In recent years, coinciding with the run of sporting success, sports medicine has received increasing attention. Not surprisingly, the emergence of the discipline in the Western World was closely linked to the Olympic movement and more recently the proliferation of professional sport and their needs for high quality medical coverage (9).

Accordingly, academic faculty is also encouraged to improve education program and learning methods in Sports Medicine. Mainly if we take into consideration that Sports Medicine is accepted as a full university based medical specialty.1

It is widely accepted that enthusiasm for teaching should be a basic qualification for physicians who want to participate in medical education.2 In fact, motivation was one of the major characteristics of effective clinical teachers identified by students.3 However, teaching is very time-consuming and poorly remunerated compared to patient care.4

In order to better recruit and retain clinical teachers, medical schools must be cognizant of the variety of factors that may motivate clinicians to teach students.5

This topic has received no attention in previous studies focused on Sports Medicine training.6, 7 In fact, to the best of our knowledge, this was the first study to focus on what factors may motivate clinical teachers in Sports Medicine Schools. These findings would be of particular interest at a time of decreasing resources for Schools of Sports Medicine to reward teaching.

A total of 32 clinical teachers (13 females [40%]; 19 males [60%]) who perform their teaching activities at Schools of Sports Medicine at Universities of Cadiz and Malaga (Spain) volunteered for this observational, cross-sectional study. Participants (43.7 ± 5.1 years-old) had, at least, one medical specialty (Sports Medicine [n = 21]; Cardiology [n = 3]; Orthopedics [n = 3]; Radiology [n = 2]; Endocrinology [n = 1]; Pediatrics [n = 1]; Internal medicine [n = 1]) and were currently performing at least one of the following professional profiles (teaching, research and/or medical care) in their daily professional activity. In a more detailed way, it should be pointed out that up to 10 participants (31.2%) also perform medical undergraduate teaching activites at Schools of Medicine in the same University.

Respondents were chosen based on their relevance to the goals of the study (clinical teachers in Sports Medicine) as opposed to being selected for their representativeness of a larger population. This collection of individuals is referred to as a person-set (P-set) and usually involves no more than fifty participants.8

To investigate motivating factors among clinical teachers in Schools of Sports Medicne we used the Q-methodology that has been applied in both clinical and non-clinical settings9, 10, 11 given that it is not difficult to implement either by participants and researchers.12

This method uncovers and identifies the range of opinions regarding a specific topic under investigation given that it assumes that opinions are subjective and can be shared, measured, and compared.13

In a more detailed way, participants were asked to consider the question ‘Why do you teach?’. They were presented with a set of 69 numbered statements about motivation of clinical teachers (Table 1) previously reported in the literature.5 These statements were listed on individual cards and participants were asked to rank-order them along an opinion continuum grid from most agreement [received a ranking of +5] to most disagreement [received a ranking of −5]). The middle [0] represented a neutral pile. It should be pointed out the grid complies with a normal distribution format.

Table 1. Motivation statements included in the Q-sort reported by Dahlstrom et al.

Apart from instructing the participant on the study objectives and how to complete the questionnaire, there was no other discussion between each participant and researchers. It should be also pointed out that a limited time frame for the data collection was required to limit staff discussion of the study before providing their opinion.5

Data were entered into the Q-methodology freeware program available at http://schmolck.userweb.mwn.de/qmethod/webq/. The variables for analysis were the statement rankings reported by participants. The statistical method of factor analysis was used to generate clusters of similar perspectives among participants. Only factors with 6 or more people mapping to them were used. A computer algorithm (varimax rotation) was used to enhance interpretability. Lastly, the demographic data were analyzed using descriptive statistics.

As regards bioethics, all participants signed a consent form prior to their involvement in the present study. Further, it should be emphasized the authors have undertaken this study in the course of their employment, with no funding from any other source and have no conflict of interest to declare. The present project was approved by an Institutional Ethics Committee.

In accordance with recommended practice, two factors emerged: factor 1 “I teach for helping others” included 23 (72%) participant's sorts (13 males; 10 females) whereas factor 2 “I teach for improving myslef” included just 9 (28%) participants (6 males; 3 females).

Statements in the most agreement zone for Factor 1 are listed in Table 2. In this respect, the statement that received the highest average score was “I want to help my students become good doctors”, the second “To show them the correct way of clinical practice in my specialty” and the third “I like the challenge of teaching students as effectively as possible”. Conversely they strongly disagree “there was no strong involvement of teaching staff in the design of the course” or “they did not feel any sense of duty to teach” or “I receive inadequate feedback from students on my performance”. These statements are listed in Table 3.

Table 2. Statements in the most agreement zones for Factors 1 “I teach for helping others” and 2 “I teach for improving myslef”.

Table 3. Statements in the most disagreement zones for Factors 1 “I teach for helping others” and 2 “I teach for improving myslef”.

Similarly, statements in the most agreement zone for Factor 2 are listed in Table 2. In a more detailed way, the statement that received the highest average score was “intellectual stimulation”, the second “be challenged in my established views”, and the third “I teach to improve my communication skills”. On the other hand, they strongly disagree “teaching was a waste of time”, “it doesn’t do anything to enhance my clinical knowledge and/or skills” and “that their knowledge was out of date”. These statements are listed in Table 3.

Previous studies have found that the success of academic medical centers depends on creating jobs that maximize the potential of its faculty.14 In addition, Gabler-Uhing15 reported that Q-methodology has increasingly been used to identify the complex attributes and behaviors that impact learning within medicine. Accordingly, the present study used Q-methodology to successfully identify factors that represent major motivations of clinicians to teach at Schools of Sports Medicine.

In a more detailed way, our results suggested clinical teachers who participated in this study were highly motivated regarding teaching activity. The current results were better than those previously published in teaching hospital settings.5, 16 This finding may be explained, at least in part, given that unlike other medical specialties with official recognition, just a few Schools of Medicine have included Sports Medicine as part of their undergraduate curriculum. Therefore, the Schools of Sports Medicine are the only venue for junior and senior clinicians interested on teaching in this specialty so that it could be expected they exhibit higher levels of motivation.

In a more detailed way, participants who mapped to factor 1, were highly motivated by the ambition to help others that was consistent with previous studies focused on physicians’ motivation.17, 18 Furthermore, previous studies reported that participation in decision making that may affect physicians’ teaching activity was an important correlate of satisfaction as was previously reported among physicians in academic medical centers.19 Similarly, participants who mapped to factor 1 reported a major disagreement with the fact that “there is no strong involvement of teaching staff in the design of the course”. In addition, the dissatisfaction of faculty with the organizational design, structure and processes was considered as major source of occupational stress that may even affect their state of health.20 Therefore, providing greater opportunities not only for teaching but also for designing the course may be strong motivators for most faculty at Sports Medicine.

Results reported by participants who mapped to Factor 2, were consistent with the fact that teaching may lead to activities that furthered professional growth. In a previous study, Abramovitch et al.,21 found teaching was associated with an increased reading of the medical literature in order to keep up with recent developments in medicine. Conversely, many others have reported an increase in their personal time spent at work to compensate for the time spent with medical students as well as a decrease in their clinical productivity not only in undergraduate22 but also in postgraduate.23 Furthermore, for this group, results suggested that the organization of formal, generally short, training programs focused on the improvement of pedagogical skills would be of great interest. Progress toward academic promotion of clinicians should be also bear in mind by Chairs of Schools. Mainly if we also take into account that academic advancement of clinician is slower than that of research faculty at medical schools.24, 25

Using the Q-method, it is possible to identify different, unique viewpoints concerning motivation among the study population, as well as commonly shared views. This level of detail, not obtainable using more traditional statistical techniques, can aid in the design of more effective strategies aimed at fulfilling the needs of clinical teachers to increase their satisfaction and reach their fullest potential. Furthermore, these findings can be used to create criteria for the hiring and promotion of clinical faculty.3 This is of particular interest given that retention of academic faculty should be considered a pressing issue for Schools of Sports Medicine at a time of decreasing resources for these Schools. In this respect, income enhancement was reported as a major reason for considering opportunities elsewhere by clinical teachers that had already left an academic medical center.26

One of the main strengths of our study could be the number of clinical teachers who participated (n = 32) that was consistent with the recommendations of Q-methodology.27 Furthermore, the methodology has shown itself to be a valuable aid to investigating subjective experiences in a group where communication may be difficult given they had different medial specialties and professional profiles on their daily activities.

The present study had some limitations such as it relies on the subjective assessments of respondents that were not chosen on random sampling procedures. Furthermore, the participants in the present study had all volunteered to become clinical teacher in Schools of Sports Medicine. Therefore, it is possible that the opinions of physicians required to take fellows in training may not be as positive. Lastly, a social desirability bias should be considered given that participants were aware that most researchers were colleagues and would be aware of their results, perhaps skewing answers to those apparently more favorably as was previously reported.5

In conclusion, a ranked-pool of factors that motivate clinicians to teach in Schools of Sports Schools has been proposed. By identifying them, these factors can be reinforced by motivational strategies to enhance teacher cooperation and compliance, thereby potentially reducing drop-out rates. Accordingly, future studies are still required to develop and investigate the effectiveness of motivational strategies.

The authors declare that they have no conflict of interest to declare.

Received 21 June 2013

Accepted 22 July 2013

Corresponding author. manuel.rosetyrodriguez@uca.es