Navigating the storm: a qualitative study of critical incidents in the teaching journey

Abstract

Background

Various events shape the professional journey of health professions teachers. Among these, critical incidents are critical due to their psychological impact, which can influence teachers’ insights and academic performance. This study aimed to identify them at Tehran University of Medical Sciences.

Methods

A qualitative approach was employed, using semi-structured interviews with 22 faculty members (to ensure diversity). Data were analyzed using conventional content analysis, based on Elo and Kyngäs’s framework, in three stages.

Results

A total of 247 initial codes were extracted, which, after merging and refinement, resulted in 83 critical incidents categorized into six general categories: critical incidents related to students; teachers’ responsibilities; colleagues, managers, and officials; the organization; and society. In this study, 72 codes were extracted for critical incidents with negative valence, and 15 for those with positive valence in identified categories.

Discussion

Various sources can lead to critical incidents in the professional lives of health profession teachers. In addition to issues such as professional responsibilities and interactions with students, numerous sources—including administrators and officials, other teachers and peers, the organization, and even society—are determinants of fateful and influential situations that can involve a teacher for long periods and affect their performance.

Conclusions

This study highlights the complexity of teacher identity and emphasizes the shared responsibility for supporting teachers’ performance, offering deeper insight into their professional journey in health sciences universities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08874-9.

Introduction

The professional journey of each teacher faces numerous ups and downs [1]. Teachers encounter a wide range of experiences, successes, and failures throughout their careers. These experiences reflect the complexities of higher education and professional responsibilities and play a critical role in the formation of the teacher identity and the professional development of teachers [2].

According to transformative learning theory, meaningful experiences—particularly those that present individuals with profound challenges—can provide opportunities for deep learning and fundamental changes, in comparison to other types of experiences [3]. For the teaching profession, critical incidents are significant, impactful, and lasting experiences that occur within or outside the classroom in connection with the teaching profession [4].

A critical incident is an event or situation that creates a turning point or significant change in the functioning of an individual or an institution [5]. The distinguishing feature of a critical incident from other events is that they affect individuals because they exceed the normal emotional threshold [6]. For this reason, critical incidents are ambiguous, new, unpredictable, and fateful [7]. These situations may lead to doubt and deep thinking regarding personal beliefs or professional motivations, yet they can simultaneously offer opportunities for learning and growth [8]. In response to critical incidents, teachers may develop strategies to rebuild their confidence [9]. Additionally, effective management of different challenging experiences can enhance their sense of emotional well-being and job satisfaction [10] and better educational outcomes for their students [11].

Identifying common crises can also lead to better planning and greater preparedness to address them. It can also provide individuals with greater psychological comfort [12]. Moreover, due to their unexpected nature and widespread impact, critical incidents can play a special role in the professional development of medical teachers [7]. This is because individuals generally gain a new understanding of themselves and their professional role by rethinking their previous beliefs, values, and assumptions. Such reflection is most effective when individuals face unexpected, challenging, and distinct circumstances—an inherent characteristic of critical incidents—that compel them to reassess their previous cognitive or behavioral patterns [13]. Thus, critical incidents can serve as powerful catalysts for cognitive and emotional changes, as well as for shaping the professional identity of medical sciences educators [14]. A concept that is today highly emphasized for its preservation and promotion and is considered one of the priorities of healthcare education institutions worldwide [15, 16].

Numerous studies have examined critical incidents in the teaching role. However, to the best of the researchers’ knowledge, these studies have primarily focused on target groups other than health sciences educators [13, 17–19]. Given the unique context and target population, there is a need for research specifically addressing health sciences educators. Additionally, prior studies have concentrated on identifying critical incidents within a single discipline [20]. Given the importance of context and the target population, a new study is needed to examine critical incidents in health profession universities. Also, in this study, the experiences of both groups of teachers —those of basic sciences and those of clinical sciences — should be examined so they can be used in the future to empower teachers and related programs. On the other hand, critical incidents with negative valence have been mentioned in other studies, but studies show that a group of critical incidents can be positive, which requires that these cases be examined. Therefore, identifying critical incidents involved in forming the identity of health sciences teachers, in addition to effectively transferring the experiences of other teachers to their peers, provides a basis for a better understanding of the complexities of this profession and an analysis of their concerns [13].

Previous studies have shown the interplay of organizational issues with academic issues in Iranian health sciences universities [21]. Also, in terms of education, there have been developments and changes in tg eachinstyles and teacher-student relationships in Iran in recent years [22, 23]. Consequently, these factors suggest that this context warrants further exploration. Furthermore, among the various research methods, qualitative methods allow us to conduct deeper research and identify concepts precisely [24]. Therefore, this study was conducted to explore the most important common critical incidents affecting teacher identity from the perspective of teachers of Tehran University of Medical Sciences.

Theoretical framework

The present study examines critical events in the professional lives of health sciences teachers. Based on theoretical approaches, two key concepts underpin this study: transformative learning theory and teacher identity.

Transformative learning theory (Mezirow, 1991)

According to this theory, individuals, when faced with specific and challenging situations, undergo cognitive and emotional changes that can lead to a rethinking of their beliefs, values, and roles [25]. For teachers at health sciences universities, these critical events can be profoundly influential, leading to a rethinking of individuals’ performance and inner selves. Such experiences provide a suitable platform for lasting changes in the individual.

Teacher identity formation

Teacher identity refers to an individual’s perception of themselves in their professional position as a teacher [26]. This concept is formed under the influence of interaction with students, colleagues, managers, organizational structures, and even society [27]. Studies have shown that critical events - whether with positive or negative valence- play an essential role in the formation or transformation of this identity [28]. In medical education, these experiences can have a greater impact due to reasons such as high educational responsibility, ethical requirements, and complex relationships with different groups. Therefore, in this study, a theoretical framework is built based on these concepts. Accordingly, critical events are seen as stimuli for individual transformations that prompt rethinking of the components of professional identity.

Methods

Design

This was a qualitative study using conventional content analysis [29], requiring cognitive and emotional engagement. Conventional content analysis was used as a pragmatic approach to gain insight into the experiences of teachers in the health profession by following Elo and Kyngäs’s approach [30] to explore the phenomenon under study [31].

The context of this study was Tehran University of Medical Sciences, the oldest and largest health sciences university in Iran. It consists of 10 schools, including Medicine, Dentistry, Pharmacy, Public Health, Rehabilitation, Persian Medicine, Nursing and Midwifery, Advanced Technologies in Medicine, Nutritional Sciences and Dietetics, and the Allied Medical Sciences. In addition, Tehran University of Medical Sciences has 16 teaching hospitals in Tehran and more than 1,600 faculty members in basic and clinical sciences [32].

Participants

To ensure participants had sufficient experience, purposive sampling was conducted, with at least 5 years of teaching experience in a health science-related field as the minimum. The selection of participants was as follows: first, a list of faculty members who met the entry criteria was prepared. Then, these members were divided based on characteristics such as gender, academic degree, and professional field (basic and clinical sciences). Since the focus of the study is on the teaching role, and one of the most common frameworks for classifying medical science faculty members is to divide them into two groups—clinical professors and basic science teachers, an effort was made to select teachers from both groups‌ (9 basic sciences and 13 clinical sciences). This approach was intended to ensure that the total number of participants was representative of each group.

The participants were contacted, given a brief explanation of the study and its objectives, and, if they agreed to participate, their email addresses were obtained, and a consent form for the interview was sent to them. During the interviews, an attempt was made to select subsequent samples from the list so that, overall, the interviewees would have diversity. During coordination with the interviewees, four teachers refused to participate in the research, citing insufficient time due to their busy schedules. Demographic information of participants is presented in Table 1.

Table 1.

Background and demographic characteristics of basic and clinical sciences faculty members participating in the study

Participants	Characteristics
Gender	Male (n = 9) Females (n = 13)
Age (year)	Range from 36 to 59 (mean = 46.6)
Academic ranks	Assistant professor (n = 3) Associate professor (n = 11) Full professor (n = 8)
Category of Disciplines	Basic sciences (n = 9) Clinical sciences (n = 13)
Discipline	Nursing (n = 3), Internal Medicine (n = 2), Public Health (n = 2), Family Medicine (n = 1), Medical Informatics (n = 1), Ophthalmology (n = 1), E-Learning (n = 1), Pharmacology (n = 1), ICU (n = 1), Speech Therapy (n = 1), Emergency Medicine (n = 1), Dentistry (n = 1), Psychiatry (n = 1), Anatomy (n = 1), Physiology (n = 1), Medical Education (n = 1), Molecular Cell (n = 1), Anesthesia (n = 1)
Teaching experience	More than 10 years: 13 Five to ten years: 9

Reflexivity

The research team of the present study consisted of three women and two men, two of whom had a Ph.D. in medical education, one a Ph.D. in clinical psychology, one a psychiatrist, and one a Ph.D. student in medical education. All of these individuals played a role in medical education and faculty development programs. Except for the Ph.D. student, the other participants were university teachers and researchers in various departments. Before conducting the study, all teachers had experience performing and publishing qualitative research. R.G., as a Ph.D. student, had also completed units in qualitative research during his academic coursework and had participated in supplementary courses to enhance his skills in this field. At the time of conducting the interviews, R.G. was a Ph.D. student in medical education and had no organizational or personal acquaintance with any of the interviewees.

Data collection

The findings were collected through semi-structured in-depth interviews with open-ended questions to identify common critical incidents affecting teachers’ identities at the University of Health Sciences. We employed purposive sampling to select participants who could provide rich, relevant information about the phenomenon under study. As mentioned in the theoretical framework, a set of experiences aligns with fundamental changes in individuals. These changes often affect the dimensions of individuals’ identity and their self-perception. Therefore, the interview questions were designed to direct individuals’ attention specifically to distinctive experiences with the characteristics mentioned above and to prompt them to examine which experiences in their professional path have confronted them with fundamental changes. These questions were developed during meetings with the research team by reviewing studies on critical incidents.

At the beginning of the session, the interview form, including the demographic information form, an explanation of the interview’s purpose and questions, ethical considerations, and consent to participate, was provided to the participants. The interview guide form is provided in the appendix. After the researcher (R.G.) explained the concept of “critical incident”, the teachers were asked to spend a few minutes reflecting on their years of teaching and to write down those experiences that, from their perspective, corresponded to the definition of a critical incident. Subsequently, they described their experiences with each critical incident. Probing questions were used to gain deeper insights and identify the key factors contributing to each critical incident from the participants’ perspectives. The interview began by asking each interviewee to describe each critical incident in detail. Then the sessions continued by asking them to describe the factors that contributed to each incident. The following interview question asked the participants to describe how these incidents had affected them as university teachers and what changes they had brought about. Finally, they were asked whether there was anything else that had not been covered in the interview that they would like to share.

The interviews were conducted face-to-face and lasted up to 2 h, depending on the interaction between the interviewer and the interviewee. Each session was planned as a one-on-one interview. Given the sensitivity of the topic under investigation, all interviews were conducted at the interviewees’ preferred times [33], and participants were asked to indicate the location and time they selected and considered suitable for a confidential interview. Therefore, most interviews were conducted in teachers’ offices at faculties or teaching hospitals such as Mahdi Clinic (Imam Khomeini Hospital), Shariati Hospital, and the faculties of dentistry, nursing, medicine, and other faculties of Tehran University of Medical Sciences.

All interviews were audio-recorded with participants’ informed consent, and field notes were taken during the sessions to provide a comprehensive overview of the incidents and ensure no key points were overlooked. Any participant-identifying data was removed from the transcripts. The first two interviews were conducted in the presence of the first researcher (R.G.) and a qualitative research expert (M.K.M.) after participants’ consent was obtained. Subsequent interviews were conducted solely by the first researcher (R.G.), who had no prior relationship with the participants. No other individuals were present during the interviews.

Various criteria may be used to determine when saturation has been reached in qualitative studies. In this study, the following measures were taken to ensure data adequacy in the interview process and to achieve saturation: Firstly, one of the most common cases is the one where no sample size is determined in advance, and interviews are continued until no new codes are obtained in the last three interviews [36, 37]. This criterion was also considered for the present study, and interviews continued until none of the cases mentioned by the interviewees in the last interviews included a new critical incident. Secondly, we asked follow-up questions to explore areas that were less discussed or needed further clarification based on the initial coding and preliminary data analysis. This process continued iteratively until data sufficiency was achieved, i.e., no new concepts or properties emerged [34]. In this process, the researcher seeks data that helps clarify categories and their characteristics, and continues until data sufficiency (i.e., no new insights or characteristics emerge) is achieved [34, 35]. This process began with the ninth interview; after all questions were asked and participants had freely shared their experiences, some questions were asked about the initial categories and subcategories that had emerged in the previous interviews. Thirdly, we conducted data analysis and coding of interview transcripts simultaneously with the interviews to examine the process of achieving data sufficiency.

Data analysis

The interviews were transcribed immediately after each session. Data analysis followed Elo and Kyngäs’s approach and was conducted in three phases [30].

Preparation phase

In this phase, each interview was transcribed and repeatedly read by the research team (R.G. and M.K.M.) to become immersed in the data. Segments of the interviews that explicitly described critical incidents were highlighted. Agreement on the meaning units associated with each critical incident was reached through two two-hour meetings between two researchers (R.G. and M.K.M.).

Organizing phase

In this phase, open coding was conducted on each interview transcript using MAXQDA 2020. This software was used to achieve a more accurate review and better management of the types of codes obtained. The codes were compared after coding the first eight interviews to identify subcategories. Two three-hour meetings between two researchers (R.G. and M.M.) were held to group similar codes into subcategories and initial categories. Disagreements from the coders’ perspectives were also resolved in the meetings through discussion and investigation of the details provided by interviewees for each incident. In addition, at this stage, to ensure the clarity and applicability of the coding framework, Inter-Coder Reliability (ICR) was assessed using the percentage agreement method. At this stage, an agreement percentage of 80% was considered acceptable [34].

Throughout this phase, the codes extracted from the interviews were repeatedly reviewed. The codes were iteratively grouped and regrouped based on their similarities and differences. Similar codes were placed together, and different categories for similar items were examined to select the most appropriate and expressive one. This process of reflection and comparison was used to determine the most logical and appropriate way to categorize the data, thereby best answering the research question. Ultimately, given the research question’s underlying concept, the source of the incident was identified as the most appropriate basis for categorization.

Reporting phase

In this phase, after reviewing all codes in relation to the research question, the research team (R.G., M.K.M., H.A., and A.M.) reached consensus on categories and subcategories through collaborative discussions. To gain a better and more comprehensive understanding of critical incidents, at this stage, critical incidents in each subcategory were divided into events with negative and positive valence. The division at this stage was based on the information participants themselves provided about each incident, for example, the references they made to feelings and thoughts they experienced in critical incidents.

Trustworthiness

To ensure data trustworthiness, Guba and Lincoln’s criteria were used as guidelines [35]. To enhance credibility, participants were selected to maximize diversity. Semi-structured, face-to-face interviews ensured precision in data collection. Interviews continued until data saturation was reached, and all research team members participated in coding evaluation. Furthermore, after transcription of each interview and initial coding, the text was sent to each person along with the initial codes to conduct member checking. In relation to the dependability criterion, an interview guide was designed, and an expert in qualitative research was involved in performing and analyzing the interviews. For the conformability criterion, a description of the research steps, including data collection, analysis, etc., was included to enable auditability of the study. In the present study, the transferability criterion was addressed by providing a complete description and introduction of the study context, characteristics of the participants, and an explanation of the process of collecting and analyzing the findings, and the authenticity criterion was addressed by acquiring skills in conducting qualitative research and disclosing any conflicts of interest.

Ethical considerations

This research was approved by the Research Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.MEDICINE.REC.1403.431). All interviews were conducted on an entirely voluntary basis. After obtaining written consent from the participants, an electronic version was emailed before the interview, and a printed version was provided on the day of the interview. The study’s objectives were communicated to participants via text messages before the interview and verbally at the beginning of each session. Participants were assured that they could withdraw from the study at any time. Confidentiality was maintained by assigning each interview a unique identifier code chosen by the participant.

Results

Overall, 247 initial codes were identified, which, after merging and refinement, resulted in 83 critical incidents categorized into six categories and 14 subcategories. In this study, 72 codes were identified for critical incidents with negative valence, and 15 for those with positive valence. The table detailing the codes, categories, subcategories, valence, and quotations is provided in the appendix (Table 2).

Critical incidents related to students

As the direct audience of university teachers, students generate a wide range of critical incidents, from positive to negative valence. The 34 critical incidents identified in the present study involved students, indicating the significant influence of students on the formation of university teachers’ professional identity. Critical incidents related to students were divided into three categories: “Student Learning and Academic Dynamics”, “Interpersonal Communication Between Teacher and Student,” and “Gratitude of Students Towards Teacher.”

Student learning and academic dynamics

Twelve critical incidents that fall into this category result from differences in the perspectives and preferences of students and teachers in the teaching-learning process, which can take the form of a lack of acceptance of the teacher’s educational actions, a generational gap in determining classroom norms, the difficulty of balancing the teacher’s strictness and student satisfaction, and a lack of attention to the necessity of attending class or being prepared to participate in class. One participant described this issue:

“Sometimes I am so surprised by what students say and think that I feel a vast gap between us. They use words and expressions that I have to ask them, ‘What does that mean?’ Many of my conversations now are like this—repeatedly asking, ‘What does that mean?‘”. (Interviewee 4, Female, Basic Sciences, Associate Professor)

Teachers being challenged by students, language barriers, disruptions in the educational process due to political, social, and cultural movements, and even the mismanagement of students’ emotional relationships have frequently led to disruptions in teaching and to critical situations. One participant recounted:

“We have a lot of student marriages in our university, but before they settle down, many things happen, and you don’t know how to handle them. The generational changes have made it even worse. They sit together in class holding hands, and when they go to the clinic or department, they want to be together. Their relationships in the clinical setting sometimes go beyond social norms, distracting other students from class. When something inappropriate happens between them, you don’t know what to do as a teacher.” (Interviewee 8, Female, Basic Sciences, Associate Professor).

On the other hand, students’ academic actions and positive or negative outcomes play a significant role in teachers’ lives. One participant described students’ successes as “one of the deepest roots of joy in life.” (Interviewee 21, Male, Clinical Sciences, Full Professor).

Another participant shared:

“Once, I was waiting at a red light and saw a board listing doctors’ names of a clinic. I noticed one of my former general medicine students, who had frequently consulted with me and was eager to work with us, had become a specialist. That moment gave me a great feeling—I realized I had made a real impact. I felt satisfied knowing that my contribution wasn’t just an output but had a true outcome.” (Interviewee 18, Male, Basic Sciences, Full Professor).

Interpersonal communication between teacher and student

According to participants, student-teacher relationships have changed significantly over the past decades, leading to unique situations such as excessive dependency, seeking sympathy, and even making unreasonable requests. Eighteen critical incidents were identified in this subcategory.

In this regard, one participant shared an experience in which a student asked for a higher grade than they had earned:

“I was confused. I thought, ‘What did I do to make this student feel they could ask me that?’ Maybe because I’m a younger teacher, I often discuss contemporary issues with them; they developed this perception of me! I tried to reassure myself that it was due to familiarity—that they didn’t understand the limits of our relationship.” (Interviewee 7, Female, Basic Sciences, Assistant Professor).

In some cases, however, the relationship took a different turn, resulting in insults towards the teacher, student rejection, scheming, or even physical harm. One interviewee recounted:

“I had parked my car in the university parking lot, and when I returned, I saw a huge scratch on my car. I had been the students’ favorite teacher for several semesters. Seeing that scratch, I froze. I couldn’t understand why. I was distraught. My colleagues said, “It’s okay, we’ll fix your car.” But I told them, ‘The issue is not a scratch on my car! The issue is that they have scratched my emotions.” (Interviewee 5, Male, Clinical Sciences, Full Professor).

Despite these challenges, some moments in the teacher-student relationships were positive. Interviewee 21 described an instance where a student sought their advice during a critical moment in their life:

“That moment made me realize this is a crucial part of teaching. Seeing how much they value your opinion—recognizing individuals and trying to understand them, being there for them at key moments, and helping them. Sometimes, your only role is to listen and support them. That’s all, and it’s enough.” (Interviewee 21, Male, Clinical Sciences, Full Professor).

Gratitude of students towards the teacher

Of 34 student-related critical incidents, four were included in this subcategory. From the teachers’ perspective, student feedback—whether appreciation or criticism—has a profound impact. A notable point mentioned in five interviews was that students’ acknowledgments and critiques were far more influential than feedback from administrators or institutions. One interviewee described a surprise event where students expressed their gratitude:

“You wouldn’t believe it—after my students surprised me… What I still remember are the teardrops that were falling down my face. That moment was so sweet to me that I got a lot of positive feelings from it, and I still do. I told my students, ‘These tears are from love and affection. I’m so happy to have you all,’ and I started describing my feelings to them.” (Interviewee 14, Female, Basic Sciences, Associate Professor).

Critical incidents related to teachers’ responsibilities

Some critical incidents stemmed from the nature of teaching and its associated responsibilities. In this category, 10 codes were identified and classified into two subcategories, including “Teaching and Instruction” and “Educational Planning.”

Teaching and instruction

From the teachers’ perspective, educational successes and failures, as a fundamental responsibility, had profound emotional impacts. Therefore, eight critical incidents were reported in this category.

One interviewee recounted a memorable success at the international level:

“I can still see it in my mind—a team from the international organization (X) came to evaluate us for the first time. On the last day, the hall was dark, and I, as the lead organizer of our educational projects, was sitting in the back, just watching what was happening. Then they announced that our education met international (X) standards, which were among the highest in our field. That was such a great feeling. That moment, that good feeling—it’s still with me… I cried. I sat in that dark hall and just cried. No one saw me. No one knew.” (Interviewee 20, Male, Clinical Sciences, Associate Professor).

Educational planning

According to the faculty members, making decisions in curriculum planning creates a tremendous mental burden and a sense of responsibility for teachers due to their fateful effects. 2 critical incidents were reported regarding this subcategory.

One of the participants mentioned in this regard:

“When you plan an educational program, you determine the content and scope of a field. These moments are emotionally intense for me. I constantly evaluate and analyze my performance. I always worry that I might emphasize areas I’m proficient in while excluding those I’m less knowledgeable about. In situations like this, you need to be careful! It’s vital what you’re doing with your students’ future on this path.” (Interviewee 9, Male, Clinical Sciences, Full Professor).

Critical incidents related to colleagues

Similar to interactions with students, critical incidents involving other faculty members have emerged in professional settings and in interpersonal relationships, encompassing 14 identified codes and two subcategories: “Interpersonal Relationships Among Faculty” and “Academic Collaboration and Professional Disputes”.

Interpersonal communication among teachers

Of the five critical incidents in this subcategory, most experiences are categorized under this theme: faculty interactions, whether in the form of receiving support or, at times, encountering conflicts and biases, have been impactful.

One interviewee describes a negative critical incident in which they were not accepted by senior colleagues and faced harsh treatment:

“In interactions with more experienced colleagues… I wouldn’t say anything; I would stay silent. Inside, I was in turmoil… And honestly, I was afraid! Afraid that an argument might break out. Afraid they would say: ‘She just got here, and she’s already being aggressive!’ Eventually, someone pointed it out to me. Someone told me, ‘Why have you changed? You used to be so normal. Why are you walking around hunched over?’ I realized that the environment here had affected me…” (Interviewee 1, Female, Clinical Sciences, Assistant Professor).

Academic collaboration and professional disputes

Some faculty members’ experiences with critical incidents stem from colleagues’ actions directly affecting their professional standing and work environment. 9 critical incidents were categorized in this subcategory.

For example, in a positive experience, one participant states:

“Many times, a teacher has called me and said, ‘I spoke highly of you somewhere for a project,’ which motivated me. You get a financial reward and forget about it in a week. But when a well-respected professor calls and says, ‘We mentioned your name and said you’re doing great work in this field,’ that has a huge impact on me…” (Interviewee 19, Male, Basic Sciences, Full Professor).

Critical incidents related to managers and officials

Some critical incidents have arisen due to faculty-administrator interactions and the decision-making approaches adopted by administrators. In this category, eight codes were identified and classified into two subcategories, including “Use of Power and Influence by Administrators” and “Administrator-Faculty Interactions”.

Use of power and influence by administrators

According to the four critical incidents identified in this part, the power and influence administrators wield and how they exercise it represent a key distinguishing feature of this group. One interviewee describes their experience:

“I saw the dean imposing their views heavily, pushing for what they wanted. I saw how much they were making things difficult. I had no authority of my own. The reality is, why should a manager have so much influence? When they give too much authority to someone who can abuse it… they will abuse it!” (Interviewee 13, Female, Basic Sciences, Assistant Professor).

On the other hand, even the simplest positive use of this power and influence can create highly memorable and meaningful experiences. For example, Interviewee 14 recounts an early career experience:

“In my first week as a university instructor, they gave us a package. I opened it and found a briefcase-like folder… Inside was a letter with a beautifully written message, signed by the university president, welcoming me and expressing good wishes for my career. That was the moment I felt that I had truly become a university instructor… I officially became a part of the academic community. (…) I felt like someone was watching over us, someone supporting us.” (Interviewee 14, Female, Basic Sciences, Associate Professor).

Administrator-teacher interactions

The nature of administrators’ interactions with faculty, which can sometimes be discriminatory or demeaning, has led to four types of critical incidents, according to university teachers. One interviewee narrates a colleague’s early career experience:

“Two of us were hired at the same time. My friend went to see the department chair and said, ‘These are my skills… These are the research projects I’d like to pursue…’ The department chair had responded, ‘Oh, really? That’s your skillset? So, you came here to sit behind a desk and do nothing? We’ll see about that!’ Well… My friend became disengaged entirely after that. He said, ‘I will never do anything for this department again.’ In the end, he emigrated.” (Interviewee 5, Male, Basic Sciences, Full Professor).

Critical incidents related to the organization

Universities and academic departments, as the primary institutions where faculty members operate, play a role in shaping critical incidents. This category includes 13 codes, divided into three main subcategories. The subcategories are “Organizational Support”, “Faculty Status and Position within Institution”, and “Organizational Policies”.

Organizational support

Regarding organizational support, six critical incidents were reported, some of which involved faculty being recognized by their institutions, but most identified codes pertained to a lack of financial support and the challenges this created, particularly for early-career faculty members. One participant recounts their experience of working a side job to compensate for financial shortfalls:

“One night, I was utterly exhausted, carrying my lab coat as I returned to the subway station. A student saw me there, and that moment made me feel inadequate. In my mind, teachers were always engaged in research and scholarship, spending their entire days at the university. They weren’t supposed to be rushing to take the subway or working elsewhere to make ends meet. I think that the student felt disillusioned too—probably thinking, ‘So this is what it comes to in the end…’” (Interviewee 7, Female, Basic Sciences, Assistant Professor).

Teacher status and position within institution

Two critical incidents stem from a lack of recognition of faculty members’ status and role in organizational decision-making. One participant describes their experience:

“Suddenly, a cleaning staff member came and placed a letter in front of me. ‘You are dismissed. Your services are no longer required.’ The fact that a staff member, not an academic peer or even an administrative assistant, delivered this message in front of residents and trainees was deeply humiliating. It unsettled me.” (Interviewee 3, Male, Clinical Sciences, Associate Professor).

Organizational policies

Restrictive, ambiguous, or impractical policies regarding faculty recruitment and promotion have created five main types of critical incidents. According to the interviewees, since policies often serve as the basis for decision-making, they can generate significant crises. In this regard, one interviewee explains:

“Another major issue is bureaucracy—ridiculous, lengthy bureaucracy. As a faculty member from day one, I had to worry about promotion, even though I think the promotion criteria don’t assess the teachers’ skills at all…” (Interviewee 15, Male, Basic Sciences, Full Professor).

Critical incidents related to society

This category includes four codes, grouped into two subcategories: “Societal Perceptions of Faculty” and “Social Expectations and Restrictions on Teachers”.

Societal perceptions of teachers

Public perceptions of faculty members’ status and prestige have led to 2 types of critical incidents, including positive and negative experiences. One interviewee shares their story:

“I had to testify in court once. It was an honest testimony, but they needed three witnesses. They asked about my profession, and I said, ‘University teacher.’ As soon as I gave my statement, the judge said, ‘Then I have no further questions.’ At that moment, I realized the importance of this title—how much faith they had in my words simply because I was a teacher. That was an incredible experience. It made me feel truly honored.” (Interviewee 16, Female, Basic Sciences, Full Professor).

Social expectations and restrictions on teachers

On the other hand, in some cases, the prestige of being a teacher has created limitations for individuals, causing two types of critical incidents. One participant describes their unique experience:

“Sometimes I join group tours, and they ask us to introduce ourselves. When I say I’m a university teacher, it imposes many restrictions. If I wanted to hike or engage in any physical activity, it became awkward… especially since younger people were in the group. They would joke around and call me ‘Professor,’ and I felt really uncomfortable.” (Interviewee 17, Female, clinical and basic sciences, Associate Professor).

Based on the identified categories and subcategories, we developed a conceptual model (Fig. 1) that illustrates how critical incidents from different sources influence teacher identity at health sciences universities. In this model, alongside the categories, the subcategories are also included as representations of the various forms through which each source exerts its influence.

Fig. 1.

Summary of sources of critical incidents affecting the teacher identity of health professions teachers

Discussion

The present study aimed to identify the most critical incidents affecting teacher identity from the perspective of faculty members at Tehran University of Medical Sciences. Through in-depth interviews with faculty members, six overarching themes emerged. Identity changes appear in the face of challenges [36], a prominent feature of critical incidents. According to the theory of transformational learning, transformations occur in cultural and social contexts [37]. Therefore, the various resources and factors that create these situations together affect the formation and transformation of identity. Furthermore, based on Mezirow’s theory of transformational learning, identity has a multi-layered structure that can be affected by changes from the superficial to the central part. Therefore, critics have suggested that changes actually go beyond the cognitive level and penetrate deep into the individual’s inner self [38]. In the present study, incidents were identified that, from the participants’ perspective, had the most profound impact on their professional identity.

Some of these critical incidents involved students and arose from various educational or even personal interactions between faculty members and students. Challenges in students’ academic progress can sometimes stem from differences in students’ and teachers’ perspectives. The root of such discrepancies, in addition to students’ lack of motivation and interest [39], may stem from generational differences between faculty members and students [40], students’ lack of understanding of the significance of their field and the content being taught [41], and other factors.

The unique and sensitive nature of the student-faculty relationship can also give rise to numerous critical incidents with both positive and negative valences. In this regard, Lannon et al. [42] in their study point out the necessity of setting and maintaining boundaries in the relationship between teacher and student [42]. Changing roles of teachers [23], the expansion of technology, changes in parenting styles, and different experiences during their education have led to a generational gap between teachers and students [43]. Which can create new and, as a result, challenging moments.

According to the present study, when faculty-student relationships are marked by students’ lack of appreciation or disrespect, faculty members experience a significant emotional burden. In this regard, a study conducted by Lakeman et al. [44] identified students’ offensive and threatening feedback as a serious source of stress and work pressure, leading to a decline in faculty members’ well-being [44]. Nevertheless, from many faculty members’ perspectives, experiencing positive professional critical incidents has been a direct result of establishing positive faculty-student relationships. Students’ appreciation and positive relationship with faculty members not only have positive effects on faculty members themselves, but are also essential for fostering students’ connection and engagement with the academic environment [45].

Another set of critical incidents is influenced by the nature of faculty members’ responsibilities in teaching and curriculum planning. Every faculty member envisions specific responsibilities for themselves and feels accountable for them. If, for any reason, they perceive themselves as lacking the necessary competence in these areas, they experience an emotional and psychological burden that presents fundamental challenges. Conversely, achievements in these areas validate their competence and strengthen their professional identity. According to a study by Cheraghi and Motaharinejad [46], faculty members’ inability to effectively teach the subjects they are responsible for leads to confusion and, if persistent, to dissatisfaction and distress [46], findings that align with the present study.

Today, professional communities and relationships among faculty members are regarded as a fundamental source of professional transformation [47, 48]. This group has also played a crucial role in shaping decisive moments in the present study. Most faculty members perceive their colleagues as companions, so they expect exceptional support and attention from them in critical situations. When such support is provided, it has numerous positive effects. However, contrary to expectations, organizational competition and academic disagreements often lead to negative experiences in faculty relationships, significantly impacting their professional trajectories. A study conducted in Iran by Raeisoon et al. shows that trust, professionalism, and interaction are low in relationships among members of Iranian health sciences universities [21], which can be considered a source of critical moments. Many of the critical incidents identified in this study fall within the realm of “academic bullying” [49, 50], an issue that, despite its substantial harm, remains prevalent beneath the seemingly ideal surface of academic environments. Improving ethical standards and greater communication with values ​​in workplaces can improve this issue [51].

Administrators and decision-makers, due to their authority and influence, play a role in shaping critical incidents for faculty members. Leadership styles and decision-making processes significantly impact the fate of institutions and their members, and educational institutions are no exception [52, 53].

As organizations subject to specific regulations, universities engage closely with faculty members in processes such as promotion, recruitment, and grant allocation, which are crucial for creating critical incidents with positive and negative valences. From Cantillon’s perspective, the formation of clinical teachers’ professional identity is not only individual but also depends on the social environment. Therefore, if there is insufficient support for it within extra-personal structures, individuals will prioritize other aspects of their profession, such as medicine or research, over teaching [54]. Based on studies, organizational support should be increased in Iranian health sciences universities and their affiliated centers. For example, in teaching hospitals, issues such as organizational discrimination, imbalance between workload and income, and lack of necessary equipment are observed [55]. Organizational rules and programs are considered the basic principles for shaping teachers’ professional identity [56–59]. The highly hierarchical structure of Iranian academic organizations, from the university teachers’ perspective, requires further reform [60].

Finally, societal influences contribute to critical incidents affecting faculty members. The relationship between society and university has gradually become more intertwined, fostering greater engagement with universities [61]. In the present study, faculty members viewed society as an extended family and a platform through which they understand their professional standing based on their interactions with individuals in that context. Although changes in societal values have sometimes led to a few negative encounters in recent years, in most cases, society continues to accord faculty members prestige and respect. While this esteemed status may impose behavioral limitations on faculty members, it is often accompanied by special recognition and appreciation and provides them with positive, memorable experiences.

Among the notable findings of the present study is that the number of identified critical incidents with negative valence differs significantly from those with positive valence. One possible explanation for this is that teachers have not encountered many positive incidents in their professional practice. However, this finding has also been observed in other studies, and part of this situation may be due to a bias in recalling negative experiences over positive ones [62]. Studies show that episodic memory, which relates to personal events and experiences at a specific time and place, is more likely to recall negative experiences, and these experiences are more persistent in the mind [63].

Critical incidents can challenge faculty members’ professional beliefs and values. They may also provoke emotional reactions, leading them to change how they teach or interact with learners and colleagues. Therefore, identifying critical incidents in educational environments is necessary from several perspectives: Firstly, a university, as an organization, must seek solutions and plan to reduce the occurrence of incidents with negative effects or consequences, or to minimize their impacts. Secondly, faculty members should use critical incidents as an opportunity to reflect and rethink their roles and their communication and teaching methods, and by better understanding their feelings in these situations, as well as understanding the problem from the perspective of students and colleagues, they should be adequately prepared to confront and manage such situations. Thirdly, educational development centers should promote this ability to reflect in faculty members through appropriate planning.

As previously noted, few studies have examined faculty members’ perceptions of critical incidents in medical education. As a result, faculty perspectives are underrepresented in the literature. This study contributes to epistemic justice in health professions education by documenting the critical events that shape teacher identity and ensuring that faculty members’ diverse experiences are recognized and valued in academic literature.

Strengths and limitations

In the present study, by gaining the confidence and support of the participating teachers, unique and first-hand information was obtained from their many years of experience, including both basic science and clinical teachers with very different scopes of activity.

Among the limitations of the present study was the reluctance of several professors to participate in the interviews, which may have been due to the subject’s sensitivity. Moreover, it can be mentioned that an attempt was made to sample in a way that, in addition to gender, age, and academic ranks, various specialized fields were considered. Despite the wide variety of majors at Tehran University of Medical Sciences, it was not possible to interview university teachers from each discipline. In other words, in the present study, discipline was used only to divide individuals into two categories —clinical and basic science professors —and an attempt was made to include both groups to represent clinical and basic science teachers as a whole. Therefore, there is no claim that the participants are representative of each discipline. In this study, the potential for power dynamics between the researcher and participants, particularly when a Ph.D. student interviewed senior faculty members, may have influenced the data. Such influences could have affected the clarity of reporting critical incidents, the choice of specific words, or the inclusion/exclusion of sensitive details. However, by explaining study objectives and importance and emphasizing confidentiality and objectivity, we attempted to minimize these effects and encourage participants to provide accurate and comprehensive accounts of their experiences. In qualitative studies, there is always a possibility of bias in exploring participants’ experiences. Despite various measures taken to control this (including interviewer briefing prior to the interviews, lack of prior acquaintance between interviewer and interviewees, and avoidance of leading questions), bias cannot be entirely ruled out.

Suggestions for future studies include conducting the study with the present approach and method in other contexts. Also, given the limited mention of positive critical incidents in the interviews, studies aimed at specifically identifying these cases could be conducted.

Conclusion

Various sources can lead to critical incidents in the professional lives of health profession teachers. In addition to issues such as professional responsibilities and interactions with students, numerous sources—including administrators and officials, other teachers and peers, the organization, and even society—are determinants of fateful and influential situations that can involve a teacher for long periods and affect their performance. In addition to highlighting the complexity of the category of teacher identity, this issue reminds us of the responsibility of each of the aforementioned groups to create appropriate conditions for teachers’ adequate performance. Identifying these factors in the present study provides a deeper understanding of teachers’ professional paths at health sciences universities.

Authors’ contributions

RG conducted the interviews. Each interview was transcribed and repeatedly read by the research team (R.G. and M.K.M.) to become immersed in the data. Agreement on the meaning units associated with each critical incident was reached through two two-hour meetings between two researchers (R.G. and M.K.M.).Open coding was conducted by R.G. and M.K.M. for each interview transcript, and the codes were compared after the coding group. Similar codes were grouped into subcategories and initial categories.After reviewing all codes in relation to the research question, the research team (R.G., M.K.M., H.A., A.M., and E.K.K.) reached consensus on categories and subcategories through collaborative discussions. Any disagreements were resolved through further discussion until a consensus was achieved. All authors reviewed and approved the final manuscript.

Funding

The authors have no relevant financial or nonfinancial interests to disclose.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethical approval and consent to participate

All participants in the study volunteered, without any impact on their careers. Additionally, they had the right to withdraw from the study at any time. Informed consent was obtained from all individual participants included in the study. The transcribed text, including initial codes from each interview, was sent to the respective interviewee for review. The study was conducted under the supervision and approval of Tehran University of Medical Sciences, with the ethics approval code IR.TUMS.MEDICINE.REC.1403.431. All study procedures and methods adhered to the principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.