Two-year longitudinal observational study of junior doctors as clinical teachers: the Associate Clinical Teaching Fellow Program


  • Henrietta Poon Former ACTFs; Worcestershire Royal Hospital, Worcester, UK
  • Mehtab Farhat Ahmad Former ACTFs; Liverpool Hospital, South Western Sydney Local Health District, Australia
  • Danielle Lowry Former ACTFs; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  • Habiba Saedon Former ACTFs; Manchester University NHS Foundation Trust, Manchester, UK
  • Nicola A. Thompson Former ACTFs; Addenbrookes Hospital, Cambridge, UK
  • Olufunso Adebola Adedeji University Hospital of North Durham, Durham, UK



Medical Education, Associate Clinical Teaching Fellow (ACTF), Faculty Development, SFDP-26, Stanford Faculty Development Program, Clinical Teaching Effectiveness Questionnaire


Introduction: Most clinical teachers are not trained to teach, though they are critical to determining the quality of clinical learning environment. The General Medical Council, United Kingdom, recognises that being a good teacher is not innate, but that skills and attributes can usually be acquired. Clinical teaching is part of training of junior doctors in the United Kingdom, and from learners’ perspectives, junior doctors are effective clinical teachers, but there are few structured opportunities to learn how to teach during clinical training. The Associate Clinical Teaching Fellow (ACTF) program was developed to provide such structured platform for clinical trainees. The aim of this paper is to evaluate the quality of teaching by the trainees against the current-standard of clinical teaching in the first 2 years of its inception, and to adapt validated feedback questionnaires for practical use.

Methods: A prospective longitudinal observational study was done over 2 years in a large 1,215 bed tertiary hospital. Multiple cross-sectional assessments of teachings by ACTFs and consultant teachers were done using two validated questionnaires, the Stanford Faculty Development Program-26 (SFDP-26) and the Clinical Teaching Effectiveness questionnaire (CTEQ), and an in-house global (IHG) feedback form prepared by third- and fifth-year students. Both trainees and consultants were unaware of the timing of the SFDP-26 and CTEQ feedbacks. A graphical representation of all responses was used to create a grading system for practical feedbacks.

Results: A total of 507 of 765 (66%) of SFPD-26 and CTEQ and 224 of 286 (78%) of IHG questionnaires were returned for 26 trainees and 31 consultants by 266 medical students. There was a statistically significant higher ratings of trainees in seven of eight domains of SFDP-26, and the median (interquartile ranges [IQR]) overall score was 115 (105–126) and 108 (99–121) for trainees and consultants, respectively (P < 0.0001). Similarly, trainees were rated significantly higher in seven of nine CTEQ domains, and this was reflected in the overall score. The patterns were similar for third- and fifth-year students, and the type of learning exposure did not make a difference. With these students, the overall teaching effectiveness correlated (Spearman Correlation Coefficient [SCC]) the most with enthusiastic and stimulating (SCC 0.711; P < 0.0001), establishes rapport (SCC 0.69; P < 0.0001) and is accessible (SCC 0.67; P < 0.0001) in CTEQ, and with learning climate (SCC 0.62; P < 0.0001), communication of goals (SCC 0.54; P < 0.0001) and evaluation (SCC 0.52; P < 0.0001) in SFDP-26.

At the end of their rotations, 30% of both groups of students were neutral or disagreed that consultants were essential to their clinical programs compared to 15% (P = 0.001) and 11% (P < 0.0001) of third- and fifth-year students, respectively, felt about trainees. By applying a new grading system derived from the full database of responses, the trainees would be graded 1 and consultants 7 out of 10 possible grades.

Conclusions: Teaching delivered by doctors in training within a formal teaching program is of good quality and well received by medical students. There is a need for an equivalent program for trainee clinical educationalists like the Integrated Academic Training scheme of the National Institute of Health Research (NIHR), UK, for trainee academics. More qualitative studies are needed to analyse some of the findings in this study.


Rodrigues J, Sengupta A, Mitchell A, Kane C, Kane C, Maxwell S, et al. The Southeast Scotland Foundation Doctor Teaching Programme – is “near-peer” teaching feasible, efficacious and sustainable on a regional scale? Med Teach 2009; 31(2): e51–7. doi: 10.1080/01421590802520915 DOI:

Iblher P, Zupanic M, Karsten J, Brauer K. Can today’s house officers teach effectively? An assessment in undergraduate emergency training. Eur J Emerg Med 2015; 22(3): 215–218. doi: 10.1097/MEJ.0000000000000142 DOI:

Rashid MS, Sobowale O, Gore D. A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE). BMC Med Educ 2011; 11: 11. doi: 10.1186/1472-6920-11-11 DOI:

Anyiam O, Mercer C, Zaheen H. Participation in teaching opportunities during core medical training: barriers and enablers. Future Hosp J 2017; 4(2): 86–91. doi: 10.7861/FUTUREHOSP.4-2-86 DOI:

General Medical Council. Good medical practice. 2013. Available from: [cited 1 October 2021].

General Medical Council. Developing teachers and trainers in undergraduate medical education. General Medical Council; 2011. [cited 05 September 2021].

Clough S, Fenton J, Harris-Joseph H, Rayton L, Magee C, Jones D, et al. What impact has the NIHR Academic Clinical Fellowship (ACF) scheme had on clinical academic careers in England over the last 10 years? A retrospective study. BMJ Open 2017; 7(6): e015722. doi: 10.1136/BMJOPEN-2016-015722 DOI:

Mohanna K, Cottrell E, Wall D, Chambers R. Teaching made easy: a manual for health professionals. 3rd ed. Taylor & Francis; 2010. Available from: ISBN 9781846194894.

Litzelman DK, Stratos GA, Marriott DJ, Skeff KM. Factorial validation of a widely disseminated educational framework for evaluating clinical teachers. Acad Med 1998; 73: 688–95. doi: 10.1097/00001888-199806000-00016 DOI:

Irby D, Rakestraw P. Evaluating clinical teaching in medicine. J Med Educ 1981; 56: 181–6. doi: 10.1097/00001888-198103000-00004 DOI:

Academy of Medical Educators. Professional standards . 4th ed. Academy of Medical Educators; 2021. Available from: [cited 21 September 2021].

Beckman TJ, Ghosh AK, Cook DA., Erwin PJ, Mandrekar JN. How reliable are assessments of clinical teaching? A review of the published instruments. J Gen Intern Med 2004;19(9): 971–7. doi: 10.1111/j.1525-1497.2004.40066.x DOI:

Fluit C, Bolhuis S, Grol R, Laan R, Wensing M. Assessing the quality of clinical teachers: a systematic review of content and quality of questionnaires for assessing clinical teachers. J Gen Intern Med 2010; 25(12): 1337–45. doi: 10.1007/s11606-010-1458-y DOI:

Afzal MF, Ali AA, Hanif A. Performance of pediatrics’ residents as clinical teachers: a student-based assessment. Pak J Med Sci 2019; 35(6): 1499–504. doi: 10.12669/PJMS.35.6.830 DOI:

Owolabi MO, Afolabi AO, Omigbodun AO. Performance of residents serving as clinical teachers: a student-based assessment. J Grad Med Educ 2014; 6(1): 123–6. doi: 10.4300/JGME-D-13-00130.1 DOI:

Snell L. The resident-as-teacher: it’s more than just about student learning. J Grad Med Educ 2011; 3(3): 440–1. doi: 10.4300/JGME-D-11-00148.1 DOI:

Kripalani S, Pope AC, Rask K, Hunt K, Dressler DD, Branch WT, et al. Hospitalists as teachers. J Genl Intern Med 2004; 19(1): 8–15. doi: 10.1111/j.1525-1497.2004.20907.x DOI:

Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med J Assoc Am Med Coll 2008; 83(5): 452–66. doi: 10.1097/ACM.0b013e31816bee61 DOI:

Cantillon P, Dornan T, De Grave W. Becoming a clinical teacher: identity formation in context. Acad Med 2019; 94(10): 1610–18. doi: 10.1097/ACM.0000000000002403 DOI:

Orsini C, Tricio J, Segura C, Tapia D. Exploring teachers’ motivation to teach: a multisite study on the associations with the work climate, students’ motivation, and teaching approaches. J Dent Educ 2020; 84(4): 429–37. doi: 10.1002/JDD.12050 DOI:

Fluit CV, Bolhuis S, Klaassen T, De Visser M, Grol R, Laan R, Wensing M. Residents provide feedback to their clinical teachers: reflection through dialogue. Med Teach 2013; 35(9): e1485–92. doi: 10.3109/0142159X.2013.785631 DOI:

Molodysky E, Sekelja N, Lee C. Identifying and training effective clinical teachers – new directions in clinical teacher training. Aust Fam Physician 2006; 35(1–2): 53–5. Available from:

Berman JR, Aizer J, Bass AR, Cats-Baril WL, Parrish EJ, Robbins L, et al. Creating an academy of medical educators: how and where to start. HSS J: Musculoskeletal J Hosp Spec Surg 2012; 8(2): 165–8. doi: 10.1007/s11420-012-9280-1 DOI:



How to Cite

Poon, H., Ahmad, M. F. ., Lowry, D., Saedon, H., Thompson, N. A., & Adedeji, O. A. . (2021). Two-year longitudinal observational study of junior doctors as clinical teachers: the Associate Clinical Teaching Fellow Program. Journal of Global Medicine, 1(2), e43.



Research Articles