Study design

A qualitative focus group study within a social constructionist framework was adopted to answer the research question. Focus groups are technical tools for investigating a research question through participants’ discussion [18]. The study complied with the Declaration of Helsinki, ensuring ethical standards were upheld to protect the rights and welfare of participants, and was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) [19]. Ethical approval was obtained from the Approval Committee for Human Research (CARP), University of Verona, Verona, Italy (Approval date: 18/05/2023; Code: 31/2022).

Participants

Recent graduates and students of the MSc in ’Rehabilitative Sciences of the Health Professions at the University of Verona (Verona, Italy) were recruited. This MSc focused on research methods and methodologies, teaching in higher education and health economics. This MSc programme focuses on research methods, pedagogy in higher education, and health economics. It includes a unique curriculum with mandatory courses such as pedagogical methodologies, curriculum design, and tutorial methodology. The programme attracts a diverse cohort of students with a BSc in one of the eight rehabilitation health professions recognised by the Italian health professional register, including physiotherapists, speech therapists, occupational therapists, orthoptists, podiatrists, psychiatric rehabilitation technicians, psychomotor therapists, and professional educators. All courses within the degree programme’s curriculum are mandatory, and the complete course curriculum can be viewed in S1 Table.

Participants were purposely sampled to identify those who were more informative to answer the research question by ensuring that the group was as heterogeneous as possible [20]. To achieve this, we sought participants with relevant experience in rehabilitation, education, and management. Specifically, the authors contacted the course leader of this MSc, asking her to reach out to the former or current students of the programme based on different criteria. The course leader contacted the students via email. She sent an email outlining the aim of the study, its design and the informed consent to be signed. She specifically explained in the email to contact BM instead of her to programme the focus groups. This decision was made to prevent the course leader from knowing which students participated in the focus groups, as she taught a course related to pedagogical methodologies. Participants were recruited based on their professional backgrounds, such as physiotherapy, speech therapy, and others, to ensure a balanced representation of various rehabilitation areas. Additionally, we included professionals with varied levels of lecturing experience (or none), those with roles in coordinating staff and departmental operations, and clinical tutors who work closely with students. Individuals with expertise in coordinating staff and departmental operations alongside clinical tutors were specifically included to capture insights on the course’s impact from professionals accustomed to managing team dynamics and mentoring students in clinical settings. Their perspective was deemed valuable for assessing the development of pedagogical and interpersonal skills relevant to educational and clinical practice. This approach aimed to capture a broad lens of experiences related to the pedagogical courses. Additional information regarding the ethical, cultural, and scientific considerations specific to inclusivity in global research is included in S1 File.

The focus groups were structured to increase variability inside them. The sample size was guided by the concept of ‘information power’ [11] rather than the commonly used but methodologically inappropriate for RTA ‘data saturation’ [12]. According to the information power model, the number of participants needed depends on factors such as the study aim, sample specificity, theoretical background, quality of dialogue, and analysis strategy [11]. Given the expertise of the researchers in qualitative research and pedagogy, the solid theoretical foundations of our study, the specificity of our research question, and the purposeful selection process, an estimate of 16 to 18 participants divided into three focus groups was considered, including at least one individual with clinical expertise, one with lecturing experience, and one with management/coordination experience per each FGD. Furthermore, the authors aimed to diversify the group by considering participants’ gender, age, and years of enrolment in the MSc.

Data collection method

A semi-structured focus group guide was constructed by BM IC and SB (Table 1). BM is a physiotherapist with experience in teaching and tutoring. SB is a physiotherapist, PhD in ‘Neurosciences’ and ‘Medical Sciences’ and temporary lecturer in ‘Pedagogical Methodology for Health Professionals’. IC is a psychologist with a PhD in ‘Migrations and intercultural processes’. SB and IC are trained in qualitative methodologies, with expertise in conducting qualitative studies, and have provided BM with all the necessary training to conduct and analyse Focus Groups Discussions (FGD), following her during this process. BM and IC identify as women; SB identifies as a man.

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Table 1. Semi structured focus group guide.

https://doi.org/10.1371/journal.pone.0314920.t001

The ‘dual moderator’ focus group included eight open-ended questions to investigate the participants’ experience of pedagogical courses [21]. One moderator (IC), with expertise in qualitative research, ensured that the focus group adhered to the correct procedures, while the other (BM) followed an interview guide to ensure all contents were addressed. Together, the moderators facilitated the progression of the focus group interview, ensuring that all topics were thoroughly investigated [21]. The initial outline was tested for relevance and comprehensibility of content in two pilot interviews conducted online with two former MSc students. Following these interviews, the semi-structured focus group guide was revised and corrected to the final version. The three FGD were conducted online by BM and IC in September 2023. In each FGD, participants were informed of the recording of the session, reassured that the data would remain anonymous, that they were free to answer or not answer questions, and that they could leave the session at any time. Prior to each FGD, the contents and topics covered within pedagogical courses in the MSc study’s objective were summarised. After the researchers introduced the study’s objectives and summarised the topics covered in the pedagogical courses, each participant briefly introduced themselves to the group. The FGD opened with an introductory question concerning expected and unfulfilled expectations regarding the courses. Then, moderators asked them which topics they found most relevant, positively or negatively. Afterwards, moderators asked them to describe their experience in these courses focusing on the figure of the lecturer. The authors tried to analyse any change of perspective regarding the lecturers’ role after the experience and the topics covered in these courses. Then, the focus shifted to the skills gained from these courses, either for teaching or other fields (e.g., clinical). The FGD ended by asking the participants whether they would recommend (or not) these courses to other colleagues and why. At the end of the group interview, space was left for further consideration. The FGD were recorded and then transcribed verbatim. The data and recordings were stored in a database on an online university drive. The recordings were deleted as soon as the transcription phases were completed. The transcription of the FGD was anonymised and shared with the other researchers.

The FGDs were conducted in Italian, the native language of all participants, to ensure that their experiences and perspectives were captured authentically. This approach allowed the researchers to generate themes directly from participants’ words in their mother tongue, thus preserving the integrity of their responses during the analysis phase. After themes were established, selected quotes and themes were translated into English for this manuscript. The translation was performed by the research team members fluent in Italian and English to ensure that the translated content remained as faithful as possible to the participants’ original meanings.

Data analysis

In addition to BM, the data analysis involved three other researchers, GB and BG. They are physiotherapists and PhD students in ‘Neurosciences’ with expertise in conducting qualitative studies. GB and BG identify themselves as men. SB guided the authors throughout the data analysis. As a first step, a descriptive sample analysis was carried out to identify data regarding age, gender, professional category and previous experience in clinical, teaching, tutoring and coordination, as well as the academic year they attended the MSc.

Qualitative data were analysed using Braun and Clark’s ‘Reflexive Thematic Analysis’ (RTA) to identify the patterns of meaning and consequently generate themes relating to the experiences of the pedagogical courses [22]. RTA was selected for analysing the qualitative data due to its flexibility and adaptability, which allowed us to capture the nuanced perspectives of participants in pedagogical training courses. RTA is particularly suitable for studies with an experiential focus, as it enables a deep exploration of participants’ personal insights and the meanings they attach to these experiences. This approach allowed us to generate themes inductively, ensuring that they authentically reflected participants’ voices without imposing pre-existing frameworks. Moreover, RTA facilitated a collaborative analysis process, enriching the rigor of theme development and aligning with the social constructionist framework of this study. From the point of view of the epistemological framework, this study adopted a social constructionist approach and an experiential orientation. The coding was mainly at a descriptive/semantic level. To analyse the focus group data, we followed the six steps of RTA as outlined by Braun and Clarke, as shown in Table 2.

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Table 2. Six steps of the RTA.

https://doi.org/10.1371/journal.pone.0314920.t002

Theme 1: A brave new pedagogical world

This theme revolves around the transformative experience participants described as encountering a “brave new pedagogical world,” shifting their understanding of teaching from a technical skill to a relational and dynamic practice. The researchers identified several codes that helped construct this theme (Table 1 in S2 Table). A key aspect of this theme is the importance of good communication in pedagogy, where participants began to recognise that effective teaching requires expertise and the ability to communicate clearly and engage students. One participant noted, “A good teacher isn’t just a guru with knowledge, but someone who can communicate effectively” (P7, 36, physiotherapist with teaching experience). This reflection shows a shift from viewing teachers as merely content experts to seeing them as facilitators who actively shape the learning environment. Another essential element is the importance of taking care of students, illustrated by how participants felt valued and supported by their instructors. One participant shared that this caring approach was meaningful: "I felt important to the teachers; they made me feel comfortable and provided all the essential materials” (P6, 34, physiotherapist with teaching experience). Experiencing this level of care firsthand helped participants understand the impact of a student-centred approach, reinforcing the importance of empathy and attentiveness in pedagogy. Participants also highlighted the importance of a consistent and good model in teaching, where the alignment between teachers’ actions and their pedagogical principles served as an inspiring example. One participant observed, “The remarkable coherence between what Professor X explained and how they taught was impressive,” adding that this consistency created a “wow” moment that left a lasting impression (P10, 29, speech therapist with clinical experience). This experience emphasised how leading by example in teaching methodology could profoundly influence students’ perceptions of teaching. The theme further includes the importance of playing an active role in learning. Rather than absorbing information passively, participants were encouraged to be active creators, directly engaging with the material through hands-on tasks and collaborative projects. As one participant described, “The active learning methodologies we used opened up a whole new world for me” (P10, 29, speech therapist with clinical experience). This code reflects a shift toward understanding learning as a participatory process, deepening participants’ appreciation for methods that invite students to actively engage and take ownership of their learning. Participants also expressed an awareness of the behind-the-scenes effort in teaching as they came to realize the extensive planning, organisation, and commitment required to create effective lessons. One participant reflected, “I realised how challenging and complicated it can be to build a lecture” (P15, 27, physiotherapist with teaching experience). This insight fostered a newfound respect for teaching as a complex and labour-intensive discipline, going beyond what they initially expected. Finally, the theme encompasses discovering how pedagogy can be fascinating, as some participants reported developing a genuine interest in teaching. For instance, one participant noted, “I never imagined that teaching could be so fascinating. I started with no expectations, but by the end, I felt an unexpected interest in becoming a lecturer” (P15, 27, physiotherapist with teaching experience). Collectively, these reflections illustrate how the experience opened up new perspectives for participants, expanding their view of teaching as not just a skill but a meaningful and inspiring profession.

Theme 2: Becoming a cutting-edge lecturer

This theme reflects participants’ desire to become “cutting-edge lecturers” who integrate technical expertise with dynamic, student-centred teaching strategies to enhance learning outcomes. The researchers identified several codes that contributed to constructing this theme (Table 2 in S2 Table). A foundational code within this theme is knowledge of adult learning mechanisms, which many participants found transformative. Participants expressed how understanding the distinct learning needs of adults allowed them to adapt their teaching styles more effectively. One participant noted, “The course showed us how adults learn and the importance of meeting different learning styles” (P3, 28, physiotherapist with tutoring experience), emphasising that this insight opened new possibilities for crafting lessons that resonate with adult learners.

Another significant code, how to tailor lectures to students, illustrates participants’ growing commitment to making lessons relevant to students’ real-world experiences. Participants highlighted how they adjusted their lectures to integrate practical examples, thereby connecting theoretical content with clinical applications. As one participant shared, “I tried to modify my lessons, bringing in concrete examples from clinical practice” (P8, 50, physiotherapist and university tutor), which helped them reframe their role as facilitators who guide students in applying knowledge to practical settings. How to evaluate students properly emerged as another key component, where participants embraced assessment frameworks such as Bloom’s taxonomy to foster critical thinking and clinical reasoning. One participant described the changes in their assessment approach, stating, “I redesigned my exams to encourage clinical reasoning, and I use a learning contract to set clear expectations” (P8, 50, physiotherapist and university tutor). This approach aimed to promote transparency and fairness, contributing to a more equitable and supportive learning environment. Participants also emphasised how to use active learning tools to create interactive and engaging experiences. They described experimenting with methods like group projects, videos, and individual tasks to make lectures more participatory and impactful. “I used group projects, videos, and individual tasks to make lectures interactive,” one participant explained, reflecting on the benefits of these strategies in making learning more dynamic and student-centred (P9, 33, physiotherapist and university tutor). How to communicate effectively with students was identified as an essential skill in capturing and maintaining student attention. Participants discussed how adopting effective communication techniques, such as modulating tone, using movement, and incorporating digital tools, enhanced classroom engagement. One participant emphasized, “It’s not just what you teach but how you convey it. Using tone, movement, and digital tools helped me keep students engaged” (P9, 33, physiotherapist and university tutor), underscoring the importance of adaptability and presence in fostering a vibrant learning environment. Finally, how to arrange pedagogical tools and project effective lessons captures participants’ increased proficiency in structuring and planning educational content. They learned to design lessons thoughtfully, ensuring that each component was aligned with learning objectives and tailored to students’ needs. One participant remarked on this approach: “Every time I have to present, I think about making the presentation captivating, with images and elements to keep attention high” (P14, 52, physiotherapist and coordinator with teaching experience). This planning allowed participants to envision themselves as forward-thinking educators, ready to inspire and connect with students in meaningful ways. Together, these codes capture the essence of becoming a “cutting-edge lecturer” by focusing on preparation, adaptability, and a strong commitment to student-centered teaching.

Theme 3: Something beyond pedagogy

This theme explores how the pedagogical skills participants gained extended beyond the classroom, significantly enriching their clinical practice and personal lives. The researchers identified several codes that contributed to constructing this theme (Table 3 in S2 Table). The first code, teamwork skills, captures how participants developed a stronger appreciation for interdisciplinary teamwork through collaborative projects. This experience enhanced their ability to communicate and engage constructively with colleagues from diverse backgrounds. As one participant reflected, “The group work allowed us to learn from each other and work together toward a common goal” (P16, 28, speech therapist with teaching experience). This collaborative experience strengthened their professional relationships and built a foundation for effective teamwork in various settings. Another core code is how to learn from experience, highlighting the participants’ newfound appreciation for self-assessment and growth through reflection. This reflective mindset helped participants approach new challenges with openness and adaptability, as one noted: “The courses encouraged me to reflect on my actions and ask questions, which helps me approach new challenges with an open mind” (P11, 34, physiotherapist with tutoring experience). This emphasis on reflection was seen as critical for both professional development and personal growth. Developing a new awareness that enhances an open mindset emerged as an important outcome, as participants expressed a renewed willingness to embrace change and challenge themselves. One participant described this transformation, stating, “The course has inspired a desire to continue, to learn, and to change” (P2, 48, physiotherapist in a coordinating role). This mindset shift was accompanied by an increased desire to do things well, with participants describing how the course sparked a motivation to pursue excellence in their work. One participant explained, “I came out of the class wanting to do better; it gave me the desire to strive for quality” (P3, 28, physiotherapist with tutoring experience). This drive was seen as foundational to their ongoing personal and professional development. The code enhancing willingness to change for good further underscores how the training inspired participants to embrace continuous improvement. This growth-oriented perspective encouraged them to view challenges as opportunities for personal and professional advancement, fostering resilience and adaptability in their careers. Becoming a critical thinker was another key code, where participants learned to approach training and educational methods with a discerning eye. This critical perspective empowered them to evaluate teaching methods more effectively and prioritize those most beneficial to learners. “These courses have taught me to look critically at teaching methods and select what truly benefits students,” explained one participant, underscoring how this skill would support their future development (P1, 26, speech therapist with teaching experience). Applying communication skills in clinical, personal, and professional settings was also transformative for participants. They reported that improved communication made their interactions with patients, colleagues, and family members clearer and more impactful. One participant shared, “I’ve applied what I learned in didactics to better communicate with patients and colleagues, making my interactions clearer and more impactful” (P6, 34, physiotherapist with teaching experience). This adaptability helped participants build rapport and understanding across diverse interactions. Lastly, increasing patient adherence based on their learning mechanisms reflects how participants transferred their pedagogical insights into clinical practice. Recognising that tailoring communication to patients’ individual learning styles could boost engagement, one participant remarked, “Knowing how to adapt my approach based on learning styles has improved my interactions with patients, especially in motivating them to follow through on exercises” (P7, 36, physiotherapist with teaching experience). This application of pedagogical principles to patient care underscores the relevance of these teaching skills in clinical settings, ultimately enriching participants’ ability to connect with and motivate their patients. Collectively, these codes reveal how the skills gained in pedagogical training extended beyond the classroom, enabling participants to enhance their effectiveness in clinical practice, strengthen their personal and professional relationships, and adopt a mindset of continuous learning and adaptability.