5%)	29 (42.6%)	18 (40.9%)	169 (50.8%)	39.206, < 0.001
	Important	4 (6.1%)	13 (14.4%)	22 (33.8%)	19 (27.9%)	7 (15.9%)	65 (19.5%)
	Slightly important	6 (9.1%)	13 (14.4%)	6 (9.2%)	14 (20.6%)	6 (13.6%)	45 (13.5%)
	Not important	16 (24.2%)	9 (10.0%)	10 (15.4%)	6 (8.8%)	13 (29.5%)	54 (16.2%)

“Positivity towards students” was highly valued, especially in the 1 st and 2nd years (62.1% and 63.3%, respectively). However, this importance was reduced by the 5th year (40.9%). “Caring” was most valued in the 1 st and 2nd years (57.6% and 56.7%, respectively). Its perceived importance decreased by the 5th year (40.9%). The trustworthiness of instructors was particularly important in the 1 st and 2nd years (60.6% and 61.1%, respectively), with a notable decline in the 5th year (40.9% in all three domains).

As shown in Table 7, the proportion of students strongly agreeing to statements on attendance, discipline in the class, & its effect on STR was compared across years of study. A good proportion of students, especially in the 5th year (36.4%), strongly agree that ignoring the disruption is the most proper action and has shown a statistically significant difference over the years. A significant portion of students believe that their attendance is affected by the student-teacher relationship, with the highest agreement in the 3rd year (43.1%) and 5th year (43.2%) (Table 7).

Table 7.

Students’ views on attendance, discipline in class, and the effect on student-teacher relationship compared between years of study

Questions		Year of study N (Percentages)					Total	Chi-square, P-value
		1 st year	2nd year	3rd year	4th year	5th year
In your opinion, your attendance is affected by the student-teacher relationship	Strongly agree	24 (36.4)	35 (38.9)	28 (43.1)	22 (32.4)	19 (43.2)	128(38.4)	9.790, 0.634
	Agree	21 (31.8)	30 (33.3)	22 (33.8)	30 (44.1)	13 (29.5)	116(34.8)
	Disagree	18 (27.3)	16 (17.8)	11 (16.9)	14 (20.6)	8 (18.2)	67(20.1)
	Strongly disagree	3 (4.5%)	9 (10.0%)	4 (6.2%)	2 (2.9%)	4 (9.1%)	22 (6.6%)
Teacher’s performance is affected by students’ attendance or absence	Strongly agree	20 (30.3%)	35 (38.9%)	24 (36.9%)	21 (30.9%)	18 (40.9%)	118 (35.4%)	8.957, 0.707
	Agree	22 (33.3)	32 (35.6%)	25 (38.5%)	33 (48.5%)	15 (34.1%)	127 (38.1)
	Disagree	20 (30.3%)	19 (21.1%)	12 (18.5%)	12 (17.6%)	10 (22.7%)	73 (21.9%)
	Strongly disagree	4 (6.1%)	4 (4.4%)	4 (6.2%)	2 (2.9%)	1 (2.3%)	15 (4.5%)
In your opinion, if there is a disruption in the class, the most proper action by the teacher is to expel the student	Strongly agree	17 (25.8%)	33 (36.7%)	21 (32.3%)	21 (30.9%)	13 (29.5%)	105 (31.5%)	16.052, 0.189
	Agree	19 (28.8%)	26 (28.9%)	22 (33.8%)	27 (39.7%)	8 (18.2%)	102 (30.6%)
	Disagree	25 (37.9%)	21 (23.3%)	17 (26.2%)	14 (20.6%)	14 (31.8%)	91 (27.3%)
	Strongly disagree	5 (7.6%)	10 (11.1%)	5 (7.7%)	6 (8.8%)	9 (20.5%)	35 (10.5%)
In your opinion, if there is a disruption in the class, the most proper action by the teacher is to reprimand the student	Strongly agree	16 (24.2%)	29 (32.2%)	15 (23.1%)	20 (29.4%)	12 (27.3%)	92 (27.6%)	7.328, 0.835
	Agree	39 (59.1%)	44 (48.9%)	30 (46.2%)	31 (45.6%)	23 (52.3%)	167 (50.2%)
	Disagree	8 (12.1%)	14 (15.6%)	15 (23.1%)	13 (19.1%)	7 (15.9%)	57 (17.1%)
	Strongly disagree	3 (4.5%)	3 (3.3%)	5 (7.7%)	4 (5.9%)	2 (4.5%)	17 (5.1%)
In your opinion, if there is a disruption in the class, the most proper action by the teacher is to Ignore it	Strongly agree	9 (13.6%)	28 (31.1%)	18 (27.7%)	19 (27.9%)	16 (36.4%)	90 (27.0%)	27.222, 0.007
	Agree	11 (16.7%)	24 (26.7%)	21 (32.3%)	20 (29.4%)	13 (29.5%)	89 (26.7%)
	Disagree	23 (34.8%)	17 (18.9%)	17 (26.2%)	20 (29.4%)	11 (25.0%)	88 (26.4%)
	Strongly disagree	23 (34.8%)	21 (23.3%)	9 (13.8%)	9 (13.2%)	4 (9.1%)	66 (19.8%)
Do you think the student-teacher relationship can positively or negatively affect academic achievement?	Strongly agree	43 (65.2%)	55 (61.1%)	38 (58.5%)	34 (50.0%)	29 (65.9%)	199 (59.8%)	11.257, 0.507
	Agree	21 (31.8%)	31 (34.4%)	26 (40.0%)	27 (39.7%)	14 (31.8%)	119 (35.7)
	Disagree	1 (1.5%)	2 (2.2%)	1 (1.5%)	5 (7.4%)	1 (2.3%)	10 (3)
	Strongly disagree	1 (1.5%)	2 (2.2%)	0 (0.0%)	2 (2.9%)	0 (0.0%)	5 (1.5)

A considerable number of students strongly believe that teacher performance is influenced by students’ attendance, with the highest in the 2nd year (38.9%) and 5th year (40.9%). Most students across all years agree that reprimanding a student is the appropriate action, with the highest agreement in the 2nd year (32.2%). The majority of students across all years strongly agree that the student-teacher relationship can affect academic achievement, with the highest agreement in the 1 st year (65.2%) and 5th year (65.9%). However, there was no statistically significant difference among the students of different years.

Table 8 shows the results of the views of students about teachers teaching methods, factors affecting trust in the teacher, and their own STRs. The proportion of students agreeing to certain statements were compared between years of study. We found a statistically significant proportion of students are influenced by previous students’ opinions, which was notably high, particularly in the 2nd and 4th years (72.2% and 72.1%, respectively) and a strong preference for interactive teaching over spoon feeding was evident, particularly in the 1 st year (77.3%) and the 3rd year (75.4%). Other sections showed different views among the different year students but were not significant.

Table 8.

Students’ views on different aspects of the student-teacher relationship compared between years of study

Factors		Year of Study N (Percentages)					Total	Chi-square, P-value
		1 st year	2nd year	3rd year	4th year	5th year
In your opinion the teacher who uses references for the lecture (book, handout, etc.) is	A good teacher	63 (95.5%)	86 (95.6%)	63 (96.9%)	68 (100.0%)	42 (95.5%)	322 (96.7%)	3.232, 0.520
	A bad teacher	3 (4.5%)	4 (4.4%)	2 (3.1%)	0 (0.0%)	2 (4.5%)	11 (3.3%)
Did the opinions of the previous students affect your view of the teacher?	Yes	27 (40.9%)	65 (72.2%)	40 (61.5%)	49 (72.1%)	27 (61.4%)	208 (62.5%)	19.450, 0.001
	No	39 (59.1%)	25 (27.8%)	25 (38.5%)	19 (27.9%)	17 (38.6%)	125 (37.5%)
In general, do you trust the teacher’s advice?	Yes	62 (93.9%)	86 (95.6%)	61 (93.8%)	62 (91.2%)	41 (93.2%)	312 (93.7%)	1.286, 0.864
	No	4 (6.1%)	4 (4.4%)	4 (6.2%)	6 (8.8%)	3 (6.8%)	21(6.3%)
I am interested in attending lectures from the teacher who uses the method of	Spoon feeding	15 (22.7%)	41 (45.6%)	16 (24.6%)	21 (30.9%)	13 (29.5%)	106 (31.8%)	12.027, 0.017
	Interactive teaching	51 (77.3%)	49 (54.4%)	49 (75.4%)	47 (69.1%)	31 (70.5%)	227 (68.2%)
How do you evaluate the current relationship between you and your teachers?	Very good	32 (48.5%)	40 (44.4%)	24 (36.9%)	23 (33.8%)	18 (40.9%)	137 (41.1%)	12.293, 0.422
	Good	33 (50.0%)	50 (55.6%)	38 (58.5%)	43 (63.2%)	25 (56.8%)	189 (56.8%)
	Bad	0 (0.0%)	0 (0.0%)	2 (3.1%)	2 (2.9%)	0 (0.0%)	4 (1.2%)
	Very bad	1 (1.5%)	0 (0.0%)	1 (1.5%)	0 (0.0%)	1 (2.3%)	3 (0.9%)

Furthermore, these comparisons were also done between different genders and the grade point average (GPA) of the students. In each of the sections, proportion of male students having a positive perception was compared to the proportion of female students.

The female students considered trust as the most important aspect of motivation to learn. They also considered trusting the teacher’s advice and following the teacher’s decision to have a positive influence on a strong STR. There was no statistically significant difference between the views of male and female students on attendance, and discipline as important contributors to a good STR (Table 9). Both male and female students had similar opinions on other motivating factors for learning, as well as factors influencing a good STR [Supplementary Tables 3, 4, 5, 6, 7]. When responses were compared between students with a GPA of more than 3 (high achievers in the context of this research) and less than 3 (low achievers), 97.9% of the students viewed their relationship with their teachers as good and very good. Students also agreed that their attendance in class, and teachers’ performance in class is influenced by the individual STRs (73.2%, and 73.5% respectively) [Supplementary Tables 8–12]. The students had significantly different opinions about whether it is a proper action to ignore it when there is a class disruption [55.5% of high achievers agreed vs. 63.2% low achievers (p = 0.006), and whether the teacher who uses references for the lecture (book, handout, etc.) is a good teacher [98.9% of high achievers agreed vs. 94.2% low achievers (p = 0.017)]. [Supplementary Tables 8–12].

Table 9.

Gender difference in perception of STR

Aspects compared	Factor	Responses	Chi-square, P-value	Significance
Characteristics of the teacher that motivate you to learn	Well-intentioned behavior	Important Males-85.8% Females-82.4%	9.012, 0.029	Male students consider the well-intention of the teacher as a significant factor influencing their motivation to learn
Characteristics of the teacher that you consider important for a strong STR	Trust-worthy behavior	Important Males-95% Females-98.7%	9.345, 0.025	Female students consider the Trustworthy behavior of the teacher as a significant factor for strong STR
Views about their teacher influencing strong STR	It is obligatory to follow the teacher’s decisions	Yes Males- 80.1% Females- 90.1%	10.865 0.012	Female students following the teacher’s decisions is a significant factor for a strong STR
Attendance, discipline, and STR	No factor shows a significant difference	An equal proportion of students of both genders had similar perception	p > 0.05	There was no gender difference in views on factors like attendance and discipline affecting STR
Aspects affecting STR	Trusting the teacher’s advice	Yes Males- 89.6% Females- 95.6%	4.362, 0.037	Female students perceived trusting the teacher’s advice as a significant factor for strong STR

Qualitative study (interviews)

A total of ten faculty and TAs participated, with six females and four males, reflecting the gender ratio in the university. The students were interviewed till a saturation of answers was obtained. Saturation was determined by the point at which no new codes or insights emerged from successive interviews. After nine student interviews, the team observed that the responses repeated prior themes without introducing new concepts, suggesting thematic saturation [33, 34]. Finally, nine students were included, with five females and four males [34].

The questions used were

1. What do you consider a successful student-teacher relationship?

2. What are the qualities that a teacher should have in order to develop a positive relationship with students?

3. How does your relationship with your teachers/students influence your emotional and mental well-being?

4. What is the role of technology, you know, in building this relationship between a teacher and a student?

5. Would you like to make some recommendations to policymakers for creating policies that support student-teacher relationships?

Thematic analysis

Thematic analysis was used for the data obtained from the interviews using Braun and Clarke’s six-phase framework for thematic analysis. The thematic analysis process with the actual responses highlighted key phrases or concepts for questions, such as easy reach, easy to communicate, full transparency (used more than once), non-judgmental, familiarization, considerate, encouraging the student to learn, and for the future, if planning in the field. Ultimately, five themes were refined to accurately represent the data: emotional and psychological support, effective communication, and transparency; role of technology, and institutional recommendations (Table 10).

Table 10.

Details of thematic analysis

Domain	Themes & Sub-Themes	Example verbatim
Psychological Support	Emotional and Psychological Support: Mental well-being, Comfort and trust, Motivation and engagement	“When I have a good relationship with my teacher, I focus more in class.” “It affects mental well-being… makes me feel supported.” “A good mentor especially influences mental health positively.”
Communication and Trust	Effective Communication: Accessibility, Timely response, Clarity in interaction	“Easy to communicate with the teacher and express my feelings.” “Technology helps in timely communication, even WhatsApp.” “Can reach teachers immediately when in doubt.”
	Transparency and Trust: Non-judgmental attitude, Openness, Familiarity	“Full transparency with the teacher… both personal and academic.” “Teachers should be non-judgmental and open to suggestions.” “Being able to speak freely without embarrassment is important.”
Teacher attributes	Interpersonal Qualities of Teachers: Empathy, Humor, Patience, Listening	“A teacher should be empathetic and willing to listen.” “Having a sense of humor helps improve the relationship.” “Patience and good listening are essential for connection.”
Leaning Infrastructure	Role of Technology: Ease of communication, WhatsApp/social media, Mixed perceptions (positive and negative)	“Using WhatsApp helps me stay connected with the teacher.” Technology has both good and bad impacts on relationships.” “PowerPoint and digital tools support learning and bonding.”
	Institutional Recommendations: Class size reduction, Small-group learning, Teacher training, Feedback loops	“Reduce class size so each teacher can focus on students.” “We need more small-group teaching to improve STR”. “Surveys help give specific feedback to teachers.”

While 80% of participants said that they have successful student-teacher relationships with one or more individuals, 20% felt it was unnecessary or time-consuming. The thematic analysis process with the actual responses highlighted key phrases or concepts for Q2 were openness, humor, kindness, good listener and advisor, empathy, open to conversation, positive attitude, tolerance, being friendly, balance between being friendly and strict, being patient, and good administrative and interested in teaching. The themes that emerged were being a good teacher, communicator, and possessing interpersonal qualities are most important for a good student-teacher relationship. The thematic map of the analysis is provided in Fig. 1.

Fig. 1.

Thematic map

All the participants believed that relationships with your teacher/student influence the emotional and mental well-being of an individual. This was more affirmative in students (having good STR) compared to the teachers, who felt that it was important but did not necessarily have a greater impact. The actual responses for Q3 were if the relationship (for the student with the teacher) is bad, the student loses interest in the subject, and does not perform well; with a bad STR student is closed off. It was interesting to note that students felt bad STR affects their learning of the subject negatively, despite putting in the same effort, compared to subjects in which they have good STR. This was related to the mental well-being and feelings around the subject.

Nine out of the ten participants felt that technology has an impact on the STR. The thematic analysis process, with the actual responses highlighted key phrases or concepts for Q4, was connectivity, timely communication, and easy approachability. While the students were positive about the use of technology, teachers felt that technology should be appropriately used for optimal benefits. Two participants strongly felt that technology is good for communication, but it can hamper STR adversely. The concern was the perceived lack of actual human interaction with digital use.

The majority of participants did not have any recommendations for Q5. Some of the actual responses “We need to reduce the class size so that there can be more focus on building STR”, the STR is always better with small groups, so we need more small-group teaching”, and “We have the surveys which give us an opportunity for specific suggestions to teachers”. These highlight a wish for better STR, which they perceive can improve teaching and learning.

In summary, the students emphasized ease of communication, transparency, empathy, and feeling encouraged, linking positive STR to better mental well-being and academic engagement. They preferred approachable, kind, and balanced teachers, and viewed technology as helpful for timely interaction. Teachers, while recognizing STR’s importance, were more reserved about its emotional impact, highlighting professional boundaries. They valued being good advisors and noted that technology, if misused, could hinder authentic interactions. Both groups suggested small-group teaching and better feedback mechanisms to improve STR. Overall, students focused on emotional connection, while teachers leaned towards structure and responsible interaction.

Integration of quantitative and qualitative results

Quantitative surveys revealed patterns of preference and significant associations between teacher characteristics and student motivation, while qualitative data explored the rationale behind it. The quantitative survey findings show qualities like impressive, inspiring, compassionate, and reliable were highly valued by students across different colleges [Table 2]. This was reinforced by qualitative interviews, where students further emphasized the importance of emotional and psychological support, trust, and interpersonal warmth as fundamental components of effective STR. The strong preference for reliability and trustworthiness among medical and pharmacy students (e.g., 75.8% and 68.8%, respectively) mirrors qualitative comments highlighting that trust and emotional safety with teachers significantly impact students’ willingness to engage and seek help [Table 10]. Students’ appreciation of respectful behavior and helpfulness outside class is consistent with qualitative themes around approachability (contacting teachers via WhatsApp and receiving timely responses) [Tables 3 and 10]. The survey showed that students agreed that STRs affect attendance and discipline (e.g., 38.4% strongly agreed that attendance is affected). Students also stated that poor relationships led to disengagement, while supportive STR leads to better attendance and class participation [Tables 4 and 10]. The qualitative responses showed that students valued non-judgmental teachers who gave clear guidance and created an open environment. This role as advisors was supported by quantitative data, where over 90% of students reported trusting their teachers’ advice [Tables 5 and 10]. While quantitative data showed a preference for interactive teaching methods, interviews revealed that such methods (e.g., small group teaching) improve emotional engagement and enhance students’ motivation to learn.

Discussions

This study explored the influence of STR on student motivation to learn, factors affecting the strength of STR from students’ perspectives, and their views on good teacher characteristics. It also compared the colleges, genders, as well as different years of students through a mixed-method study. The convergent parallel approach allowed for the simultaneous collection of broader quantitative patterns and rich qualitative insights, to explore both depth and breadth to understand STR [35]. The consistency across data types affirms the validity of the multi-methods approach and highlights the value of integration in understanding STR in health professions education. Although several studies report STR in the context of school students, there is a paucity of data reporting in college, rarer still in the context of higher education like health professions education [36–40]. In this study, it was found that certain characteristics of the teachers had a positive influence on students’ motivation to learn. Impressive and inspiring teachers, who are warm, compassionate, and demonstrate trustworthy, well-intentioned, and reliable behavior, can instill confidence in students. These are positive motivations to learn. Empirical studies in school students have shown that students with good STR with their teachers participate more often in learning activities [41, 42]. They have not included students in college or specific qualities, attitudes, and behaviors in detail. Another study similarly reports that the students feel positive about STR when they like teachers’ personalities, especially conversation style and humor [43]. However, humor in particular was not explored in our study.

Relationships in general are a complex process and bidirectional in nature. The teacher-student relationship is also dynamic through stages of life and educational levels [43]. It has the potential to affect both persons in a relationship equally. It has been shown that teachers’ professional and personal well-being is affected by individual STR [44]. Studies have also shown that a positive STR can promote students’ academic goals, achievements as well and learning by regulating mental emotions [45, 46]. According to Thornberg et al. (2020), teachers’ actions inside and outside the classroom can significantly affect STR. Students feel encouraged when the teacher is caring and supportive [47]. Our study also reported that teachers help the students outside the class, answer questions during lectures, and respect them. Our study participants expressed their agreement that STR can affect teachers’ performance, students’ attendance in class, as well as their academic achievements. A recent study involving college students by Malik (2023), showed that (college) students acknowledge the influence of STRs on their classroom engagement, academic attainment, behavior, and adaptability, among other factors [48]. These earlier research findings are in accordance with our study, which also shows that STR has a profound influence on students’ learning in health professions education.

Yu et al. (2018) reported that “free” and “same-level” conversations promote positive TSRs in the adolescent age group. In our study, the students were in late adolescence-adulthood [39]. Hence, they also expressed that the friendly attitude of the teachers is conducive to STRs. Similar to the existing research, the views did not differ significantly in the majority of aspects on the gender of the students [43, 48, 49].

It was discovered that factors affecting the creation of strong STR are teachers’ respect, openness, willingness to communicate, curiosity, and positive enthusiasm toward students in a school context [13, 43]. Later, Malik (2023) demonstrated that teachers’ characteristics and ages, pedagogy, friendlier approach, attitude, students’ characteristics, positive and negative experiences, and cultural similarities affect students to make relationships with teachers [48]. This is following our study where the factors are friendly, reliable, trustworthy, and having a positive attitude towards students. Other researchers similarly suggested that teachers can be considered listeners in mental health, leaders in academic learning, and supporters in creative thinking in the relationship between teachers and students, to establish and promote positive teacher-student relationships and improve students’ learning outcomes [45, 46].

The study by Abdulrehman (2021) comprehensively compares the different aspects of STR concerning the GPA of the students [50]. It showed that only 61% of the samples evaluated their relationship with their teachers as good or very good, and it was significantly associated with their grades (p = 0.012). This is in contrast with our study showing that 97.9% of the students viewed their STRs as good and very good, and there was no association with their GPAs (p = 0.888). Similarly, students of different GPAs have different views on whether it is appropriate to expel the students from the class due to disruptive behavior. While 68.4% of students with a GPA of less than three felt it was appropriate, only 56.7% of students with a GPA of more than three felt so. This was in contrast with the study by Abdulrehman, where 84.1% of students with higher and above-average grades felt that expulsion from class was an appropriate means of controlling the class. The views were statistically different between the groups regarding whether it is appropriate to ignore students’ disruptive behavior (p.006). However, in accordance with the study by Abdulrahman, the responses to most of the items by the students were independent of their grades.

A few qualitative studies explored factors affecting STR in the context of education in schools. Research reported that dimensions of closeness, conflict, and dependency affect STR in schools. Additional dimensions such as authority, balance, distance, fairness, increasing student motivation, patience, and strictness were identified [51]. The study also reported that although the basic concepts remain the same, the relative influences of these factors are contextual and differ with regard to collectivistic versus individualistic culture [51]. It agrees with our studies in certain aspects, like fairness, increasing student motivation, balance, and patience. However, faculty & students in health professional education also viewed the relationship from an adult perspective and expressed that openness, humor, kindness, being a good listener and advisor, empathy, open to conversation, positive attitude, tolerance, and being friendly are important factors for a good STR. Additionally, the effect of technology was explored in our study. Both students and teachers felt that technology has a potential for adversely affecting STR, but can be helpful if used appropriately.

Strengths and limitations

The limitations of this study are that it was conducted in one university and involved only students of health professions education. Furthermore, experts were not consulted while preparing the questionnaire, and individual comparisons of study findings were limited due to a paucity of literature about the STR in the context of health professions education. However, the faculty members consulted were experienced in medical education, as well as in qualitative research, and the discussion compared the findings to STR at other contexts. The strengths are that it is one of the very few exploring different aspects of STR, and its influence on learning, through a multi-method study. It further compared the different college students, genders, and different academic years.

Significance of the study

The significance of studying the student-teacher relationship in the healthcare profession lies in its profound impact on the quality of education, clinical competence, and professional development of future healthcare providers. Positive and negative STR can directly influence their learning outcomes as a supportive environment for learning skills, asking questions, making mistakes, and being corrected will develop students’ critical thinking, problem-solving, and clinical judgement. Students expect qualities like empathy, humor, patience, and active listening in their teachers (Table 10), who often act as mentors, shaping students’ attitudes toward patient care, teamwork, and responsibility.

Positive student-teacher relationships are linked to improved academic performance as depicted in Tables 4 and 7, greater student motivation as shown in Table 9, and better mental and emotional well-being as opined in the details of the thematic analysis in Table 10.

By systematically investigating the factors that influence student-teacher relationships, the researchers aim to uncover critical insights that can enhance the quality of these relationships. For educators, the findings will provide evidence-based strategies to foster more effective and supportive interactions with students, thereby enhancing teaching effectiveness and student learning experiences. Institutions can utilize the recommendations to create policies and programs that promote a positive and inclusive educational environment, ultimately leading to better educational outcomes and higher retention rates.

This study offers actionable insights that can drive systemic improvements and support the holistic development of students in healthcare education.

Conclusion

The student-teacher relationship is complex, dynamic, and bidirectional. It affects students in terms of attendance, discipline, and academic achievement, and teachers in self-confidence and performance as an educator. Health professional students consider teacher characteristics like friendly approach, reliability, and trustworthiness as important factors for STR, and motivation to learn. Both teachers and students agree that technology should be appropriately used to be beneficial for STR. There is a need for future studies on student-teacher relationships in the context of higher education, as well as health professional education.

Recommendations

The researchers would like to make the following recommendations to the faculty:

The first and most important one is effective communication. Communication and feedback mechanisms are essential for fostering a positive student-teacher relationship. Another important aspect of this relationship is student engagement. Teachers should actively engage with students, sharing their thoughts and providing clarification. Moreover, keeping a record of progress is of utmost importance as regular assessments and individual tutoring help teachers identify and address learning challenges, creating a supportive learning environment. With the fragile egos and sensitivities of the present generation, respect and equality are fundamental, with teachers recognizing each student’s individuality and avoiding authoritarianism. Additionally, teachers must prioritize students’ mental health, providing emotional support alongside academic guidance. Teachers can enhance students’ resilience and development by addressing these academic and emotional needs.

Abbreviations

STR

Student Teacher Relationship

SoTL

Scholarship of Teaching and Learning

CI

Confidence interval

TA

Teaching Assistant

GPA

Grade Point Average

SPSS

Statistical Package for Social Sciences

Authors’ contributions

Dr. H.Z. and Dr. R.D. conceived the idea, discussed it with other authors, and prepared the questionnaires and the first draft. Dr. M.G. and Dr. S.S.K. revised the questionnaires and sent them to the participants and conducted the interviews. Dr. O.J. & Dr. M.G. analyzed the data, and finally, Dr. H.Z., Dr. R.D., and Dr. S.S.K. wrote the results and discussions. In the end, all the authors revised the manuscript and finalized it.

Funding

No funding was received for the research.

Data availability

All the data for the study is either included in the text or provided as supplementary material. It is not deposited in any external repository.

Declarations

Ethics approval and consent to participate

This research follows the steps of the Declaration of Helsinki (revised 2013). It was approved by the Research & Ethics Committee of RAK Medical and Health Sciences University (RAKMHSU-REC-232-2022/23-F-GE) dated July 10, 2023.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.