“The successful teacher is no longer on a height, pumping knowledge at high pressure into passive receptacles...He is a senior student anxious to help his juniors.”Sir William Osler
INTRODUCTION
The word ‘Doctor’ stems from the latin verb docēre, meaning ‘to teach. Whilst this role was traditionally adopted by senior physicians, the publication of the General Medical Council’s Doctors as Teachers, has led to a paradigm shift. Emphasising the need for medical education to be considered the responsibility of all physicians, this guidance has necessitated junior doctors act as educators for medical students and colleagues alike. Correspondingly, clinical teaching is now considered a priority within junior doctor training, and fundamental for career development.That being said, the ability to function as an effective clinical teacher is not intuitive yet formal teacher training is not commonplace within current undergraduate and postgraduate curricula. As such, physicians looking to strengthen their teaching ability must do so through supplementary courses. For some, engagement in medical education is merely an obligation and one for which there is little time for in a busy clinical schedule, resulting in inferior quality teaching for students.Consequently clinical teaching fellowships have become increasingly popular in recent years, with fellows regarded as an effective means of delivering high quality and reliable teaching. Correspondingly fellows, themselves junior doctors, are afforded the opportunity to develop their teaching prowess, gain involvement in managerial roles and enhance leadership and communication skills. Principally, these schemes offer trainees the chance to garner experience in medical education alongside their clinical training. At present, teaching fellowship programmes exist within several trusts in Northern Ireland, with one such programme currently in Altnagelvin Hospital.Founded in 2014, the Western Trust teaching fellowship is now in its third year. Starting with a single fellow, the scheme has grown steadily, recruiting 12 participants this academic year. The current fellows represent trainees from a variety of medical and surgical specialities, based at both the Altnagelvin and South West Acute Hospital sites.
TEACHING FELLOW PROGRAMME
The teaching fellowship is a 6-12-month programme for trainee doctors at the level of ST3 and above. Potential applicants must complete a competency-based application, demonstrating their previous undergraduate and postgraduate teaching experience alongside their professional and personal motivations for applying.The role of the teaching fellow is designed to run synergistically alongside trainee clinical commitments, with the fellows receiving 4 hours per week of protected time to design and deliver teaching. Undergraduate curriculum delivery encompasses the majority of the workload, with specific importance placed on third and final year students. Fellows are advocated to provide additional postgraduate level training within their speciality for junior staff. Predominantly teaching is delivered through didactic lectures, small group tutorials and clinical experiential bedside learning however fellows are afforded access to novel teaching techniques such as simulation, and their use is highly encouraged.In addition to the provision of teaching, fellows are involved in organisation of undergraduate QUB Final MB and postgraduate PACES exams. Principally this is through the sourcing of patients and the overseeing of the examination. Moreover, fellows aid the FY0 apprenticeship programme, acting as mentors to the forthcoming foundation doctors as they transition from undergraduate students to NHS doctors.In return, fellows are remunerated through funding for medical education related courses. This helps facilitate further teacher training and as such, enhance the ability of the fellows to function as effective educators. Presently, several of my colleagues are completing their Postgraduate Certificate in Medical Education and I myself (EK) intend to train further in simulation.
BENEFITS OF A TEACHING FELLOW
In extorting the virtues of a teaching fellow programme, one must consider the benefits to both the educators and students alike.For students, the use of teaching fellows is viewed favourably, with fellows often considered more reliable and approachable. This is important twofold as it allows informal discussion regarding students concerns and difficulties, with the fellow providing a pastoral role. Moreover, students consider the fellows more accessible and as such, report feeling more comfortable in asking questions, seeking clarification and discussing areas of difficulty. In my experience (EK), this improved level of communication between educator and pupil has helped empower students to express their learning needs, placing greater emphasis on student centred teaching. Accordingly, a recent study by Woodfield & O’Sullivan (2014), reported students favoured fellow led teaching over that of consultants, given that fellows tended to pitch teaching at a more appropriate level.Similarly, a plethora of benefits exist for teaching fellows. Most notably, the aforementioned funding allows fellows to pursue additional qualifications in medical education, thus affording them the opportunity to develop understanding of theories and practical elements underpinning medical education. Additionally, fellows are encouraged to participate in educational research projects. As such, they can garner greater understanding of research methodologies whilst also generating results suitable for conference abstract submission and potential publication.As teaching fellows, there is increased access to a myriad of teaching resources, including contemporary techniques such as simulation. Fellows are therefore able to generate a dynamic and contemporary portfolio of teaching experiences, indispensable for CV enhancement. Equally, student feedback is documented after each session, allowing for personal reflection on the teaching provided. Potential weakness in teaching techniques can thereby be addressed by the fellow, with positive student reviews acting as a source of encouragement.Working as a member of a fellow team has additional benefits. Observing the teaching of fellow colleagues is constructive as it enhances awareness of alternative teaching styles, promoting self-comparison and reflection on one’s own teaching. Such engagement in collegial teaching is further advantageous through the provision of formal and informal peer feedback in a supportive environment. Peer collaboration and the sharing of ideas can enhance opportunities in relation to collective quality improvement and research projects.Organisational and management skills are strengthened as a teaching fellow. Whilst protected teaching time exists, fellows must continue to manage their role as physicians with its associated stressors, necessitating skills in time management, prioritisation and teamwork. Additionally, leadership skills are augmented through the mentoring role a fellow assumes, supporting students in both their clinical and personal/ professional development.Perhaps the greatest benefit of being a teaching fellow is the ability to improve as a teacher. Regular engagement in teaching helps establish a sense of confidence in public speaking, ultimately leading to a more personal and effective teaching style. For me (EK), I have developed a better understanding of core clinical topics, essential in order to explain difficult concepts in an understandable manner to students. Moreover, I believe this has enhanced me as a physician and improved my communication with patients. Furthermore, the opportunity to engage with students and their enthusiasm for learning, has encouraged me to challenge myself in creating new ideas and more innovative ways to teach.
CONCLUSION
Working as a teaching fellow is a wonderful opportunity for trainees wanting to enhance or develop as a medical educator. It is both a rewarding experience for the fellow and plays an integral role in enhancing the training of future doctors. Inevitably the varied nature of the role means it extends beyond simply “teaching,” offering a myriad of opportunities for a trainees personal and professional development.