“When teaching turns turbulent: a mixed-methods study on prioritizing critical incidents of health sciences teachers”

Critical incidents significantly impact teacher identity, either constructively or disruptively. However, without knowing which incidents are most impactful, interventions and long-term plans cannot be designed. This study aimed to identify and prioritize critical incidents from faculty members’ perspectives at Tehran University of Medical Sciences, focusing on their perceived influence on their teacher identity. This sequential mixed-methods study was conducted in three phases. Firstly, Semi-structured interviews with 22 faculty members were conducted to identify critical incidents. Then, using a systematic literature review in five databases (ERIC, PubMed, WoS, Scopus, ProQuest), we enriched interview-derived codes. Finally, our three-round modified Delphi study (48 panelists in round 1, 34 in rounds 2–3) prioritized incidents based on the 20/80 concept - derived from the Pareto principle- as a threshold. Eight negative-valenced incidents reached the highest priority from the teachers’ perspective on identity: “Cognitive Preoccupation and Stress Experienced by Teachers Due to Financial and Economic Pressures”, “Mismatch Between Institutional Expectations of Teachers and the Level of Financial Support Provided by the University”, “Teachers’ Confrontation with Low-Motivated Students in the Learning Process”, “Unfair and Discriminatory Regulations in Teacher Recruitment, Promotion, and Evaluation Processes”, “Impact of Personal Conflicts Among Teachers on Professional Relationships”, “Conflict Between Institutional Priorities and Teachers’ Personal Interests”, “Teacher–Student Generational Gap in Defining Values and Educational Norms”, and “Receiving Poor Student Evaluation Results”. Four positive valenced incidents also reached high priority: “Support from Administrators or Colleagues for Teachers in Critical Situations”, “Seeking Advice from Teachers by Students in Critical Life or Career Situations”, “Students’ Academic and Professional Success Achieved Under Teacher Support”, and “Recognition and Appreciation of Teachers by Administrators and Educational Authorities.” These findings apply to contexts similar to Iran and underscore that organizational and financial support matters alongside student related and professional factors for faculty worldwide.