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Instructional Skills Workshops Improve Clinical Teachers' Self-Efficacy, but Only Some Gains Track Feedback Experience_ A Two-Cohort Study

This two-cohort study demonstrates that while an Instructional Skills Workshop significantly and replicably boosts clinical teachers' self-efficacy across student engagement, instructional strategies, and classroom management, only gains in the first two dimensions are consistently associated with specific feedback experiences, suggesting classroom management improvements may stem from other sources.

Original authors: Leyuan Xiang, Huan Mao, Jing Shu

Published 2026-06-25

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Leyuan Xiang, Huan Mao, Jing Shu

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

The Big Picture: Fixing the "Expert Teacher" Problem

Imagine a brilliant surgeon who is amazing at saving lives but has never been taught how to stand in front of a classroom and teach those skills to others. They are a master of their craft but a novice at explaining it. This is the reality for many "clinical teachers" (doctors who teach students).

To help them, researchers ran a special training camp called the Instructional Skills Workshop (ISW). Think of this workshop like a flight simulator for teachers. Instead of just listening to lectures, the doctors get to "fly" (teach) for a few minutes, get immediate feedback from their peers and a coach, and then try again. They do this in a loop: Teach → Get Feedback → Try Again.

The researchers wanted to know two things:

Does this "flight simulator" actually make doctors feel more confident in their teaching?
Is the feedback they receive the main engine driving that confidence, or are there other factors at play?

The Experiment: Two Groups, One Goal

The team ran this workshop twice, in 2022 and 2024, with two different groups of doctors (about 37 in the first group and 39 in the second). This is like running the same experiment on two different days to make sure the results weren't just a lucky fluke.

They measured the doctors' confidence (called "self-efficacy") in three specific areas:

Student Engagement: Can I get the students interested and involved?
Instructional Strategies: Can I use good tricks and methods to explain things?
Classroom Management: Can I keep the room organized, calm, and running on time?

They also asked the doctors how they felt about the feedback they received during the workshop (Was it helpful? Did they actually use it?).

The Results: A Big Win, But a Surprising Twist

1. The Good News: Confidence Skyrocketed
The workshop was a huge success. In both groups, the doctors' confidence in all three areas jumped significantly.

The Analogy: Imagine a driver who was nervous about parallel parking, using turn signals, and merging onto a highway. After a weekend of practice, they felt like a pro at all three. The training worked broadly and powerfully.

2. The Twist: Not All Confidence Comes from Feedback
Here is where the story gets interesting. The researchers looked closely at why the confidence grew. They expected that the better the feedback the doctors received, the more their confidence would rise.

The "Strategy" and "Engagement" Wins: For the ability to use good teaching tricks and keep students interested, the doctors' confidence did track closely with the feedback. If they felt the feedback was high-quality and they actually used it to improve, their confidence in these areas went up.
- Analogy: It's like learning to shoot a basketball. If a coach tells you, "Bend your knees more," and you listen and try it, you get better at shooting. The feedback directly caused the improvement.
The "Classroom Management" Surprise: However, for Classroom Management (keeping the room orderly and calm), the results were different. The doctors' confidence in this area grew just as much as the others, but it had nothing to do with the feedback they received.
- Analogy: Imagine you are learning to drive a car. You get great feedback on how to shift gears (Strategy) and how to talk to passengers (Engagement). But suddenly, you feel incredibly confident about keeping the car in the lane and managing traffic flow (Management). The coach didn't give you specific feedback on lane-keeping, yet you still felt like a master at it.

Why Did This Happen? (The Researchers' Guess)

The paper suggests a reason for this "Classroom Management" mystery based on how the workshop was designed.

The workshop included a special introductory lecture at the very beginning that explained the "big picture" of how to structure a lesson (using a framework called BOPPPS).

The Theory: The researchers guess that the confidence in "Classroom Management" came from this big-picture lecture and the demonstrations, not from the specific feedback on individual teaching attempts.
The Metaphor: Think of the workshop as building a house.
- The Feedback Loop helped the teachers fix the details: painting the walls better, choosing better furniture (Strategies/Engagement).
- But the Introductory Lecture gave them the blueprint for the whole house. Once they saw the blueprint and watched a master builder demonstrate the foundation, they suddenly felt confident they could keep the whole structure standing (Classroom Management), even without someone pointing out specific errors in their foundation work.

The Bottom Line

The study concludes that while this type of training is excellent for boosting teacher confidence, feedback isn't the only magic ingredient.

Feedback is great for improving specific skills and methods.
Direct instruction and big-picture frameworks (like the intro lecture) might be what builds confidence in managing the overall classroom environment.

The researchers are careful to say this is an "exploratory" finding. They aren't saying feedback is useless, but rather that different teaching skills might need different "fuel" to grow. Some skills grow from being corrected; others grow from seeing the big picture.

Technical Summary: Instructional Skills Workshops Improve Clinical Teachers' Self-Efficacy, but Only Some Gains Track Feedback Experience

Problem Statement
Core clinical teachers often possess strong subject-matter expertise but lack systematic pedagogical training, relying instead on accumulated experience. While brief, intensive faculty development programs like the Instructional Skills Workshop (ISW) are well-suited to this demographic, existing literature on their effectiveness faces several limitations:

Evidence Gaps: Most studies rely on satisfaction surveys or single-group pre-post designs with small samples, lacking robust replication across independent cohorts.
Holistic Treatment of Outcomes: Training effects are frequently treated as a single global outcome, failing to examine whether gains are uniform across different dimensions of teaching competence.
Mechanism Assumptions: There is a prevailing assumption that feedback is the singular mechanism driving all improvements. However, teaching self-efficacy is a multidimensional construct (encompassing Student Engagement, Instructional Strategies, and Classroom Management), and it is unclear if all dimensions rely equally on the feedback loop for improvement.

Methodology
This study employed a single-group pre–post design implemented across two independent annual cohorts of core clinical teachers (2022 cohort, N = 37; 2024 cohort, N = 39) at a Chinese university of traditional Chinese medicine and its affiliated institutions. To strengthen reproducibility without a randomized control group, the study utilized cross-cohort conceptual replication.

Intervention: A localized, 2-day intensive ISW program. Unlike the standard ISW, this version included:
- An introductory lecture on instructional design principles.
- Systematic demonstration of the BOPPPS framework (Bridge-In, Outcome, Pre-Assessment, Participatory Learning, Post-Assessment, Summary).
- Standard ISW cycles of microteaching, peer/facilitator feedback, and re-practice.
- Video-based self-observation and observation of award-winning teaching demonstrations.
Measures:
- Teaching Self-Efficacy: Measured using a 12-item adapted Teachers' Sense of Efficacy Scale (TSES) covering three dimensions: Student Engagement (SE), Instructional Strategies (IS), and Classroom Management (CM).
- Feedback Experience: Measured using a 30-item adapted Assessment Experience Questionnaire (AEQ) covering five dimensions (e.g., quality of feedback, what learners do with feedback).
Analysis: Paired t-tests and Cohen's d assessed pre-post changes. Pearson correlations examined associations between feedback experience dimensions and self-efficacy gain scores ( $\Delta$ ). Given the exploratory nature and sample size, no correction for multiple comparisons was applied; credibility relied on replication across the two independent cohorts rather than single-test significance.

Key Results

Replicable Gains in Self-Efficacy: Both cohorts demonstrated significant and substantial improvements across all three self-efficacy dimensions (all p < .001). Effect sizes were large (Cohen's d ranging from 1.31 to 1.79), with consistent direction and magnitude across the two years. Notably, Classroom Management (CM) showed gains comparable to or exceeding those of the other dimensions.
Divergent Association with Feedback: The relationship between feedback experience and self-efficacy gains was not uniform:
- Instructional Strategies (IS) & Student Engagement (SE): Gains in these dimensions showed significant positive correlations with specific feedback dimensions, particularly "what learners do with the feedback" and "quality of feedback." For instance, $\Delta$ IS correlated significantly with "what you do with the feedback" in both cohorts (r = .39 and .35, respectively).
- Classroom Management (CM): Gains in CM showed no significant association with any of the five feedback dimensions in either cohort (highest r = .27 in 2022; highest r = .18 in 2024). The authors interpret this as a failure to detect a significant association at the current sample size rather than definitive proof of no association, yet the pattern was consistent across cohorts.

Key Contributions

Replication Evidence: The study provides robust evidence of the ISW's effectiveness for clinical teachers through cross-year replication, addressing the scarcity of such evidence in medical faculty development literature.
Dimensional Specificity: It challenges the view of training effects as monolithic, demonstrating that gains in different teaching competencies are not uniform in their magnitude or their drivers.
Mechanism Boundaries: The study empirically tests the role of feedback, finding that while feedback is strongly associated with gains in instructional strategies and student engagement, it may not be the primary driver for gains in classroom management efficacy.

Significance and Claims
The paper claims that the ISW-based program is effective in broadly improving clinical teachers' teaching self-efficacy. However, its primary theoretical contribution is the divergence in mechanisms: the assumption that feedback is the "single unifying mechanism" for all teaching competence gains is not supported.

The authors propose that gains in Classroom Management may stem from sources other than the feedback cycle, such as the direct acquisition of an overall teaching framework provided by the introductory instructional design lecture and demonstrations. This suggests that different teaching competencies may require different developmental pathways:

Feedback-dependent: Skills like instructional strategies and student engagement, which can be iteratively refined through specific peer/facilitator feedback.
Framework-dependent: Holistic competencies like classroom management, which may rely more on direct instruction, observation of models, and a shift in overall design awareness.

The study concludes that faculty development programs should not presume feedback alone drives all improvements; instead, they should deliberately incorporate direct teaching of instructional design and classroom organization principles to address competencies that feedback cycles may not effectively target. The authors maintain a modest stance, acknowledging that their design (single-group pre-post) limits causal inference and that the proposed mechanisms are hypotheses warranting further investigation with more rigorous designs.