Constructing Educational Judgment in a Transnational Faculty Development Program for Educators from Laos and Vietnam: A Qualitative Study of Reflective Portfolios

Constructing Educational Judgment in a Transnational Faculty Development Program for Educators from Laos and Vietnam: A Qualitative Study of Reflective Portfolios | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Constructing Educational Judgment in a Transnational Faculty Development Program for Educators from Laos and Vietnam: A Qualitative Study of Reflective Portfolios Yoonjung Lee, Seung-Hee Lee, Sang-Hoon Na This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8802034/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Transnational faculty development programs operate across institutional systems that differ in authority, infrastructure, and regulatory expectations. Evaluations focusing solely on post-program implementation risk overlooking early forms of professional learning, particularly in low- and middle-income settings. Our study examined how reflective portfolios functioned as epistemic work—analytic activity through which educators constructed educational judgment—within a cross-border faculty development program implemented in South Korea for participants from Laos and Vietnam. Methods: An interpretivist qualitative design informed by practice-based perspectives guided the analysis of longitudinal reflective portfolios and semi-structured interviews from twelve health professions educators participating in a ten-week South Korea-based international faculty development program. The dataset comprised 168 pre-program portfolios, 167 post-program portfolios, and 24 interviews. Template Analysis was conducted through iterative coding, longitudinal before–after comparison, and cross-case synthesis. Rigor was ensured through triangulation, member checking, peer debriefing, and maintenance of an audit trail. Results: Five analytic clusters captured participants’ reconfiguration of educational reasoning during the program. Educators reconceptualized educational practice as coordinated, system-dependent work; differentiated legitimate agency across individual, departmental, and institutional levels; exercised feasibility-based judgment by evaluating conditions required for responsible enactment; reasoned about the timing of action, distinguishing conceptual understanding from readiness; and anticipated relational and system-level consequences of educational decisions. Reflection operated not merely as documentation but as epistemic work shaped by transnational institutional realities. Conclusion: Judgment formation emerged as a meaningful outcome of a transnational faculty development initiative where immediate implementation was structurally constrained. Conceptualizing reflection as epistemic work offers a process-oriented lens that complements implementation-focused evaluation and enhances understanding of how educators reason about practice within cross-border, resource-variable contexts. Faculty development Medical education Reflective practice Epistemic work Practice-based learning LMICs Cross-border education Qualitative research Figures Figure 1 Introduction Faculty development has long been used to strengthen medical education, yet many initiatives now operate across national borders where institutional structures, regulatory expectations, and available resources differ markedly. Participants from low- and middle-income countries (LMICs) often engage in programs facilitated by institutions in high-income settings, and they return to local environments characterized by limited authority, insufficient infrastructure, and hierarchical decision-making systems [ 1 – 3 ]. Under such cross-border conditions, newly introduced educational concepts must be interpreted, adapted, and evaluated within institutional realities that frequently restrict opportunities for immediate implementation. When these constraints are present, judging program effectiveness solely by post-program enactment risks overlooking important forms of learning that occur before visible change is possible [ 4 ]. Much of the faculty development literature focuses on outcomes such as skill acquisition, teaching performance, or transfer of training into practice [ 5 , 6 ]. Although implementation remains meaningful, this focus provides an incomplete account of learning within transnational programs, which are often short in duration, culturally diverse, and structurally heterogeneous. In such contexts, the absence of immediate implementation does not necessarily indicate limited learning; rather, educators may be engaged in reinterpreting concepts through the lens of their institutional authority, workflow, and governance arrangements [ 7 , 8 ]. Research on practice-based and workplace learning offers a different perspective. It suggests that professional learning includes changes in how practitioners understand their work, locate responsibility, and judge what is appropriate or feasible within their own institutions [ 9 – 13 ]. From this viewpoint, faculty development influences not only what educators do, but also how they think and how they interpret educational problems, consider possible actions, and define responsible practice. Such shifts in judgment can emerge before, or even without, observable changes in behavior [ 14 ]. Yet few empirical studies have examined these processes within transnational faculty development, where educators must integrate globally introduced concepts with locally governed educational systems and resource environments [ 15 – 17 ]. Reflection has increasingly been conceptualized as an analytic process through which practitioners examine assumptions, evaluate alternatives, and determine what constitutes responsible action[ 18 – 20 ]. From this perspective, reflective writing functions as a form of epistemic work rather than solely as documentation or personal reflection. International faculty development programs, where globally introduced educational concepts must be interpreted within varying institutional realities, offer a particularly relevant context in which to examine this process[ 21 , 22 ]. Our study addresses this gap by analyzing reflective portfolios and longitudinal interviews from participants in Korean-hosted transnational faculty development program for educators from Laos and Vietnam. The analysis examined how educators reasoned about educational practice while learning was still in progress before implementation was possible or appropriate and how they reconfigured their understanding of educational work, agency, feasibility, timing, and relational consequences within transnational institutional contexts. The study was guided by two research questions: RQ1. In what ways did participants’ reflections reveal reconfigurations in understandings of educational work, legitimate agency, and feasible practice during the program? RQ2. How did participants use portfolio-based reflection to translate newly introduced educational concepts into contextually grounded educational judgments? By focusing on how educators form judgment before action, our study offers a different way of understanding learning in transnational faculty development programs. Methods Study Design and Qualitative Paradigm An interpretivist qualitative design informed by practice-based perspectives was used to examine how participants in a transnational faculty development program reasoned about educational practice while learning was still in progress. This orientation was appropriate given the study’s focus on meaning-making, judgment formation, and the reconfiguration of educational reasoning within cross-border institutional contexts rather than observable behavioral outcomes. Template Analysis was selected because it accommodates theory-informed sensitizing concepts while supporting inductive refinement and is well suited for identifying patterned reasoning across large longitudinal datasets. Program Context: Dr. Lee Jong Wook Fellowship for Health Professions Education The study was conducted within the Dr. Lee Jong Wook Fellowship for Health Professions Education (LJWF-HPE), a Korean-hosted transnational faculty development program developed in partnership with institutions in Laos and Vietnam. Established in 2016, the program aims to strengthen educational capacity among health professionals in low- and middle-income countries. The program is funded by *** and implemented by *** as part of an official development assistance initiative. The 2022 cohort comprised twelve health professionals from institutions in Laos and Vietnam who participated in a 10-week program consisting of fourteen modules on teaching and learning, curriculum development, assessment, educational leadership, digital education, and related areas. Participants were nominated by their home institutions and selected through joint online interviews conducted by *** and ***. Participants Twelve health professionals from Laos and Vietnam participated in the study, representing a diverse set of educational and clinical backgrounds. Participants included faculty members, clinical doctors with teaching responsibilities, and technical officers supporting educational programs. Their primary fields spanned pediatrics, medicine, obstetrics and gynecology, oral health, pharmacy, radiology, community and family medicine, public health, and health professions education units. A concise summary of participant characteristics is presented in Table 1 , with extended details available in Supplementary Table 1. Table 1 Summary of Participant Characteristics Characteristic n (%) Country Vietnam 6 (50%) Laos 6 (50%) Gender Female 8 (67%) Male 4 (33%) Age 30s 5 (41.7%) 40s 5 (41.7%) 50s 2 (16.7%) Major Pediatrics 2 (16.7%) Internal Medicine 2 (16.7%) Obstetrics & Gynecology 1 (8.3%) Dentistry 1 (8.3%) Pharmacy 1 (8.3%) Radiology 1 (8.3%) Family Medicine 1 (8.3%) Public Health 1 (8.3%) Tropical Medicine 2 (16.7%) Data Sources Three primary data sources were included in the analysis. Pre-program (Before) Portfolios Reflective portfolios completed prior to the start of the program captured participants’ prior educational experiences, existing assumptions, and initial understandings of teaching and educational practice across the fourteen modules. Portfolio prompts asked participants to describe previous learning experiences related to each module, articulate their prior knowledge or impressions, reflect on the institutional or national context in which the topic was situated, and specify their individual learning objectives for the module. Post-program (After) Portfolios Reflective portfolios completed toward the end of the program documented participants’ evolving interpretations of educational concepts and their emerging judgments about applicability. Participants were asked to reflect on what they had learned, how they interpreted or felt about the module content, how newly introduced ideas might be applied within their home institution or country, and what additional aspects of the topic they wished to explore further. Semi-structured Interviews Each participant completed two semi-structured interviews, one at program entry and one at program completion. Interviews lasted 60–80 minutes and were conducted in English by program staff who were not involved in participant assessment and had no prior relationship with participants. Interview questions explored participants’ conceptions of teaching roles, perspectives on student learning, interpretations of newly introduced educational ideas, and perceived changes in their reasoning over the course of the program. All interviews were audio-recorded, transcribed verbatim, and returned to participants for member checking to ensure accuracy and clarity, given variation in English proficiency. Data Analysis Analysis was informed by practice-based perspectives that conceptualize professional learning as shifts in how practitioners define educational work, locate agency and responsibility, and judge feasibility within institutional constraints. Reflection was examined as a form of epistemic work through which participants interrogated assumptions, compare possibilities, and delineate what they considered responsible or achievable within transnationally shaped systems. Template Analysis followed King and Brooks’s iterative [ 23 ], hierarchical approach. The workflow is summarized in Fig. 1 . All pre- and post-program portfolios and interview transcripts were first read multiple times to become familiar with the content. Based on this initial review, a provisional coding template was created using sensitizing concepts drawn from practice-based and workplace learning literature, together with inductive codes derived directly from the data. Two researchers coded an initial subset of the dataset independently using ATLAS.ti. Coding differences were discussed, and the coding template was revised by adjusting code definitions and hierarchical relationships. The revised template was then applied to the full dataset by the primary researcher, with ongoing peer review through analytic discussions. Pre- and post-program portfolios for each participant were compared to identify changes over time. Interview data were reviewed alongside portfolios to provide additional contextual information. After coding was completed, related codes were grouped together, and these groups were organized into five higher-order clusters. The final coding structure is presented in Table 2 . Table 2 Practice-Based Reconfiguration of Educational Reasoning During Faculty Development Program Analytic Cluster Reconfigured Educational Reasoning and Epistemic Work Illustrative Quotations Cluster 1. Redefining the Object of Educational Practice Teaching reconceptualized from individual instructional performance to coordinated, resource-dependent educational work. Reflection surfaced implicit assumptions about teaching, highlighted the invisible preparatory tasks (planning, sequencing, alignment), and made structural and material conditions—expert staff, time, space, functioning equipment—explicit. Participants increasingly acknowledged the limits of individual action and recognized curriculum and assessment work as collective, system-embedded processes. • “Teaching is not only standing in front of students. It is planning the learning objectives, choosing teaching methods, and considering how assessment aligns with those objectives.” (1st interview) • “To conduct item analysis or improve assessment, we need people with the right technical skills, enough time, and institutional support.” (2nd interview) • “Preparing PBL requires much more planning than I expected; most of the work is invisible.” (1st interview) Cluster 2. Repositioning Agency and Authority Agency understood as distributed across individual, departmental, and institutional levels. Reflection delineated actions participants could autonomously undertake (e.g., modifying slides) versus those requiring formal authorization, faculty agreement, or committee decision-making (e.g., assessment or curriculum reform). Participants increasingly described leadership as relational rather than positional and recognized that capacity to act was shaped by institutional norms, hierarchies, and workload structures. • “Some things I can change myself, but assessment or curriculum reform cannot be done by one person.” (2nd interview) • “Leadership is not only position. It depends on where I can influence and where I cannot.” (2nd interview) • “Institutional processes and faculty agreement determine what can move forward.” (1st interview) Cluster 3. Exercising Feasibility-Based Judgment Educational ideals were re-evaluated through ongoing appraisal of material, human, and organizational feasibility. Participants assessed prerequisites for responsible implementation—technical expertise, time, staff support, facilities, reliable equipment—while identifying constraints such as large class sizes and uneven faculty readiness. Reflections emphasized the risks of premature or unsupported implementation, noting that pedagogically sound methods could become merely procedural or harmful without adequate preparation. • “To do item analysis, we need skills, time, and people. Without that, it becomes only a form.” (1st interview) • “Assessment is not only writing questions. It requires clear criteria, feedback, and analysis; otherwise it may create confusion.” (After portfolio) • “If we implement too quickly, it may confuse students or create inconsistency among teachers. (2nd interview) Cluster 4. Temporalizing Educational Action Participants differentiated conceptual understanding from readiness to act. Reflection supported judgments about appropriate timing, sequencing, and pacing of educational change. They reasoned that immediate implementation could generate unexpected problems or disrupt ongoing coursework and emphasized the importance of preparation, alignment with existing structures, and collegial coordination. Delayed or gradual implementation became reframed as responsible professional action. • “Understanding the method does not mean I can use it immediately. It needs more preparation.” (2nd interview) • “If I change this alone, it may affect others. We need discussion before any change.” (2nd interview) • “Sometimes delaying action is more responsible than acting quickly.” (After portfolio) Cluster 5. Anticipating Relational Consequences and Collective Accountability Educational decisions evaluated in terms of fairness, coherence, institutional trust, and shared accountability. Participants anticipated how changes might be interpreted by learners (e.g., fairness of assessment), colleagues (e.g., workload implications), and the broader program. Reflection highlighted second- and third-order relational consequences, emphasizing that even well-intentioned changes could undermine trust or consistency if introduced without adequate coordination. • “If we change assessment without coordination, students may feel it is unfair.” (After portfolio) • “Implementing something without preparation may confuse students or colleagues.” (Interview 2) • “This is not only my responsibility. If something goes wrong, the department is involved.” (2nd interview) Data Volume and Units of Analysis The corpus included 168 pre-program portfolios, 167 post-program portfolios, and 24 interview transcripts. Portfolio entries ranged from 200–500 words per module. Interview transcripts were 10–20 pages in length. Coding occurred at the level of meaning units within each data source, followed by within-participant longitudinal comparison and cross-case synthesis. Methodological Rigor Rigor was ensured through triangulation across data sources, member checking of interview transcripts, maintenance of a detailed audit trail, reflexive memoing, and attention to disconfirming cases. Transferability was supported through detailed contextual description. Researcher Reflexivity The primary researcher’s dual role as program coordinator and analyst enabled close engagement with the program context but required explicit attention to reflexivity. Analytic decisions and assumptions were documented through reflexive memos, and emerging interpretations were discussed with research team members who were not involved in program delivery. Ethical Considerations This study involved secondary analysis of anonymized data originally collected for program evaluation. Ethical review was conducted by the Institutional Review Board of Seoul National University College of Medicine and Seoul National University Hospital, which determined the study to be exempt from full review (IRB No. E-2212-032-1383). All identifying information was removed prior to analysis, and data were stored securely. Results Rather than indicating uniform improvement or post-program implementation, the findings demonstrate how participants reconfigured their understanding of educational work, agency, feasibility, timing, and relational consequences while learning was still in progress. Across all clusters, portfolio-based reflection functioned as a space in which participants engaged in ongoing epistemic work—interrogating assumptions, examining conditions of action, and delimiting what counted as appropriate educational practice within their institutional contexts. Five analytic clusters capture these shifts in educational reasoning(Table 2 ). Cluster 1. Redefining the Object of Educational Practice: From Instructional Performance to Organized Educational Work Early reflections characterized teaching primarily as a performance centered on transmitting knowledge. Participants described “explaining clearly,” “presenting confidently,” or “summarizing content well” as the core elements of good teaching. These entries suggested an emphasis on the visible moment of instruction rather than the broader processes that support it. As the program progressed, participants expanded their conceptualization of instructional work. They increasingly described teaching as an organized set of tasks involving the articulation of learning objectives, the selection and sequencing of methods, and the alignment of assessments with curricular goals. Several participants noted that preparing PBL, TBL, or skills-based sessions “required much more planning than I expected” and demanded work that was “not visible when standing in front of students.” Participants also became more attentive to the structural and material conditions that enable educational practice. Across portfolios and interviews, they emphasized the need for staff with analytic expertise, time allocated for item-writing and review, reliable assessment systems, adequate physical space, and functioning equipment. Some reflected that when these conditions were lacking, assessment tasks “became only procedural” and did not meaningfully contribute to learning or evaluation. A recurring thread in this cluster involved acknowledging the limits of individual action. Participants noted that major changes—such as redesigning assessments or modifying curricula—required collaboration and departmental coordination. As one participant wrote, “Improving my teaching is important, but curriculum reform is not something one person can do.” Overall, Cluster 1 captures a shift from conceiving teaching as individual performance to depicting it as coordinated, resource-intensive educational work embedded in organizational systems. Cluster 2. Repositioning Agency and Authority: Locating Educational Action Within Organizational Systems Early entries often presented educational improvement as primarily dependent on individual effort. Participants described intentions to adopt new methods, adjust their teaching style, or introduce innovations on their own initiative. Later reflections revealed a more layered understanding of agency. Participants distinguished clearly between actions they could undertake independently—such as modifying slides or adjusting discussion facilitation—and those requiring formal authorization or collective decision-making. One participant summarized this boundary by noting, “Some things I can change myself, but assessment or curriculum reform cannot be done by one person.” Participants also described how organizational norms, roles, and hierarchies shaped their capacity to act. Although some leaders expressed support for innovation, participants explained that broader faculty agreement or approval from senior colleagues was often necessary. Several pointed out that institutional processes, committee structures, and workload constraints influenced whether proposed changes could move forward. Leadership was increasingly portrayed as relational rather than positional. Participants emphasized that influence depended on “where my role allows me to contribute” and “where I do not have authority.” Some noted feeling responsible for educational quality while simultaneously limited by structural boundaries or unclear mandates. By the end of the program, participants articulated a more complex understanding of educational agency—one that acknowledged both their potential for influence and the organizational structures that defined the legitimacy and feasibility of their actions. Cluster 3. From Endorsing Ideals to Exercising Feasibility-Based Judgment Early reflections often accepted newly introduced educational approaches as inherently valuable. Participants expressed positive views of PBL, TBL, OSCE, or structured assessment tools, but seldom examined what their implementation would practically require. As participants progressed through the program, their reflections shifted toward detailed evaluation of feasibility. They identified technical expertise, available time, staff support, adequate facilities, functioning equipment, and coordinated workflow as essential prerequisites for responsible implementation. One participant noted that without training and dedicated time, “item analysis becomes only a formality.” Participants also described structural constraints that limited what could be executed. Large class sizes, insufficient rooms for group work, outdated equipment, short class durations, and uneven faculty capacity were frequently cited. Reflections described situations in which methods were pedagogically appropriate but contextually impractical. Importantly, participants began to articulate the risks of premature or unsupported implementation. They expressed concern that introducing a method “without preparation” could confuse students, create inconsistency among instructors, or generate additional work for colleagues. As one participant wrote, “This method is meaningful, but if we do it too quickly or without support, it may cause harm.” Cluster 3 highlights the emergence of feasibility-based judgment as central to participants’ reasoning, marking a shift from endorsing educational ideals to evaluating the conditions under which they could be enacted responsibly. Cluster 4. Temporalizing Educational Action: Reasoning About When, Not Whether, to Act Early reflections suggested a direct connection between understanding a new approach and acting on it. Participants often assumed that newly learned methods could or should be applied immediately. Over time, participants displayed increasing attention to timing. Many emphasized that conceptual understanding did not automatically translate into readiness to implement. They described the need for preparation, alignment with existing curricula, and coordination with colleagues. Several explained that immediate implementation could lead to “unexpected problems” or disrupt ongoing coursework. Participants also identified the relational dimensions of timing. They noted that unilateral changes could influence colleagues’ teaching, interfere with course sequencing, or create inconsistencies within programs. This led some to adopt gradual, incremental changes or to delay implementation until broader discussions could occur. By the end of the program, participants conceptualized educational action as a temporally sequenced process that required preparation, discussion, and appropriate pacing. Cluster 4 demonstrates how participants came to understand when to act—not only whether to act—as an essential dimension of responsible educational practice. Cluster 5. Anticipating Relational Consequences and Collective Accountability Later reflections contained substantial attention to the relational and institutional consequences of educational decisions. Participants expressed particular concern about fairness from the learner's perspective. They noted that modifying assessment formats or criteria without coordination could lead students to perceive evaluations as arbitrary or inequitable. Participants also considered broader system-level implications. They warned that implementing changes “without preparation” could produce confusion, inconsistency, or loss of trust in the institutional assessment system. Comments emphasized that even well-intentioned changes could generate negative effects if not introduced coherently. Reflections further highlighted the collective nature of educational responsibility. Participants recognized that educational decisions affect colleagues, departments, and programs. As one noted, “If something goes wrong, the department is involved.” Some also reflected on how colleagues’ hesitations or anxieties emerged when expectations were unclear or when they felt excluded from decision-making processes. Across these accounts, participants moved beyond individualistic notions of teaching and began anticipating how educational changes would be interpreted and experienced by others. Cluster 5 captures a shift toward relational and system-oriented reasoning, emphasizing fairness, coherence, trust, and shared accountability as key considerations in educational decision-making. Discussion The first research question is primarily addressed in Clusters 1–3, which trace how participants reconfigured what counted as educational work, legitimate agency, and feasible practice. The second research question is most clearly reflected in Clusters 3–5, where reflective reasoning extended to judgments about timing, relational consequences, and collective accountability. Reframing Outcomes in International Faculty Development Faculty development initiatives are often evaluated through post-program implementation, transfer of training, or observable behavioral change[ 1 , 24 ]. Such approaches assume that educational contexts enable immediate enactment and that learning is best evidenced through action. Transnational programs however operate across institutional systems that vary in governance structure, curricular regulations, and material resources. Participants in our study engaged with Korean-designed educational models while situated within home institutions where authority, workflow, and coordination cultures differed substantially. Under these conditions, immediate implementation is neither expected nor feasible. The findings therefore redirect attention to forms of learning that occur prior to action and are shaped by cross-border contextual contrast. Findings from the present study redirect attention to this neglected phase of professional learning. Analysis of reflective portfolios and interviews demonstrated systematic changes in how participants reasoned about educational practice during the program period. Across five analytic clusters, participants reconfigured their understanding of what educational work entails, who can legitimately act, under what conditions practices can be enacted responsibly, when action is appropriate, and how educational change may affect others within institutional systems. These patterns indicate that judgment formation, rather than immediate implementation, constituted a central outcome of participation. Reflection as a Site of Epistemic Work Reflection occupies a prominent place in medical education, often linked to self-awareness, professionalism, or identity development[ 25 , 26 ]. While prior often conceptualized reflection as inward-oriented, the present findings highlight its outward, analytic, and context-comparative functions.[ 27 , 28 ]. Much of this literature, however, conceptualizes reflection as an inward-facing activity oriented toward personal insight. Portfolio-based reflection operated as epistemic work through which participants examined assumptions, made sense of international pedagogical models, and translated them into judgments grounded in domestic institutional realities. The present findings suggest a complementary but distinct function. Portfolio-based reflection operated as epistemic work through which participants reasoned about educational practice as organized, system-dependent activity. Reflection supported interrogation of assumptions about teaching, articulation of structural and material conditions, and delimitation of responsibility and legitimacy. Rather than merely expressing learning, reflective writing became a mechanism for constructing educational judgment. Such an interpretation is consistent with scholarship in practice-based and workplace learning, where professional learning is understood as a gradual shift in how practitioners define their work and reason through the decisions it demands[ 29 ] Reconstructing Educational Practice Beyond Individual Performance Early reflections in the dataset framed teaching as individual instructional performance, emphasizing content mastery and presentation skills. Similar assumptions have been documented in prior studies of educators’ initial conceptions of teaching[ 30 , 31 ]. Over time, participants increasingly conceptualized education as coordinated work requiring planning, alignment, analytic capacity, and institutional support. Reframing the object of practice marks a shift from viewing education as an isolated act performed by individual teachers to understanding it as work embedded within broader organizational arrangements. The reframing holds theoretical importance because it shifts attention away from individual competencies and toward system-oriented understandings of how educational work is organized[ 32 , 33 ]. In international contexts where individual educators often lack authority over curriculum and assessment, such reconceptualization provides a more realistic basis for reasoning about educational change[ 34 , 35 ]. Locating Legitimate Agency Within Organizational Systems Changes in how participants understood educational practice were closely linked to changes in how agency and authority were conceptualized. Early reflections often assumed that motivated educators could initiate change independently. Later reflections differentiated between actions within personal control and those requiring departmental or institutional authorization. Leadership was reframed as situational and relational rather than positional, echoing leadership models in health professions education[ 36 , 37 ]. Participants did not interpret limited authority as personal failure. Instead, reflection supported articulation of boundaries around responsibility and legitimacy. Educational judgment involved not only deciding what should change, but also determining who had the mandate to initiate such change. Feasibility-Based Judgment and the Integrity of Practice Participants also demonstrated a qualitative shift in how educational ideals were evaluated. Rather than endorsing or rejecting new concepts abstractly, participants assessed practices in relation to the human, material, and organizational conditions required for meaningful enactment. Time, analytic expertise, and institutional support were treated as constitutive elements of practice rather than as external barriers. Previous research has often framed constraint-oriented reasoning as resistance to change[ 38 , 39 ]. However, our findings suggest that participants’ constraint-focused reflections functioned not as resistance but as epistemic work aimed at safeguarding the integrity of educational practice by recognizing that insufficient preparation could render new methods merely procedural or even harmful. Such feasibility-based judgment reflects epistemic maturation rather than reluctance. Educational judgment was exercised not in deciding whether an idea was pedagogically sound, but in determining whether conditions existed for its responsible enactment. Temporal Reasoning and Reflective Restraint Feasibility-based reasoning was accompanied by more differentiated temporal judgment. Participants explicitly distinguished conceptual understanding from readiness to act and framed delayed implementation as a responsible professional stance. Immediate action was increasingly associated with risk rather than success. Reflective restraint emerged as a salient outcome of learning. Non-action was not interpreted as lack of motivation but as an ethical and professional decision grounded in awareness of preparation, coordination, and potential consequences. The pattern challenges expectations that faculty development should yield immediate change and aligns with critiques of linear transfer-of-training models[ 40 – 42 ]. Relational Consequences and Collective Accountability Educational judgment extended beyond feasibility and timing to encompass relational and system-level consequences. Participants anticipated how changes might be perceived by students and colleagues and reasoned about fairness, trust, and institutional coherence. Responsibility for educational action was increasingly framed as collective rather than individual. A relational orientation of this kind aligns with scholarship on educational professionalism that emphasizes accountability to learners, colleagues, and institutions[ 43 ]. Incorporating relational consequences into judgment formation reflected an emerging understanding of education as a shared enterprise rather than an individual endeavor. Differentiated Trajectories of Judgment Formation Not all participants engaged in epistemic work in identical ways. Variations in depth and scope of reasoning reflected differences in institutional roles, prior experience, and positional authority. Practice-based research suggests that such variation is characteristic of situated learning rather than indicative of uneven program effectiveness[ 44 , 45 ]. Within transnational faculty development, the heterogeneity of reasoning represents not a limitation but a hallmark of how educators translate internationally introduced concepts into institutionally grounded judgment. Limitations and Directions for Future Research The analysis focused on articulated reasoning during the program period and did not examine post-program enactment across national institutions. Portfolios and interviews capture expressed judgment rather than enacted change. Future research could trace how epistemic resources acquired during transnational faculty development shape later decisions, negotiations, and institutional reforms. The study was situated within a Korea-implemented transnational faculty development program for participants from Laos and Vietnam, and the analytic model should therefore be understood as context-specific rather than universally representative. Comparative work across other partnerships and regulatory systems would deepen insights into how educational judgment develops in varied transnational settings. Conclusion The study showed how educators participating in a transnational faculty development program involving participants from Laos and Vietnam and implemented in Korea developed educational judgment through portfolio-based reflection while learning was still in progress. Reflection functioned as epistemic work through which participants interrogated assumptions, articulated conditions for responsible practice, and located their legitimate scope of agency within institutionally and nationally distinct systems. Through this process, educators reconceptualized education as coordinated work, differentiated personal from institutional authority, evaluated feasibility through locally grounded criteria, reasoned about the timing of change, and anticipated relational and system-level consequences. Changes in educational reasoning identified in this study represent meaningful outcomes of transnational faculty development, particularly in environments where immediate implementation was structurally constrained. The capacity to exercise feasibility-based judgment, adopt reflective restraint, and anticipate downstream consequences reflected maturation in professional reasoning rather than limited program impact. Conceptualizing reflection as epistemic work within cross-border settings therefore offered a more context-sensitive and realistic account of faculty development—one that complements implementation-centered evaluation and aligns with the complex realities of global medical education partnerships. Declarations • Ethics approval and consent to participate Ethical review was conducted by the Institutional Review Board of Seoul National University College of Medicine and Seoul National University Hospital, which determined the study to be exempt from full review (IRB No. E-2212-032-1383), as it involved analysis of anonymized, non-identifiable data and posed minimal risk to participants. Written informed consent was not required in accordance with IRB determination. All procedures were performed in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. • Consent for publication Not applicable. • Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. • Competing Interests The authors declare that they have no competing interests. • Funding This research was supported by *** as part of Dr. Lee Jong Wook Fellowship for Health Professions Education program. • Authors' contributions Conceptualization: Lee YJ, Na SH. Methodology: Lee YJ, Na SH. Validation: Lee SH, LEE YJ, Na SH. Visualization: Lee YJ. Writing - original draft: Lee YJ, Na SH. Writing - review & editing: Lee YJ, Na SH, Lee SH. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. 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Current status and challenges of faculty development in Korean medical education and strategies for advancement. Korean J Med Educ. 2024;36(4):415. Tran TD, Vu PM, Pham HT, Au LN, Do HP, Doan HT, Huynh N, Huynh QT, Le BK, Ngo DQ. Transforming medical education to strengthen the health professional training in Viet Nam: A case study. Lancet Reg Health–Western Pac 2022, 27. Cintra KA, Borges MC, Panúncio-Pinto MP, de Almeida Troncon LE, Bollela VR. The impact and the challenges of implementing a faculty development program on health professions education in a Brazilian Medical School: a case study with mixed methods. BMC Med Educ. 2023;23(1):784. van Diggele C, Burgess A, Roberts C, Mellis C. Leadership in healthcare education. BMC Med Educ. 2020;20(Suppl 2):456. Ha TM, Nguyen HV, Ngo MQ, Van Le P, Hermiston ML, Nguyen QT. Faculty development in health professions education: exploring need assessment, challenges, and opportunities in Vietnam. BMC Medical Education; 2025. Price I, Regehr G. Barriers or costs? Understanding faculty resistance to instructional changes associated with curricular reform. Can Med Educ J. 2022;13(3):113. Steinert Y, Naismith L, Mann K. Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide 19. Med Teach. 2012;34(6):483–503. O'Sullivan PS, Irby DM. Reframing research on faculty development. Acad Med. 2011;86(4):421–8. Billett S. Integrating learning experiences across tertiary education and practice settings: A socio-personal account. Educational Res Rev. 2014;12:1–13. Tynjälä P. Toward a 3-P model of workplace learning: A literature review. Vocations Learn. 2013;6(1):11–36. Goodwin AM, Oliver SW, McInnes I, Millar KF, Collins K, Paton C. Professionalism in medical education: the state of the art. Int J Med Educ. 2024;15:44. Olmos-Vega FM, Stalmeijer RE. Using theoretical engagement to understand workplace learning across contexts—Bringing worlds apart together. Med Educ. 2025;59(1):65–74. Wijga M, Beausaert S, Kyndt E. What drives workplace learning: a systematic review of key antecedents. J Workplace Learn. 2025;37(9):90–113. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 11 Mar, 2026 Editor assigned by journal 12 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 12 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8802034","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604194861,"identity":"b8bf9ec3-9106-46f8-b079-c6ad1939dd6e","order_by":0,"name":"Yoonjung Lee","email":"","orcid":"","institution":"Hanyang University","correspondingAuthor":false,"prefix":"","firstName":"Yoonjung","middleName":"","lastName":"Lee","suffix":""},{"id":604194862,"identity":"1f5d0898-12b7-4eda-9a66-2c067032948f","order_by":1,"name":"Seung-Hee Lee","email":"","orcid":"","institution":"Seoul National University","correspondingAuthor":false,"prefix":"","firstName":"Seung-Hee","middleName":"","lastName":"Lee","suffix":""},{"id":604194863,"identity":"403d7b9e-9fe9-4438-8625-84ae50dedf25","order_by":2,"name":"Sang-Hoon Na","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYPCCA0DMDCIkZEjRwpYA0sJDihYeAxCLsBZz9uMPPxf8uiPHL93z+dWNGgseBvbDRzfg02LZk2MsPbPvmbHknLPbrHOOAR3Gk5Z2A58WgwM5DNK8PYcTN9zI3WacwwbUIsFjhl/L+eePf0O05DwzzvlHjJYbCWbSPD/AWpgf57YRpeWNmTVvw2FjyRlpZsy5fRI8bAT9cj798W2eP4fl+CWSH3/O+VYnx89++BheLWDA2Aam2CTAJEHlYPAHTDJ/IE71KBgFo2AUjDQAAFDyS56+kU8tAAAAAElFTkSuQmCC","orcid":"","institution":"Seoul National University","correspondingAuthor":true,"prefix":"","firstName":"Sang-Hoon","middleName":"","lastName":"Na","suffix":""}],"badges":[],"createdAt":"2026-02-06 03:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8802034/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8802034/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104668635,"identity":"68655c93-04dd-4454-8919-2813758ce875","added_by":"auto","created_at":"2026-03-15 16:54:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":271980,"visible":true,"origin":"","legend":"\u003cp\u003eTemplate Analysis Workflow\u003c/p\u003e\n\u003cp\u003eFigure 1. Template Analysis workflow used in this study. The analysis proceeded through six iterative phases: (1) familiarization with portfolio and interview data; (2) development of the initial coding template using sensitizing concepts; (3) iterative coding and refinement in ATLAS.ti; (4) longitudinal comparison across pre- and post-program portfolios; (5) abstraction into higher-order themes;\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8802034/v1/323d3a1cebfc502fc5f01af4.png"},{"id":104668661,"identity":"e49543de-7698-4b76-8e0d-b16701760ba6","added_by":"auto","created_at":"2026-03-15 16:54:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1402155,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8802034/v1/58f16ee9-131f-49a3-a2ce-832359bd13d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Constructing Educational Judgment in a Transnational Faculty Development Program for Educators from Laos and Vietnam: A Qualitative Study of Reflective Portfolios","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFaculty development has long been used to strengthen medical education, yet many initiatives now operate across national borders where institutional structures, regulatory expectations, and available resources differ markedly. Participants from low- and middle-income countries (LMICs) often engage in programs facilitated by institutions in high-income settings, and they return to local environments characterized by limited authority, insufficient infrastructure, and hierarchical decision-making systems [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Under such cross-border conditions, newly introduced educational concepts must be interpreted, adapted, and evaluated within institutional realities that frequently restrict opportunities for immediate implementation. When these constraints are present, judging program effectiveness solely by post-program enactment risks overlooking important forms of learning that occur before visible change is possible [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMuch of the faculty development literature focuses on outcomes such as skill acquisition, teaching performance, or transfer of training into practice [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although implementation remains meaningful, this focus provides an incomplete account of learning within transnational programs, which are often short in duration, culturally diverse, and structurally heterogeneous. In such contexts, the absence of immediate implementation does not necessarily indicate limited learning; rather, educators may be engaged in reinterpreting concepts through the lens of their institutional authority, workflow, and governance arrangements [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch on practice-based and workplace learning offers a different perspective. It suggests that professional learning includes changes in how practitioners understand their work, locate responsibility, and judge what is appropriate or feasible within their own institutions [\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. From this viewpoint, faculty development influences not only what educators do, but also how they think and how they interpret educational problems, consider possible actions, and define responsible practice. Such shifts in judgment can emerge before, or even without, observable changes in behavior [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Yet few empirical studies have examined these processes within transnational faculty development, where educators must integrate globally introduced concepts with locally governed educational systems and resource environments [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eReflection has increasingly been conceptualized as an analytic process through which practitioners examine assumptions, evaluate alternatives, and determine what constitutes responsible action[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. From this perspective, reflective writing functions as a form of epistemic work rather than solely as documentation or personal reflection. International faculty development programs, where globally introduced educational concepts must be interpreted within varying institutional realities, offer a particularly relevant context in which to examine this process[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study addresses this gap by analyzing reflective portfolios and longitudinal interviews from participants in Korean-hosted transnational faculty development program for educators from Laos and Vietnam. The analysis examined how educators reasoned about educational practice while learning was still in progress before implementation was possible or appropriate and how they reconfigured their understanding of educational work, agency, feasibility, timing, and relational consequences within transnational institutional contexts.\u003c/p\u003e \u003cp\u003eThe study was guided by two research questions:\u003c/p\u003e \u003cp\u003eRQ1. In what ways did participants\u0026rsquo; reflections reveal reconfigurations in understandings of educational work, legitimate agency, and feasible practice during the program?\u003c/p\u003e \u003cp\u003eRQ2. How did participants use portfolio-based reflection to translate newly introduced educational concepts into contextually grounded educational judgments?\u003c/p\u003e \u003cp\u003eBy focusing on how educators form judgment before action, our study offers a different way of understanding learning in transnational faculty development programs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Qualitative Paradigm\u003c/h2\u003e \u003cp\u003eAn interpretivist qualitative design informed by practice-based perspectives was used to examine how participants in a transnational faculty development program reasoned about educational practice while learning was still in progress. This orientation was appropriate given the study\u0026rsquo;s focus on meaning-making, judgment formation, and the reconfiguration of educational reasoning within cross-border institutional contexts rather than observable behavioral outcomes. Template Analysis was selected because it accommodates theory-informed sensitizing concepts while supporting inductive refinement and is well suited for identifying patterned reasoning across large longitudinal datasets.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProgram Context: Dr. Lee Jong Wook Fellowship for Health Professions Education\u003c/h3\u003e\n\u003cp\u003eThe study was conducted within the Dr. Lee Jong Wook Fellowship for Health Professions Education (LJWF-HPE), a Korean-hosted transnational faculty development program developed in partnership with institutions in Laos and Vietnam. Established in 2016, the program aims to strengthen educational capacity among health professionals in low- and middle-income countries. The program is funded by *** and implemented by *** as part of an official development assistance initiative. The 2022 cohort comprised twelve health professionals from institutions in Laos and Vietnam who participated in a 10-week program consisting of fourteen modules on teaching and learning, curriculum development, assessment, educational leadership, digital education, and related areas. Participants were nominated by their home institutions and selected through joint online interviews conducted by *** and ***.\u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003e Twelve health professionals from Laos and Vietnam participated in the study, representing a diverse set of educational and clinical backgrounds. Participants included faculty members, clinical doctors with teaching responsibilities, and technical officers supporting educational programs. Their primary fields spanned pediatrics, medicine, obstetrics and gynecology, oral health, pharmacy, radiology, community and family medicine, public health, and health professions education units. A concise summary of participant characteristics is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, with extended details available in Supplementary Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Participant Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVietnam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMajor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics \u0026amp; Gynecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTropical Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData Sources\u003c/h3\u003e\n\u003cp\u003eThree primary data sources were included in the analysis.\u003c/p\u003e\n\u003ch3\u003ePre-program (Before) Portfolios\u003c/h3\u003e\n\u003cp\u003eReflective portfolios completed prior to the start of the program captured participants\u0026rsquo; prior educational experiences, existing assumptions, and initial understandings of teaching and educational practice across the fourteen modules. Portfolio prompts asked participants to describe previous learning experiences related to each module, articulate their prior knowledge or impressions, reflect on the institutional or national context in which the topic was situated, and specify their individual learning objectives for the module.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePost-program (After) Portfolios\u003c/h2\u003e \u003cp\u003eReflective portfolios completed toward the end of the program documented participants\u0026rsquo; evolving interpretations of educational concepts and their emerging judgments about applicability. Participants were asked to reflect on what they had learned, how they interpreted or felt about the module content, how newly introduced ideas might be applied within their home institution or country, and what additional aspects of the topic they wished to explore further.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSemi-structured Interviews\u003c/h3\u003e\n\u003cp\u003e Each participant completed two semi-structured interviews, one at program entry and one at program completion. Interviews lasted 60\u0026ndash;80 minutes and were conducted in English by program staff who were not involved in participant assessment and had no prior relationship with participants. Interview questions explored participants\u0026rsquo; conceptions of teaching roles, perspectives on student learning, interpretations of newly introduced educational ideas, and perceived changes in their reasoning over the course of the program. All interviews were audio-recorded, transcribed verbatim, and returned to participants for member checking to ensure accuracy and clarity, given variation in English proficiency.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAnalysis was informed by practice-based perspectives that conceptualize professional learning as shifts in how practitioners define educational work, locate agency and responsibility, and judge feasibility within institutional constraints. Reflection was examined as a form of epistemic work through which participants interrogated assumptions, compare possibilities, and delineate what they considered responsible or achievable within transnationally shaped systems.\u003c/p\u003e \u003cp\u003eTemplate Analysis followed King and Brooks\u0026rsquo;s iterative [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], hierarchical approach. The workflow is summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All pre- and post-program portfolios and interview transcripts were first read multiple times to become familiar with the content. Based on this initial review, a provisional coding template was created using sensitizing concepts drawn from practice-based and workplace learning literature, together with inductive codes derived directly from the data.\u003c/p\u003e \u003cp\u003eTwo researchers coded an initial subset of the dataset independently using ATLAS.ti. Coding differences were discussed, and the coding template was revised by adjusting code definitions and hierarchical relationships. The revised template was then applied to the full dataset by the primary researcher, with ongoing peer review through analytic discussions.\u003c/p\u003e \u003cp\u003ePre- and post-program portfolios for each participant were compared to identify changes over time. Interview data were reviewed alongside portfolios to provide additional contextual information. After coding was completed, related codes were grouped together, and these groups were organized into five higher-order clusters. The final coding structure is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractice-Based Reconfiguration of Educational Reasoning During Faculty Development Program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnalytic Cluster\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReconfigured Educational Reasoning and Epistemic Work\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIllustrative Quotations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCluster 1. Redefining the Object of Educational Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeaching reconceptualized from individual instructional performance to coordinated, resource-dependent educational work. Reflection surfaced implicit assumptions about teaching, highlighted the invisible preparatory tasks (planning, sequencing, alignment), and made structural and material conditions\u0026mdash;expert staff, time, space, functioning equipment\u0026mdash;explicit. Participants increasingly acknowledged the limits of individual action and recognized curriculum and assessment work as collective, system-embedded processes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Teaching is not only standing in front of students. It is planning the learning objectives, choosing teaching methods, and considering how assessment aligns with those objectives.\u0026rdquo; (1st interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;To conduct item analysis or improve assessment, we need people with the right technical skills, enough time, and institutional support.\u0026rdquo; (2nd interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Preparing PBL requires much more planning than I expected; most of the work is invisible.\u0026rdquo; (1st interview)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCluster 2. Repositioning Agency and Authority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgency understood as distributed across individual, departmental, and institutional levels. Reflection delineated actions participants could autonomously undertake (e.g., modifying slides) versus those requiring formal authorization, faculty agreement, or committee decision-making (e.g., assessment or curriculum reform). Participants increasingly described leadership as relational rather than positional and recognized that capacity to act was shaped by institutional norms, hierarchies, and workload structures.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Some things I can change myself, but assessment or curriculum reform cannot be done by one person.\u0026rdquo; (2nd interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Leadership is not only position. It depends on where I can influence and where I cannot.\u0026rdquo; (2nd interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Institutional processes and faculty agreement determine what can move forward.\u0026rdquo; (1st interview)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCluster 3. Exercising Feasibility-Based Judgment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducational ideals were re-evaluated through ongoing appraisal of material, human, and organizational feasibility. Participants assessed prerequisites for responsible implementation\u0026mdash;technical expertise, time, staff support, facilities, reliable equipment\u0026mdash;while identifying constraints such as large class sizes and uneven faculty readiness. Reflections emphasized the risks of premature or unsupported implementation, noting that pedagogically sound methods could become merely procedural or harmful without adequate preparation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; \u0026ldquo;To do item analysis, we need skills, time, and people. Without that, it becomes only a form.\u0026rdquo; (1st interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Assessment is not only writing questions. It requires clear criteria, feedback, and analysis; otherwise it may create confusion.\u0026rdquo; (After portfolio)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;If we implement too quickly, it may confuse students or create inconsistency among teachers. (2nd interview)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCluster 4. Temporalizing Educational Action\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants differentiated conceptual understanding from readiness to act. Reflection supported judgments about appropriate timing, sequencing, and pacing of educational change. They reasoned that immediate implementation could generate unexpected problems or disrupt ongoing coursework and emphasized the importance of preparation, alignment with existing structures, and collegial coordination. Delayed or gradual implementation became reframed as responsible professional action.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Understanding the method does not mean I can use it immediately. It needs more preparation.\u0026rdquo; (2nd interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;If I change this alone, it may affect others. We need discussion before any change.\u0026rdquo; (2nd interview)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Sometimes delaying action is more responsible than acting quickly.\u0026rdquo; (After portfolio)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCluster 5. Anticipating Relational Consequences and Collective Accountability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducational decisions evaluated in terms of fairness, coherence, institutional trust, and shared accountability. Participants anticipated how changes might be interpreted by learners (e.g., fairness of assessment), colleagues (e.g., workload implications), and the broader program. Reflection highlighted second- and third-order relational consequences, emphasizing that even well-intentioned changes could undermine trust or consistency if introduced without adequate coordination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; \u0026ldquo;If we change assessment without coordination, students may feel it is unfair.\u0026rdquo; (After portfolio)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Implementing something without preparation may confuse students or colleagues.\u0026rdquo; (Interview 2)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;This is not only my responsibility. If something goes wrong, the department is involved.\u0026rdquo; (2nd interview)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Volume and Units of Analysis\u003c/h2\u003e \u003cp\u003eThe corpus included 168 pre-program portfolios, 167 post-program portfolios, and 24 interview transcripts. Portfolio entries ranged from 200\u0026ndash;500 words per module. Interview transcripts were 10\u0026ndash;20 pages in length. Coding occurred at the level of meaning units within each data source, followed by within-participant longitudinal comparison and cross-case synthesis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMethodological Rigor\u003c/h2\u003e \u003cp\u003eRigor was ensured through triangulation across data sources, member checking of interview transcripts, maintenance of a detailed audit trail, reflexive memoing, and attention to disconfirming cases. Transferability was supported through detailed contextual description.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eResearcher Reflexivity\u003c/h2\u003e \u003cp\u003eThe primary researcher\u0026rsquo;s dual role as program coordinator and analyst enabled close engagement with the program context but required explicit attention to reflexivity. Analytic decisions and assumptions were documented through reflexive memos, and emerging interpretations were discussed with research team members who were not involved in program delivery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eThis study involved secondary analysis of anonymized data originally collected for program evaluation. Ethical review was conducted by the Institutional Review Board of Seoul National University College of Medicine and Seoul National University Hospital, which determined the study to be exempt from full review (IRB No. E-2212-032-1383). All identifying information was removed prior to analysis, and data were stored securely.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eRather than indicating uniform improvement or post-program implementation, the findings demonstrate how participants reconfigured their understanding of educational work, agency, feasibility, timing, and relational consequences while learning was still in progress.\u003c/p\u003e \u003cp\u003eAcross all clusters, portfolio-based reflection functioned as a space in which participants engaged in ongoing epistemic work\u0026mdash;interrogating assumptions, examining conditions of action, and delimiting what counted as appropriate educational practice within their institutional contexts. Five analytic clusters capture these shifts in educational reasoning(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCluster 1. Redefining the Object of Educational Practice: From Instructional Performance to Organized Educational Work\u003c/h2\u003e \u003cp\u003eEarly reflections characterized teaching primarily as a performance centered on transmitting knowledge. Participants described \u0026ldquo;explaining clearly,\u0026rdquo; \u0026ldquo;presenting confidently,\u0026rdquo; or \u0026ldquo;summarizing content well\u0026rdquo; as the core elements of good teaching. These entries suggested an emphasis on the visible moment of instruction rather than the broader processes that support it.\u003c/p\u003e \u003cp\u003eAs the program progressed, participants expanded their conceptualization of instructional work. They increasingly described teaching as an organized set of tasks involving the articulation of learning objectives, the selection and sequencing of methods, and the alignment of assessments with curricular goals. Several participants noted that preparing PBL, TBL, or skills-based sessions \u0026ldquo;required much more planning than I expected\u0026rdquo; and demanded work that was \u0026ldquo;not visible when standing in front of students.\u0026rdquo;\u003c/p\u003e \u003cp\u003eParticipants also became more attentive to the structural and material conditions that enable educational practice. Across portfolios and interviews, they emphasized the need for staff with analytic expertise, time allocated for item-writing and review, reliable assessment systems, adequate physical space, and functioning equipment. Some reflected that when these conditions were lacking, assessment tasks \u0026ldquo;became only procedural\u0026rdquo; and did not meaningfully contribute to learning or evaluation.\u003c/p\u003e \u003cp\u003eA recurring thread in this cluster involved acknowledging the limits of individual action. Participants noted that major changes\u0026mdash;such as redesigning assessments or modifying curricula\u0026mdash;required collaboration and departmental coordination. As one participant wrote, \u0026ldquo;Improving my teaching is important, but curriculum reform is not something one person can do.\u0026rdquo;\u003c/p\u003e \u003cp\u003eOverall, Cluster 1 captures a shift from conceiving teaching as individual performance to depicting it as coordinated, resource-intensive educational work embedded in organizational systems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCluster 2. Repositioning Agency and Authority: Locating Educational Action Within Organizational Systems\u003c/h2\u003e \u003cp\u003eEarly entries often presented educational improvement as primarily dependent on individual effort. Participants described intentions to adopt new methods, adjust their teaching style, or introduce innovations on their own initiative.\u003c/p\u003e \u003cp\u003eLater reflections revealed a more layered understanding of agency. Participants distinguished clearly between actions they could undertake independently\u0026mdash;such as modifying slides or adjusting discussion facilitation\u0026mdash;and those requiring formal authorization or collective decision-making. One participant summarized this boundary by noting, \u0026ldquo;Some things I can change myself, but assessment or curriculum reform cannot be done by one person.\u0026rdquo;\u003c/p\u003e \u003cp\u003eParticipants also described how organizational norms, roles, and hierarchies shaped their capacity to act. Although some leaders expressed support for innovation, participants explained that broader faculty agreement or approval from senior colleagues was often necessary. Several pointed out that institutional processes, committee structures, and workload constraints influenced whether proposed changes could move forward.\u003c/p\u003e \u003cp\u003eLeadership was increasingly portrayed as relational rather than positional. Participants emphasized that influence depended on \u0026ldquo;where my role allows me to contribute\u0026rdquo; and \u0026ldquo;where I do not have authority.\u0026rdquo; Some noted feeling responsible for educational quality while simultaneously limited by structural boundaries or unclear mandates.\u003c/p\u003e \u003cp\u003eBy the end of the program, participants articulated a more complex understanding of educational agency\u0026mdash;one that acknowledged both their potential for influence and the organizational structures that defined the legitimacy and feasibility of their actions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCluster 3. From Endorsing Ideals to Exercising Feasibility-Based Judgment\u003c/h2\u003e \u003cp\u003eEarly reflections often accepted newly introduced educational approaches as inherently valuable. Participants expressed positive views of PBL, TBL, OSCE, or structured assessment tools, but seldom examined what their implementation would practically require.\u003c/p\u003e \u003cp\u003eAs participants progressed through the program, their reflections shifted toward detailed evaluation of feasibility. They identified technical expertise, available time, staff support, adequate facilities, functioning equipment, and coordinated workflow as essential prerequisites for responsible implementation. One participant noted that without training and dedicated time, \u0026ldquo;item analysis becomes only a formality.\u0026rdquo;\u003c/p\u003e \u003cp\u003eParticipants also described structural constraints that limited what could be executed. Large class sizes, insufficient rooms for group work, outdated equipment, short class durations, and uneven faculty capacity were frequently cited. Reflections described situations in which methods were pedagogically appropriate but contextually impractical.\u003c/p\u003e \u003cp\u003eImportantly, participants began to articulate the risks of premature or unsupported implementation. They expressed concern that introducing a method \u0026ldquo;without preparation\u0026rdquo; could confuse students, create inconsistency among instructors, or generate additional work for colleagues. As one participant wrote, \u0026ldquo;This method is meaningful, but if we do it too quickly or without support, it may cause harm.\u0026rdquo;\u003c/p\u003e \u003cp\u003eCluster 3 highlights the emergence of feasibility-based judgment as central to participants\u0026rsquo; reasoning, marking a shift from endorsing educational ideals to evaluating the conditions under which they could be enacted responsibly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCluster 4. Temporalizing Educational Action: Reasoning About When, Not Whether, to Act\u003c/h2\u003e \u003cp\u003eEarly reflections suggested a direct connection between understanding a new approach and acting on it. Participants often assumed that newly learned methods could or should be applied immediately.\u003c/p\u003e \u003cp\u003eOver time, participants displayed increasing attention to timing. Many emphasized that conceptual understanding did not automatically translate into readiness to implement. They described the need for preparation, alignment with existing curricula, and coordination with colleagues. Several explained that immediate implementation could lead to \u0026ldquo;unexpected problems\u0026rdquo; or disrupt ongoing coursework.\u003c/p\u003e \u003cp\u003eParticipants also identified the relational dimensions of timing. They noted that unilateral changes could influence colleagues\u0026rsquo; teaching, interfere with course sequencing, or create inconsistencies within programs. This led some to adopt gradual, incremental changes or to delay implementation until broader discussions could occur.\u003c/p\u003e \u003cp\u003eBy the end of the program, participants conceptualized educational action as a temporally sequenced process that required preparation, discussion, and appropriate pacing. Cluster 4 demonstrates how participants came to understand when to act\u0026mdash;not only whether to act\u0026mdash;as an essential dimension of responsible educational practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eCluster 5. Anticipating Relational Consequences and Collective Accountability\u003c/h2\u003e \u003cp\u003eLater reflections contained substantial attention to the relational and institutional consequences of educational decisions. Participants expressed particular concern about fairness from the learner's perspective. They noted that modifying assessment formats or criteria without coordination could lead students to perceive evaluations as arbitrary or inequitable.\u003c/p\u003e \u003cp\u003eParticipants also considered broader system-level implications. They warned that implementing changes \u0026ldquo;without preparation\u0026rdquo; could produce confusion, inconsistency, or loss of trust in the institutional assessment system. Comments emphasized that even well-intentioned changes could generate negative effects if not introduced coherently.\u003c/p\u003e \u003cp\u003eReflections further highlighted the collective nature of educational responsibility. Participants recognized that educational decisions affect colleagues, departments, and programs. As one noted, \u0026ldquo;If something goes wrong, the department is involved.\u0026rdquo; Some also reflected on how colleagues\u0026rsquo; hesitations or anxieties emerged when expectations were unclear or when they felt excluded from decision-making processes.\u003c/p\u003e \u003cp\u003eAcross these accounts, participants moved beyond individualistic notions of teaching and began anticipating how educational changes would be interpreted and experienced by others. Cluster 5 captures a shift toward relational and system-oriented reasoning, emphasizing fairness, coherence, trust, and shared accountability as key considerations in educational decision-making.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe first research question is primarily addressed in Clusters 1\u0026ndash;3, which trace how participants reconfigured what counted as educational work, legitimate agency, and feasible practice. The second research question is most clearly reflected in Clusters 3\u0026ndash;5, where reflective reasoning extended to judgments about timing, relational consequences, and collective accountability.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eReframing Outcomes in International Faculty Development\u003c/h2\u003e \u003cp\u003eFaculty development initiatives are often evaluated through post-program implementation, transfer of training, or observable behavioral change[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Such approaches assume that educational contexts enable immediate enactment and that learning is best evidenced through action. Transnational programs however operate across institutional systems that vary in governance structure, curricular regulations, and material resources. Participants in our study engaged with Korean-designed educational models while situated within home institutions where authority, workflow, and coordination cultures differed substantially. Under these conditions, immediate implementation is neither expected nor feasible. The findings therefore redirect attention to forms of learning that occur prior to action and are shaped by cross-border contextual contrast.\u003c/p\u003e \u003cp\u003eFindings from the present study redirect attention to this neglected phase of professional learning. Analysis of reflective portfolios and interviews demonstrated systematic changes in how participants reasoned about educational practice during the program period. Across five analytic clusters, participants reconfigured their understanding of what educational work entails, who can legitimately act, under what conditions practices can be enacted responsibly, when action is appropriate, and how educational change may affect others within institutional systems. These patterns indicate that judgment formation, rather than immediate implementation, constituted a central outcome of participation.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eReflection as a Site of Epistemic Work\u003c/h2\u003e \u003cp\u003eReflection occupies a prominent place in medical education, often linked to self-awareness, professionalism, or identity development[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. While prior often conceptualized reflection as inward-oriented, the present findings highlight its outward, analytic, and context-comparative functions.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Much of this literature, however, conceptualizes reflection as an inward-facing activity oriented toward personal insight. Portfolio-based reflection operated as epistemic work through which participants examined assumptions, made sense of international pedagogical models, and translated them into judgments grounded in domestic institutional realities.\u003c/p\u003e \u003cp\u003eThe present findings suggest a complementary but distinct function. Portfolio-based reflection operated as epistemic work through which participants reasoned about educational practice as organized, system-dependent activity. Reflection supported interrogation of assumptions about teaching, articulation of structural and material conditions, and delimitation of responsibility and legitimacy. Rather than merely expressing learning, reflective writing became a mechanism for constructing educational judgment.\u003c/p\u003e \u003cp\u003eSuch an interpretation is consistent with scholarship in practice-based and workplace learning, where professional learning is understood as a gradual shift in how practitioners define their work and reason through the decisions it demands[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eReconstructing Educational Practice Beyond Individual Performance\u003c/h2\u003e \u003cp\u003eEarly reflections in the dataset framed teaching as individual instructional performance, emphasizing content mastery and presentation skills. Similar assumptions have been documented in prior studies of educators\u0026rsquo; initial conceptions of teaching[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Over time, participants increasingly conceptualized education as coordinated work requiring planning, alignment, analytic capacity, and institutional support. Reframing the object of practice marks a shift from viewing education as an isolated act performed by individual teachers to understanding it as work embedded within broader organizational arrangements. The reframing holds theoretical importance because it shifts attention away from individual competencies and toward system-oriented understandings of how educational work is organized[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In international contexts where individual educators often lack authority over curriculum and assessment, such reconceptualization provides a more realistic basis for reasoning about educational change[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLocating Legitimate Agency Within Organizational Systems\u003c/h2\u003e \u003cp\u003eChanges in how participants understood educational practice were closely linked to changes in how agency and authority were conceptualized. Early reflections often assumed that motivated educators could initiate change independently. Later reflections differentiated between actions within personal control and those requiring departmental or institutional authorization.\u003c/p\u003e \u003cp\u003eLeadership was reframed as situational and relational rather than positional, echoing leadership models in health professions education[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Participants did not interpret limited authority as personal failure. Instead, reflection supported articulation of boundaries around responsibility and legitimacy. Educational judgment involved not only deciding what should change, but also determining who had the mandate to initiate such change.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eFeasibility-Based Judgment and the Integrity of Practice\u003c/h2\u003e \u003cp\u003eParticipants also demonstrated a qualitative shift in how educational ideals were evaluated. Rather than endorsing or rejecting new concepts abstractly, participants assessed practices in relation to the human, material, and organizational conditions required for meaningful enactment. Time, analytic expertise, and institutional support were treated as constitutive elements of practice rather than as external barriers.\u003c/p\u003e \u003cp\u003ePrevious research has often framed constraint-oriented reasoning as resistance to change[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, our findings suggest that participants\u0026rsquo; constraint-focused reflections functioned not as resistance but as epistemic work aimed at safeguarding the integrity of educational practice by recognizing that insufficient preparation could render new methods merely procedural or even harmful. Such feasibility-based judgment reflects epistemic maturation rather than reluctance. Educational judgment was exercised not in deciding whether an idea was pedagogically sound, but in determining whether conditions existed for its responsible enactment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eTemporal Reasoning and Reflective Restraint\u003c/h2\u003e \u003cp\u003eFeasibility-based reasoning was accompanied by more differentiated temporal judgment. Participants explicitly distinguished conceptual understanding from readiness to act and framed delayed implementation as a responsible professional stance. Immediate action was increasingly associated with risk rather than success.\u003c/p\u003e \u003cp\u003eReflective restraint emerged as a salient outcome of learning. Non-action was not interpreted as lack of motivation but as an ethical and professional decision grounded in awareness of preparation, coordination, and potential consequences. The pattern challenges expectations that faculty development should yield immediate change and aligns with critiques of linear transfer-of-training models[\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eRelational Consequences and Collective Accountability\u003c/h2\u003e \u003cp\u003eEducational judgment extended beyond feasibility and timing to encompass relational and system-level consequences. Participants anticipated how changes might be perceived by students and colleagues and reasoned about fairness, trust, and institutional coherence. Responsibility for educational action was increasingly framed as collective rather than individual.\u003c/p\u003e \u003cp\u003eA relational orientation of this kind aligns with scholarship on educational professionalism that emphasizes accountability to learners, colleagues, and institutions[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Incorporating relational consequences into judgment formation reflected an emerging understanding of education as a shared enterprise rather than an individual endeavor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eDifferentiated Trajectories of Judgment Formation\u003c/h2\u003e \u003cp\u003eNot all participants engaged in epistemic work in identical ways. Variations in depth and scope of reasoning reflected differences in institutional roles, prior experience, and positional authority. Practice-based research suggests that such variation is characteristic of situated learning rather than indicative of uneven program effectiveness[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Within transnational faculty development, the heterogeneity of reasoning represents not a limitation but a hallmark of how educators translate internationally introduced concepts into institutionally grounded judgment.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLimitations and Directions for Future Research\u003c/h3\u003e\n\u003cp\u003eThe analysis focused on articulated reasoning during the program period and did not examine post-program enactment across national institutions. Portfolios and interviews capture expressed judgment rather than enacted change. Future research could trace how epistemic resources acquired during transnational faculty development shape later decisions, negotiations, and institutional reforms.\u003c/p\u003e \u003cp\u003eThe study was situated within a Korea-implemented transnational faculty development program for participants from Laos and Vietnam, and the analytic model should therefore be understood as context-specific rather than universally representative. Comparative work across other partnerships and regulatory systems would deepen insights into how educational judgment develops in varied transnational settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study showed how educators participating in a transnational faculty development program involving participants from Laos and Vietnam and implemented in Korea developed educational judgment through portfolio-based reflection while learning was still in progress. Reflection functioned as epistemic work through which participants interrogated assumptions, articulated conditions for responsible practice, and located their legitimate scope of agency within institutionally and nationally distinct systems. Through this process, educators reconceptualized education as coordinated work, differentiated personal from institutional authority, evaluated feasibility through locally grounded criteria, reasoned about the timing of change, and anticipated relational and system-level consequences.\u003c/p\u003e \u003cp\u003eChanges in educational reasoning identified in this study represent meaningful outcomes of transnational faculty development, particularly in environments where immediate implementation was structurally constrained. The capacity to exercise feasibility-based judgment, adopt reflective restraint, and anticipate downstream consequences reflected maturation in professional reasoning rather than limited program impact. Conceptualizing reflection as epistemic work within cross-border settings therefore offered a more context-sensitive and realistic account of faculty development\u0026mdash;one that complements implementation-centered evaluation and aligns with the complex realities of global medical education partnerships.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e• Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical review was conducted by the Institutional Review Board of Seoul National University College of Medicine and Seoul National University Hospital, which determined the study to be exempt from full review (IRB No. E-2212-032-1383), as it involved analysis of anonymized, non-identifiable data and posed minimal risk to participants. Written informed consent was not required in accordance with IRB determination. All procedures were performed in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e• Consent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e• Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e• Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e• Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by *** as part of Dr. Lee Jong Wook Fellowship for Health Professions Education program. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;• Authors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Lee YJ, Na SH. Methodology: Lee YJ, Na SH. Validation: Lee SH, LEE YJ, Na SH. Visualization: Lee YJ. Writing - original draft: Lee YJ, Na SH. Writing - review \u0026amp; editing: Lee YJ, Na SH, Lee SH.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eORCID iDs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe names of authors should be the same as those in the title page.\u003c/p\u003e\n\u003cp\u003eYoonjung Lee https://orcid.org/0000-0002-4164-625X\u003c/p\u003e\n\u003cp\u003eSang-Hoon Na https://orcid.org/ 0000-0002-1289-7965\u003c/p\u003e\n\u003cp\u003eSeung Hee Lee https://orcid.org/0000-0001-8672-5253\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKim DH, Yoon HB, Hwang J, Kim EJ, Lee S, Shin JS, Sung M, Yoo DM. 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Med Teach. 2012;34(6):483\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Sullivan PS, Irby DM. Reframing research on faculty development. Acad Med. 2011;86(4):421\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBillett S. Integrating learning experiences across tertiary education and practice settings: A socio-personal account. Educational Res Rev. 2014;12:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTynj\u0026auml;l\u0026auml; P. Toward a 3-P model of workplace learning: A literature review. Vocations Learn. 2013;6(1):11\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodwin AM, Oliver SW, McInnes I, Millar KF, Collins K, Paton C. Professionalism in medical education: the state of the art. Int J Med Educ. 2024;15:44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlmos-Vega FM, Stalmeijer RE. Using theoretical engagement to understand workplace learning across contexts\u0026mdash;Bringing worlds apart together. Med Educ. 2025;59(1):65\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWijga M, Beausaert S, Kyndt E. What drives workplace learning: a systematic review of key antecedents. J Workplace Learn. 2025;37(9):90\u0026ndash;113.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Faculty development, Medical education, Reflective practice, Epistemic work, Practice-based learning, LMICs, Cross-border education, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-8802034/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8802034/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eTransnational faculty development programs operate across institutional systems that differ in authority, infrastructure, and regulatory expectations. Evaluations focusing solely on post-program implementation risk overlooking early forms of professional learning, particularly in low- and middle-income settings. Our study examined how reflective portfolios functioned as epistemic work\u0026mdash;analytic activity through which educators constructed educational judgment\u0026mdash;within a cross-border faculty development program implemented in South Korea for participants from Laos and Vietnam.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e An interpretivist qualitative design informed by practice-based perspectives guided the analysis of longitudinal reflective portfolios and semi-structured interviews from twelve health professions educators participating in a ten-week South Korea-based international faculty development program. The dataset comprised 168 pre-program portfolios, 167 post-program portfolios, and 24 interviews. Template Analysis was conducted through iterative coding, longitudinal before\u0026ndash;after comparison, and cross-case synthesis. Rigor was ensured through triangulation, member checking, peer debriefing, and maintenance of an audit trail.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eFive analytic clusters captured participants\u0026rsquo; reconfiguration of educational reasoning during the program. Educators reconceptualized educational practice as coordinated, system-dependent work; differentiated legitimate agency across individual, departmental, and institutional levels; exercised feasibility-based judgment by evaluating conditions required for responsible enactment; reasoned about the timing of action, distinguishing conceptual understanding from readiness; and anticipated relational and system-level consequences of educational decisions. Reflection operated not merely as documentation but as epistemic work shaped by transnational institutional realities.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eJudgment formation emerged as a meaningful outcome of a transnational faculty development initiative where immediate implementation was structurally constrained. Conceptualizing reflection as epistemic work offers a process-oriented lens that complements implementation-focused evaluation and enhances understanding of how educators reason about practice within cross-border, resource-variable contexts.\u003c/p\u003e","manuscriptTitle":"Constructing Educational Judgment in a Transnational Faculty Development Program for Educators from Laos and Vietnam: A Qualitative Study of Reflective Portfolios","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-15 16:53:16","doi":"10.21203/rs.3.rs-8802034/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-11T05:46:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T06:52:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T06:21:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-02-12T06:17:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25be7dd3-47ac-4bcc-a2d7-52f2c47144c1","owner":[],"postedDate":"March 15th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-15T16:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-15 16:53:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8802034","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8802034","identity":"rs-8802034","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}