How to stop the runaway train of clinical trainingBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2254 (Published 25 May 2016) Cite this as: BMJ 2016;353:i2254
- Richard Thomson, clinical subdean1,
- Amy Loveland, teaching fellow1,
- Jane Stewart, senior lecturer in medical education2,
- James Fisher, specialist registrar in geriatric medicine1
Whatever the reasons for undertaking a teaching fellowship it provides the perfect opportunity for junior doctors to sit back and think, sayRichard Thomson,Amy Loveland,Jane Stewart,andJames Fisher
The common feeling among junior doctors that clinical training is similar to being on a conveyor belt or a runaway train1 may have prompted a rise in the number of teaching fellowship posts.2 A teaching fellowship provides junior doctors with the perfect way to slow the training process down and broaden their horizons.
Becoming a teaching fellow allows the time to develop as a clinical teacher, and potentially makes fellows better doctors and more rounded people. We are writing from the perspectives of having managed, supervised, supported, and ourselves been fellows (past and present).
People are drawn to the role for different reasons: some already know that they want to work in medical education, while others wish to improve their curriculum vitae (CV) for specialty training applications. For many, the motivation for exploring such a post is partly negative—disaffection with one size fits all clinical training and a need to try something different. Whatever the reasons, there are many benefits, both anticipated and unanticipated, in disembarking the clinical training train at the station marked “teaching fellow.”
Developing as an educator
We all have ideas about teaching and learning based on our own experiences; becoming a teaching fellow will expand these ideas, but the right post can be truly transformative. A good posting can provide the luxury of a scholarly milieu in which peer discourse, critical reflection, problem solving, as well as problem setting, creativity, and innovation are supported and encouraged. Such a posting allows protected time for planning, and longitudinal engagement with learners and their curriculum. Alongside these advantages are the benefits of peer observation: personal, targeted feedback and time for reflection. These conditions are rarely found outside a teaching fellowship, because of the challenges of service provision and the demands of out-of-hours working.
Exposure to educational theory gives fellows a vocabulary to discuss teaching and learning, moving beyond the “lay usage” of these terms. With such experience comes a deeper, richer understanding of the complex world of education and practice. And, with insight into implicit learning and tacit knowledge, deconstructing the complexity of educational practice can revolutionise a fellow’s understanding of medical practice.
Developing as a doctor
Time spent outside medical practice, while remaining closely engaged with it, affords a new and richer perspective on doctoring. There are parallels here with other out of programme experiences, such as a secondment to biomedical research, but we contend that teaching is a uniquely powerful way to achieve this perspectival transformation.
Teaching demands that we “know our stuff” and consequently provides a potent motivation for the continued development of our knowledge. Furthermore, the extra time spent considering teaching content helps to test our understanding and existing schema, so that we emerge really “knowing our stuff.”
What happens when teaching fellows return to clinical practice? Can they remember how to be doctors? Our experience is that they return feeling refreshed, not rusty. With the realisation that being a teacher is not just regurgitating facts and filling students with knowledge, a doctor may become reconciled to not knowing everything, and so be more comfortable with uncertainty. Being able to relate this back to doctoring, to admit to knowledge gaps, helps to drive the development and maturation of emotional intelligence and may translate to patient safety benefits. Such advantages may not be apparent to the teaching fellow until they return to practice, however—to paraphrase TS Eliot, “the end of all that exploring is to arrive where you started and know the place for the first time.”
Developing as a person
Medicine is hierarchical and risk averse. Teaching, with its flatter organisational structure, offers a culture in which creativity and risk taking may be more valued. Teaching fellows may find themselves creating something entirely novel and leading a team to make it happen. This autonomy is, for some, the role’s most valuable aspect. A new teaching idea may not always succeed, but the freedom to fail is a powerful driver for development.3
We believe teaching fellows make better future career choices, through thinking more deeply about their strengths and weaknesses, their approach to medicine and teaching, and their professional relationships with others. Such an outlook protects against burnout, which benefits doctors, institutions, and ultimately patients.
Undertaking a fellowship can be a richly rewarding experience and a ripe opportunity for personal and professional development, enabling the holder to return to clinical practice with a new perspective. In fact, it could be the best decision you ever make.
In the last 15 years Northumbria Healthcare NHS Foundation Trust has supported over 100 teaching fellows, of one to three years’ duration, with varying proportions of teaching, clinical work, and biomedical or educational research. Individuals who become fellows come from all training grades (from F2 to ST7) and complete Newcastle University’s medical education programme to at least certificate level (www.ncl.ac.uk/postgraduate/courses/degrees/medical-education-mmeded-pgdip-pgcert). In the post they are supported by an educational supervisor and educationalist.
We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.