Abstract
BACKGROUND: Active learning is an effective instructional tool in medical education. However, its integration by nephrology faculty remains limited despite residents' declining interest in nephrology. STUDY DESIGN: A sequential explanatory mixed-methods study design was used to explore nephrology faculty understanding of difficult teaching topics and active learning integration using the theory of planned behavior as theoretical framework. SETTING & PARTICIPANTS: Nephrology faculty at 6 residency sites in Singapore were recruited. METHODOLOGY: A 28-item questionnaire was administered to conveniently sampled faculty followed by 1-to-1 semi-structured interviews of a purposively sampled subset. ANALYTICAL APPROACH: Quantitative data were analyzed using descriptive and regression statistics. Qualitative data were analyzed using thematic analysis in line with the theory of planned behavior constructs (attitude, subjective norm, perceived behavioral control, intention, and behavior). RESULTS: 49 of 82 invited faculty responded, with 49% and 42% perceiving self-directed learning and interactive lectures, respectively, as active learning formats. Fluid, electrolyte, and acid-base disturbances; transplantation immunology; glomerulonephritis; and hemodialysis adequacy were cited as difficult topics by 75%, 63%, 45%, and 31% of responders, respectively. Only 55% reported integrating active learning formats when teaching difficult topics. Faculty in leadership roles and teaching difficult topics more regularly were more likely to adopt active learning formats. Multivariable logistic regression analysis showed that faculty attitude strongly and significantly predicted active learning intention. Thematic analysis identified 4 themes: active learning competence, barriers and challenges, environmental influence, and self-identity. Self-identity, defined as values developed from past behavior and experience, emerged as an important contributor to active learning adoption outside the theory of planned behavior framework. LIMITATIONS: Sampling, context, and measurement biases may affect study reliability and generalizability. CONCLUSIONS: Nephrology faculty lack active learning competence and face cognitive challenges when teaching difficult topics. Faculty teaching experience significantly influenced active learning adoption. Our findings build on the theoretical understanding of faculty instructional innovation adoption and can inform nephrology faculty development initiatives.