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Reinventing Undergraduate Clinical Placements with a Switch to Delivery by Clinical Teaching Fellows: A Medical Student’s Perspective [Response to Letter]
Authors Hossain S , Shah S, Scott J, Dunn A, Hartland AW, Hudson S, Johnson JA
Received 20 January 2022
Accepted for publication 18 February 2022
Published 9 March 2022 Volume 2022:13 Pages 225—226
Sabir Hossain,1 Shilen Shah,1 Jonathan Scott,1 Abigail Dunn,1 Alexander W Hartland,1 Sonia Hudson,1 Jo-Anne Johnson2
1Medical Education Department, Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, CM1 7ET, UK; 2School of Medicine, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK
Correspondence: Sabir Hossain, Medical Education Department, Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, CM1 7ET, UK, Tel +44 1245 362000, Email [email protected]
View the original paper by Dr Hossain and colleagues
This is in response to the Letter to the Editor
Dear editor
We appreciate the comments of Ratcliffe and George regarding the article “Reinventing Undergraduate Clinical Placements with a Switch to Delivery by Clinical Teaching Fellows”.1 From a teaching perspective, our study demonstrates how a clinical teaching fellow (CTF) led teaching programme can significantly improve medical student experience on hospital placements.2 The authors’ observation that traditional undergraduate clinical placements are outdated was one of the reasons for the implementation of our novel teaching model.
Our analysis from the focus group discussions resonates with the authors’ insights regarding the potential for CTFs to act as a reliable reference point throughout placements and enable student improvement ahead of Objective Structured Clinical Examinations (OSCEs). As the authors point out, having CTFs in placement settings can help to ease concerns regarding the lack of staff familiarity students commonly experience at hospitals.
Future research should look at the impact of CTF-led teaching programmes on student experience within year groups of medical students other than final years. Although theoretical at this point, it is reasonable to suggest that the presence of regular CTFs in clinical settings would help to allay the “imposter syndrome” students on initial placements can feel as suggested by the authors.3 Quantitative data analysis from our study supports that a CTF-led programme helps students to feel more comfortable in ward environments and integrated within medical teams. The authors make a valuable observation that CTF presence could enable students to maximise learning in clinical settings early on in the course, helping to smooth the difficult transition from student to doctor.4
Despite the potential benefits of early CTF involvement with first year medical students, there is usually a degree of pre-clinical to clinical divide in UK medical school curriculums and a focus on the learning theory of constructivism.5 Studies show how medical students benefit from acquiring knowledge of basic sciences before studying more clinical medicine.6 Whilst students learn the scientific theory of medical practice, it is natural that they will not spend as much time with CTFs compared to students in higher year groups who are on placements where the CTFs are based. Furthermore, CTFs themselves only have a limited amount of time to give to first years, particularly as multiple year groups are likely to be on clinical placements at the same Trust simultaneously. It is also possible that while on placement first year students may value more consultant teaching to provide an overview of a topic rather than the detailed supervision a regular CTF may provide.
Our study also shows a method for hospital trusts to improve staffing and make savings on locum costs by employing CTFs. If Trusts did want to employ more CTFs for both service provision and teaching benefits for all year groups, it would require more expenditure overall. The expansion in medical school places in the UK and associated SIFT (Service Increment for Teaching) tariff uplifts could be a helpful funding stream.7 This is demonstrated in our study with the opening of Anglia Ruskin University Medical School.
In conclusion, we agree that it would be valuable to garner the opinions of younger students on CTF-led teaching. We recognise the benefits that CTF presence could provide for younger groups of medical students, while appreciating that due to limited time and resources hospitals may struggle to accommodate these year groups to the same degree as older ones. Our study suggests that CTF-led teaching placements would provide an overall benefit to medical education, but we theorise that its impact will vary depending on the year group in question and the design of a medical school curriculum.
Disclosure
Sabir Hossain, Shilen Shah, Jonathan Scott, Abigail Dunn and Alexander W Hartland are CTFs employed at Broomfield Hospital. Jo-Anne Johnson is the senior lecturer in child and family health at Anglia Ruskin University. Sonia Hudson is a consultant in Critical Care Medicine at Broomfield Hospital, clinical sub-dean for Anglia Ruskin University and an associate dean for Queen Mary University of London. The authors report no other conflicts of interest in this communication.
References
1. Ratcliffe G, George N. Reinventing undergraduate clinical placements with a switch to delivery by clinical teaching fellows: a medical student’s perspective [Letter]. Adv Med Educ Pract. 2022;13:111–112. doi:10.2147/AMEP.S357603
2. Hossain S, Shah S, Scott J, et al. Reinventing undergraduate clinical placements with a switch to delivery by clinical teaching fellows. Adv Med Educ Pract. 2021;12:1429–1438. doi:10.2147/AMEP.S336912
3. Levant B, Villwock JA, Manzardo AM. Impostorism in American medical students during early clinical training: gender differences and intercorrelating factors. Int J Med Educ. 2020;11:90–96. doi:10.5116/ijme.5e99.7aa2
4. Ng KYB, Lynch S, Kelly J, Mba O. Medical students’ experiences of the benefits and influences regarding a placement mentoring programme preparing them for future practice as junior doctors: a qualitative study. BMJ Open. 2020;10(1):e032643. doi:10.1136/bmjopen-2019-032643
5. Dennick R. Constructivism: reflections on twenty five years teaching the constructivist approach in medical education. Int J Med Educ. 2016;7:200–205. doi:10.5116/ijme.5763.de11
6. Pangaro L. The role and value of the basic sciences in medical education: the perspective of clinical education -students’ progress from understanding to action. Med Sci Educ. 2010;20(3):307–313.
7. Royal College of Physicians. Double or quits: a blueprint for expanding medical school places. 2021.
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