Integrating transformative learning in healthcare education: a sequential explanatory mixed-methods study of educator preparedness, practice and institutional conditions

Abstract Background Transformative learning is increasingly recognised as important for preparing health professionals to address complex challenges related to sustainability, equity, ethics and global health. However, limited empirical evidence exists on how healthcare educators integrate transformative learning principles into teaching, how prepared they feel to do so and which conditions shape their practice. This study examined these dimensions at Karolinska Institutet. Methods A sequential explanatory mixed-methods design combined a quantitative survey of healthcare educators (n = 62) with a qualitative focus-group workshop (n = 12). Survey respondents rated their current practice and perceived preparedness across eight transformative learning principles. Internal consistency was assessed using Cronbach’s alpha. Paired-samples t-tests compared current practice with perceived preparedness at the principle level, followed by exploratory dimension-level analyses for principles showing statistically significant differences. Descriptive statistics were calculated, and qualitative data were analysed using content analysis. Findings were integrated during interpretation. Results Educators reported moderate to high levels of current practice across all eight principles. Current-practice means ranged from 3.20 to 3.91 on a five-point scale, while perceived-preparedness means ranged from 3.19 to 3.73. Statistically significant gaps between current practice and perceived preparedness were found for promoting inclusive behaviours in teaching and learning and for engaging in critical self-reflection and continuous learning. Dimension-level analyses indicated that these gaps were concentrated in inclusive communication, inclusion of diverse voices, modelling vulnerability and respect, reflection on practice and continuous professional development. Qualitative findings identified professional development opportunities, organisational conditions and classroom-level factors as interconnected influences on integration. Conclusions Transformative learning was integrated to varying degrees, but educators did not always feel fully prepared to enact practices they reported using. The findings support a competency-system perspective in which educator capabilities, pedagogical practices and institutional conditions interact. Health professions education institutions should align faculty development, protected time, peer learning and organisational support to strengthen educators’ capacity to integrate transformative learning.