Exploring the dimensions of role transition to clinical educator among master’s anaesthesia students in Iran: protocol for a sequential multimethod study (exploratory–analytical)

Abstract

Introduction

The transition from clinical practice to an academic role presents a multifaceted challenge for anaesthesia master’s students in Iran, as it demands not only clinical expertise but also the development of educational competencies. This protocol outlines a sequential multimethod study designed to explore the dimensions of this role transition, identify the challenges and facilitators inherent in assuming a clinical educator role, and ultimately provide a foundation for evidence-based educational interventions.

Methods and analysis

This sequential multimethod protocol comprises three phases. Phase I involves qualitative thematic content analysis using semistructured focus groups and, where necessary, individual interviews with MSc anaesthesia students to explore experiences of role transition. Qualitative data will be analysed using Braun and Clarke’s six-phase approach. Phase II consists of an integrated review of the literature to synthesise existing evidence on transition to clinical educator roles in anaesthesia and related healthcare disciplines. Phase III integrates findings from both phases using the Pillar Integration Process to generate a comprehensive, evidence-informed framework of role transition.

Ethics and dissemination

Ethical approval for the study has been obtained from Tehran University of Medical Sciences (IR.TUMS.SPH.REC.1403.236), and written informed consent will be secured from all participants. Findings will be disseminated through publications in reputable peer-reviewed journals and presentations at national and international conferences, contributing to the refinement of training programmes for clinical educators within anaesthesia education.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study uses a sequential multimethod design combining qualitative thematic content analysis and an integrated review to provide a comprehensive understanding of role transition.

• It focuses on anaesthesia master’s students in Iran, an under-researched population in clinical education research.

• Data integration is strengthened through the Pillar Integration Process, enhancing methodological rigour and transparency.

• The cultural and educational specificity of the Iranian context may limit the transferability of findings to other settings.

• Reliance on self-reported data may affect the accuracy of participants’ accounts of their experiences.

Background

The transition from a predominantly clinical role to that of a clinical educator represents a complex, multifaceted process that has garnered increasing attention in the field of healthcare education.¹ Traditionally, the training of anaesthesia professionals in Iran has focused heavily on the development of advanced clinical competencies.² However, as healthcare systems evolve, graduates of anaesthesia master’s programmes are increasingly expected to undertake educational responsibilities in both academic and clinical settings.³ This dual expectation necessitates not only clinical excellence but also a significant shift in professional identity, requiring the acquisition of pedagogical skills, effective communication strategies and the ability to foster an engaging learning environment.⁴

A growing body of literature indicates that clinicians transitioning to educator roles often face considerable challenges.^{5 6} These include the lack of formal training in educational methodologies, role ambiguity⁷ and the psychological stress associated with the sudden shift in responsibilities.⁸ Moreover, the absence of structured support systems and mentoring programmes compounds these difficulties, resulting in varied levels of preparedness among new clinical educators.⁹ In many instances, the clinical educator role is assumed with minimal preparatory training, leading to gaps in teaching competencies that can adversely affect both the quality of education and patient care outcomes.^{10 11}

Recent advances in competency-based education, particularly through frameworks such as entrustable professional activities (EPAs), have offered promising avenues for standardising and improving clinical teaching. EPAs provide a structured approach to defining the essential tasks that clinical educators should be able to perform independently, thus serving as a bridge between clinical expertise and educational proficiency.¹² Despite their proven utility in several international contexts, the application of these frameworks within the Iranian healthcare education system remains limited. This gap is particularly evident in the training of anaesthesia master’s students, where curricular emphasis has traditionally been placed on clinical skill acquisition rather than on teaching and mentorship capabilities.¹³

Furthermore, studies conducted in other regions have underscored the critical importance of tailored transition programmes that support the development of teaching skills alongside clinical competencies.¹⁴ Key challenges reported in these studies include identity conflicts, time management issues and a lack of effective feedback mechanisms, all of which hinder the smooth transition into an educational role.^{15 16} Although these findings provide valuable insights, they are often derived from contexts that differ significantly in terms of cultural, structural and educational norms when compared with the Iranian setting.

Evidence from nurse anaesthesia and other healthcare disciplines indicates that transitions from clinical practice to educator roles are frequently accompanied by significant professional and psychological challenges. Studies among nurse educators, midwives and advanced practice clinicians have highlighted recurring difficulties such as role ambiguity, identity conflict, insufficient pedagogical preparation, limited institutional support and increased workload during early teaching experiences.^{8 10 16} In nurse anaesthesia education specifically, the emphasis on clinical expertise often precedes formal preparation for teaching roles, leaving graduates underprepared for educational responsibilities.^{1 12}

Commonly reported dimensions of role transition include professional identity reconstruction, development of teaching competence, perceived readiness, mentorship and organisational support, and emotional adaptation to new responsibilities.^{8 10 16} Understanding these dimensions is critical, as ineffective role transition may negatively affect teaching quality and learner outcomes.¹⁷ Despite growing recognition of these challenges, there remains a lack of context-specific, integrated evidence addressing how nurse anaesthesia students experience and navigate this transition, particularly within non-Western educational systems.

Given these considerations, there is a compelling need to investigate the unique experiences, challenges and facilitators associated with the transition to the clinical educator role among anaesthesia students in Iran. A sequential exploratory multimethods approach, incorporating both qualitative data from focus group discussions and semistructured interviews as well as an integrated review of the literature, offers a robust framework for addressing this research gap.¹⁸ This methodological strategy will enable a comprehensive exploration of the lived experiences of novice clinical educators while simultaneously situating these findings within the broader context of existing research.¹⁹ Ultimately, the insights gained from this study are expected to inform the development of evidence-based educational interventions and support structures tailored to the needs of MSc anaesthesia students. By enhancing the transition process, these initiatives can contribute to improved teaching effectiveness, better learner outcomes and, ultimately, higher standards of patient care in clinical environments.

Study objectives

The primary objective of this study is to explore and conceptualise the dimensions of role transition from clinical practice to the clinical educator role among anaesthesia master’s students in Iran. The secondary objectives are: (1) To identify perceived challenges and facilitators influencing the transition to the clinical educator role. (2) To synthesise existing evidence on role transition to clinical educator roles in MSc anaesthesia and related healthcare disciplines through an integrated review. (3) To integrate qualitative findings and literature-based evidence using the Pillar Integration Process (PIP) in order to generate a comprehensive, evidence-informed framework of role transition.

Methods

Study design

This study will employ a sequential multimethods approach, integrating both exploratory and analytical designs. Although this study employs an integration framework, it is conceptualised as a sequential multimethod design rather than a mixed-methods study, as quantitative and qualitative data are not collected concurrently or merged at the level of primary data. A detailed chart illustrating the stages of this study is provided in figure 1. The study is planned to commence in April 2025 and will continue until December 2026.

Figure 1. Study stages showing the study’s sequential multimethod design with key phases and activities.

Phase I: thematic content analysis

Participants/sample size

Participants will be purposefully selected from master’s students of anaesthesia at Tehran University of Medical Sciences and Iran University of Medical Sciences. A minimum of 8–10 students will be recruited for each focus group session, and sampling will continue until theoretical saturation is achieved.²⁰ This approach ensures that the insights and experiences regarding the transition to the clinical educator role are drawn from a targeted and contextually relevant population, enabling a rich exploration of the unique challenges and facilitators within the anaesthesia discipline.

Inclusion criteria

Eligible participants must be currently enrolled in a master’s programme in anaesthesia at either Tehran University of Medical Sciences or Iran University of Medical Sciences and be either actively engaged in or preparing for the transition to a clinical educator role. They should have sufficient experience in both clinical practice and academic training to provide comprehensive insights into their transitional experiences. Additionally, participants must provide written informed consent prior to participation, ensuring that their involvement is both voluntary and ethically compliant.

Exclusion criteria

Individuals who are unwilling to consent to audio recording or participation in focus group sessions, or who face significant scheduling conflicts that hinder active engagement, will be omitted.

Interview guide development

The interview guide will be developed through a rigorous process that includes consultations with experts in clinical education and qualitative research methodologies. The guide is specifically designed to facilitate semistructured interviews, ensuring that a core set of questions directs the discussion while allowing interviewers the flexibility to probe deeper into emerging themes.²¹ Initial questions will focus on exploring the key dimensions of transitioning to a clinical educator role, with particular emphasis on the challenges and facilitators relevant to anaesthesia. Example questions include: ‘Can you describe how your professional identity has shifted since you began taking on educational responsibilities?’, ‘What specific challenges have you faced in balancing your clinical duties with the requirements of teaching?’ and ‘What factors in your clinical or academic environment have most facilitated your transition to an educator role?’

The draft guide will undergo pilot testing in an initial focus group session, and feedback from both academic and clinical experts will be integrated to enhance its clarity, relevance and comprehensiveness. This iterative development process ensures that the guide effectively supports dynamic and in-depth discussions aligned with the study’s objectives.

Data collection

Data will be collected through semistructured focus group discussions conducted in a confidential and supportive environment. Each session, facilitated by a trained moderator with expertise in qualitative research techniques, will last approximately 60–90 min. With the participants’ consent, sessions will be audio-recorded to ensure precise transcription, and detailed field notes will be maintained to capture non-verbal cues and contextual details. Data collection will continue until no new themes emerge, thereby ensuring an in-depth exploration of the transitional experiences of MSc anaesthesia students. Individual semistructured interviews will be conducted if focus group participation is not feasible or if deeper exploration of individual experiences is required.

Data analysis

Data analysis will be conducted using thematic content analysis following the six-phase approach described by Braun and Clarke.²² The process includes:

1. Familiarisation with the data: Researchers will begin by reading and rereading the transcribed interview recordings to immerse themselves in the data. This initial phase involves noting preliminary observations and reflections to develop an in-depth understanding of the content.

2. Generating initial codes: During this stage, researchers will systematically work through the transcripts, identifying and labelling segments of text that are pertinent to the research objectives. Each meaningful segment will be assigned a code using qualitative data analysis software (eg, MAXQDA), ensuring that even subtle nuances are captured.

3. Searching for themes: After coding, the next step involves collating related codes into potential themes. Researchers will review and group codes that share common features or patterns, forming broader categories that encapsulate the key aspects of the data. This grouping will aid in revealing underlying patterns across participants’ experiences.

4. Reviewing themes: The preliminary themes will then be refined through an iterative process. Researchers will verify that each theme accurately represents the coded data and the overall data set. This step may involve merging similar themes, splitting those that are too broad or discarding themes that lack sufficient supporting data, thereby creating a coherent thematic map.

5. Defining and naming themes: In this phase, each theme will be clearly defined and given a concise name that reflects its essence. Researchers will articulate what each theme represents, how it relates to the research questions and what unique insights it provides into the transition process. This ensures that each theme is distinct, coherent and grounded in the data.

6. Producing the report: The final step involves synthesising the analysis into a comprehensive report. Researchers will select vivid data extracts to illustrate each theme, linking the findings back to the research objectives and existing literature. The report will present a coherent narrative that explains the key insights and implications regarding the transition to a clinical educator role among MSc anaesthesia students.

Throughout this process, strategies such as member checking, triangulation and peer debriefing will be employed to ensure the credibility and reliability of the analysis. Multiple researchers will independently code the data and collaborate to resolve any discrepancies, thereby strengthening the trustworthiness of the final themes.

Rigor and trustworthiness

To ensure rigour and trustworthiness, the following strategies will be applied:

Credibility: Extended engagement with the data, member checking and peer debriefing will validate that the interpretations accurately reflect participants’ experiences.²³

Dependability: An audit trail will document all data collection and analysis steps, with independent coding by multiple researchers and resolution of discrepancies through consensus.²⁴

Confirmability: Triangulation, the use of qualitative data analysis software (eg, MAXQDA) and reflexive journaling will ensure that findings are grounded in the data and free from researcher bias.²³

Transferability: Rich contextual descriptions of the study setting and participant characteristics will allow others to assess the applicability of the findings to similar contexts.²⁵

Phase II: integrated review

The transition from student to clinical educator involves multifaceted dimensions, including individual preparedness, institutional support and cultural context. An integrated review excels in handling such complexity by systematically synthesising findings across studies to identify patterns, contradictions and gaps.²⁶ This protocol is reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The details of the integrative review in this study will be as follows:

Search strategy

A systematic search will be conducted across multiple bibliographic databases including PubMed, Scopus, Web of Science and CINAHL. The search will employ both controlled vocabulary (eg, Medical Subject Headings terms) and free-text keywords such as ‘Transition to Clinical Educator Role’, ‘Nurse Anesthesia Education’, ‘Clinical Educator’ and ‘Competency-Based Education’. Boolean operators (AND, OR) will combine these terms to enhance the search’s comprehensiveness. Limits will be applied to capture literature published in the last ten years in English and Persian. Persian-language studies will be identified through national databases such as Scientific Information Database (SID) and MagIran, and relevant findings will be integrated alongside international literature. The 10-year publication limit was applied to capture contemporary evidence, reflecting recent advancements in competency-based education frameworks such as EPAs.

An example search strategy for PubMed will include the following string: ((“clinical educator”[Title/Abstract] OR “clinical teaching”[Title/Abstract] OR “clinical instructor”[Title/Abstract] OR “nurse educator”[Title/Abstract] OR “nurse anesthesia”[Title/Abstract] OR “anesthesia nursing”[Title/Abstract]) AND (“role transition”[Title/Abstract] OR “professional transition”[Title/Abstract] OR “academic role”[Title/Abstract] OR “transition to practice”[Title/Abstract] OR “role adaptation”[Title/Abstract])) AND (“2015/01/01”[Date - Publication] : “3000”[Date - Publication]).

Additionally, the reference lists of key articles will be manually reviewed to identify any relevant studies that may have been missed during the initial search. Methodological quality will be assessed using the Mixed Methods Appraisal Tool, which allows consistent appraisal across qualitative, quantitative and mixed-design studies included in this integrated review.

Inclusion and exclusion criteria

Studies will be included if they focus on aspects of the transition to clinical educator roles within the context of anaesthesia education. Eligible articles must present empirical data or comprehensive reviews, be published in peer-reviewed journals and have been published in the last 10 years. Both qualitative and quantitative studies will be considered, provided they offer insights into the challenges, facilitators and outcomes associated with this transition. Articles that do not pertain specifically to nurse anaesthesia or that lack clear methodological frameworks will be excluded, as will publications not available in full text or not written in English or Persian.

While focusing on peer-reviewed articles, contemporary dissertations like Martinez⁹ were included to capture unique data on nurse faculty transitions currently unavailable in journals. This aligns with integrated review principles to synthesise diverse evidence types.

Phase III: data synthesis

The synthesis of data will be guided by the PIP as described by Johnson et al.²⁷ In this phase, data from Phase I (qualitative findings from focus groups and semistructured interviews) and Phase II (the integrated review) will be systematically juxtaposed using a joint display matrix. This matrix will facilitate the visual comparison of themes, enabling the identification of convergent patterns, discrepancies and complementary insights across the different data sets.²⁸ The process ensures that the emergent themes are robustly grounded in both the subjective experiences of the MSc anaesthesia students and the broader evidence from the literature.

Initially, the qualitative data will be organised into thematic domains derived from the thematic content analysis of focus group discussions and semistructured interviews. Concurrently, the quantitative data and findings from the integrated review will be categorised according to their respective dimensions. These two distinct data sets will then be aligned side by side in a joint display, with each column representing elements from one data source. The integration process will proceed by mapping these elements against one another to reveal the extent to which the qualitative insights corroborate, extend or challenge the quantitative trends, thereby identifying areas of convergence where both data types support similar interpretations and areas of divergence where discrepancies may offer opportunities for further inquiry.

Subsequent to this comparative mapping, integrated pillars will be constructed. Each pillar will represent a core theme in the transition to the clinical educator role and will be substantiated by evidence drawn from both data sources. This step involves synthesising the aligned data into coherent, integrated statements that capture the complexity of role transition. These integrated pillars not only consolidate the key facilitators and barriers identified throughout the study phases but also serve to articulate the underlying mechanisms that influence the transition process, thereby providing a comprehensive, evidence-based understanding of the phenomenon.

Finally, the joint display and the resultant pillars will inform an interpretative narrative that contextualises the integrated findings within the broader framework of clinical educator role transition.

Validity and accuracy

To ensure the validity and accuracy of our synthesised findings, we draw on principles from the Mixed Methods Integration Quality Framework as outlined by Fàbregues et al²⁹ while maintaining a sequential multimethod study design. This framework provides clear guidelines for achieving methodological coherence, integration transparency and credible metainferences in mixed-methods research.

Initially, thematic domains derived from our qualitative analysis are systematically aligned with the corresponding dimensions identified in the quantitative integrated review. This alignment is visually represented in a joint display matrix, which not only facilitates the identification of convergent and divergent findings but also serves as a transparent audit trail of the integration process.²⁹

Transparency is further ensured by meticulously documenting each step of data categorisation, mapping and synthesis. Detailed records of how qualitative insights were compared with quantitative trends allow for external scrutiny and enhance the reproducibility of our methods. In addition, iterative validation procedures, including member checking, triangulation and peer debriefing, are employed throughout the synthesis phase.²⁹ These techniques help verify that the integrated pillars accurately reflect the complex process of transitioning to the clinical educator role.

Discussion

The transition from clinical practitioner to clinical educator represents a pivotal shift for anaesthesia master’s students in Iran, necessitating a blend of advanced clinical expertise and newly acquired pedagogical competencies. This protocol outlines a novel sequential multimethod study designed to explore the dimensions of this role transition, identify the challenges and facilitators inherent in assuming a clinical educator role and lay the groundwork for evidence-based educational interventions. By integrating qualitative thematic content analysis with an integrated review, this study aims to provide a comprehensive and contextually grounded understanding of the transition process, addressing a critical gap in the literature that has largely overlooked the experiences of MSc anaesthesia students in Iran.

This protocol represents a novel initiative to explore the role transition of MSc anaesthesia students into clinical educator positions within the Iranian context. This study’s emphasis on contextual factors will enrich the global discourse by illustrating how systemic and cultural elements shape the transition experience, offering a counterpoint to studies conducted in more resource-rich environments. Recognising the evolving demands placed on clinical educators in modern healthcare, this study seeks to generate insights that may drive both educational and operational reforms. By focusing on the nuanced experiences of anaesthesia students, the research aims to fill a critical gap in the literature, one that has largely overlooked the specific challenges and facilitators associated with transitioning from a clinical role to an educator role. In doing so, the study promises to enhance our understanding of the interplay between individual readiness, institutional support and broader cultural factors in shaping effective clinical teaching.

The methodological rigour of this protocol is underscored by its application of the PIP for data synthesis. This approach is particularly noteworthy as it provides a systematic framework for integrating qualitative and quantitative findings into a cohesive, transparent narrative.²⁹ For example, while studies like Gray et al used scoping reviews to map midwives’ transitions to teaching roles, they did not employ a mixed-methods integration process as robust as PIP, limiting their ability to synthesise diverse data types.⁸ By contrast, this study’s multimethod design positions it to offer a replicable model for future investigations into clinical educator development. Unlike conventional methods that may treat data sources independently, the PIP enables a direct comparison and synthesis of thematic insights and statistical trends, thereby ensuring that convergent and divergent elements are clearly identified and addressed. By leveraging the PIP, the study not only enhances the credibility and validity of its findings but also offers a replicable model for future multimethod and integrative research in clinical education.

As a protocol, this study outlines a robust methodology but does not yet present empirical data, limiting its ability to confirm anticipated findings. The proposed sample size, while suitable for qualitative research, may restrict generalisability beyond MSc anaesthesia students in Iran. Additionally, the focus on a single cultural context may not fully capture the diversity of experiences across healthcare disciplines or regions. As participants are recruited from two Tehran-based universities, regional and urban, rural differences within Iran may not be fully represented, potentially influencing the transferability of findings. Future research should build on this study by employing longitudinal designs to track the transition process over time, as suggested by Martinez,⁹ or by testing the efficacy of specific interventions, such as EPA-based training programmes.¹² Cross-cultural comparisons could further elucidate how contextual factors influence role transition globally.

Ethics and dissemination

Ethical approval and authorisation for this study have been secured from Tehran University of Medical Sciences under reference code IR.TUMS.SPH.REC.1403.236.

Prior to participation, individuals will be required to provide written informed consent, which will outline essential details such as the study’s objectives, voluntary nature of participation, data protection protocols, security measures and confidentiality assurances. Audio recordings and transcripts will be anonymised and stored on password-protected devices accessible only to the research team. Participants will be informed that they may withdraw at any time, and support will be offered if discussions evoke psychological discomfort related to role challenges.

The results of this study will be shared through publications in reputable journals and presentations at national and international conferences.