Statements of competence for core higher specialist training (HST) include contributing to the training of undergraduate medical students, postgraduate trainees and other professionals, for example nurses, teachers and social workers, and participation in departmental teaching programmes, including journal clubs.1 However, the ability to teach others is not an innate gift and opportunities to acquire skills necessary to fulfil this responsibility is an important aspect of postgraduate training.2 This was a UK study looking at the role of specialist registrars (SpRs) in medical education. SpRs are in higher specialist training, having completed 2 or 3 years of basic specialist training and passed the membership examination of the Royal College of Paediatrics and Child Health. The aims of this study were to (1) see if SpRs were involved in teaching; (2) ascertain the type of teaching activities undertaken; (3) ascertain training/qualifications in teaching; (4) enquire about inhibitory factors affecting teaching; and (5) elicit SpRs’ views on how to encourage them to become educators of the future.

METHOD

This study was conducted over a 3-month period (June to August 2007). A 17-item questionnaire contained tick box responses to 16 questions and a final free text question asking for any other comments on the trainee’s role as the teacher. The first 10 questions were about teaching (table 1) while the next six collected demographic data. The questionnaire was distributed to all 133 SpRs in the West Midlands Deanery at regional SpR training days and to non-attendees by post and email. A follow-up email was sent to non-responders.

RESULTS

There was a 92% (122/133) response rate with 54% (66) being female and 80% (98) working full time. There were 48 (39%) questionnaires from core trainees (years 1 and 2) and 73 (60%) from post-core trainees (years 3 and above). Trainees’ specialities were general paediatrics (37% (45)), community paediatrics (19% (23)), subspecialty (27% (33)) and neonates (16% (20)). One SpR did not state year of training and speciality.

All reported doing some form of teaching (table 2) with the majority teaching junior medical trainees and students. Seventy-three per cent (89) reported using both formal (planned) teaching and informal (unplanned) teaching while 25% (31) practised informal teaching only. One SpR utilised formal teaching alone and the other did not state type of teaching undertaken. The 38 (31%) SpRs teaching for 2 or more hours per week were predominately from years 4 and 5. Not surprisingly, trainees working part time were teaching less in the daytime compared to full-time SpRs (52% and 20%, respectively, for less than 30 minutes per week). During out of hours the amount of teaching was reduced, with 21% (26) of SpRs reporting doing no teaching. There was no difference in the teaching delivered by SpRs in terms of subspecialty. Enthusiasm to teach was present with nearly half of SpRs (46%) using study and/or annual leave to teach on courses. Only two SpRs were granted professional leave to do this.

Factors that inhibited teaching are shown in table 2. Other reasons included lack of interest, no opportunity given to teach due to no students (especially in the community) or no time allocated on rota and no formal teaching recognition.

Over half (55% (67)) of SpRs had completed some formal training in teaching (table 2). A need for formal training in teaching was expressed in the free text comments. In developing SpRs as educators this was felt to be best achieved through mandatory training (61% (74), themed regional SpR training days on education (61% (74)) and Deanery funding for education conferences (51% (62)). SpRs see teaching as an important aspect of their job plan and wanted support for teaching including protected rostered teaching sessions, inclusion in departmental teaching programmes and formal recognition by the Deanery through bursaries, merits or awards (73% (89)) for medical education.

DISCUSSION

It was encouraging that all SpRs were involved in teaching with the majority teaching junior trainees and medical students. To our knowledge there have been no previous studies that have looked specifically at registrars’ roles as clinical educators in the hospital setting although studies have looked at general practitioners’ teaching roles.3 4

SpRs were using a variety of teaching methods with bedside teaching and lectures or presentations being the most common. Almost three-quarters of the respondents stated that they used both formal and informal teaching methods. Bedside teaching and teaching on ward rounds may be planned (formal) or may take place as and when time permits, or form a part of service commitment (informal).

Sixty-seven (55%) SpRs had undertaken formal training for teaching, which is a necessity for medical staff to provide good-quality teaching while ensuring service provision continues within the National Health Service.2^–4 The West Midlands Deanery provides funding for “Teach the Teacher” courses so that they are free for trainees and also provides bursaries for university qualifications in medical education. This has helped to give SpRs enthusiasm about medical education and they have formed their own special interest group, MAPLE (Midlands Association for Paediatricians for Learning and Education).

Most SpRs found that being too busy was an important inhibiting factor to teaching. This is comparable to community studies where lack of time and anxieties about clinical cover while teaching are seen as barriers.3 4 The problems of time and shift patterns are likely to become more marked when the working week reduces to 48 h in August 2009 with increased pressure on medical staff to prioritise service provision over education and training.5 It was of concern that one-fifth of SpRs considered that they did no teaching out of hours and this finding warrants further exploration.

SpRs want to be involved in teaching and see it as an important part of their job plan. They feel it is important to have recognition of their teaching role with protected teaching time incorporated into their rota. These findings were recommended by the Standing Committee on Postgraduate Medical Education (SCOPME 1992).

SpRs make a valuable contribution to education. It is important that teaching is in the personal development plan of all specialty trainees and forms part of educational appraisal and assessment. Achievement of the core higher specialist training competencies for teaching should be mandatory with support at local (Deanery and Trust) level to encourage trainees in their role as clinical educators. This is applicable not only to the UK but also to trainees in any country.