Towards a Quality‐Assured Framework of Professional Development for Clinical Teaching Fellows in Undergraduate Medical Education

Clinical teaching fellows (CTFs) play a crucial role in medical education and clinical training, making them integral to the educational and healthcare system [1]. Typically, early-career doctors, they balance service commitments with responsibilities for teaching, student mentoring, curriculum implementation, and assessment. In recent years, the role has gained prominence [2] due to healthcare workforce expansion, new medical schools and curriculum reform. However, CTF roles vary considerably across institutions, leading to a fragmented approach to professional development [3]. The multifaceted nature of their responsibilities can overwhelm early-career doctors, particularly without clear expectations and consistent support. This may restrict career progression and diminish the learning environment, contributing to dissatisfaction [4]. For example, Harris et al. [1] found that CTFs often experience frustration due to ambiguous job roles, limited feedback, and lack of mentorship. Emerging data suggest that these challenges contribute to broader systemic issues such as burnout and attrition. Kilday [5] highlighted that early-career doctors are vulnerable to burnout, often feeling underprepared. Earlier national findings identified inconsistencies in CTF posts across UK medical schools, including lack of formal training, limited oversight and unclear expectations [3]. More recent qualitative research reinforces this: CTFs report early withdrawal due to lack of clarity, progression, and mentorship [1]. Burnout remains high globally with 47.3% prevalence among postgraduate medical trainees, associated with job dissatisfaction and poor workplace support [6]. There is also a rise in doctors stepping out of training, with two-thirds taking a year out [5]. This reflects efforts to manage stress and explore roles like CTF posts. Only one-third feel they have opportunities to develop leadership skills, crucial for both personal growth and delivering medical education [2, 5]. A recent General Medical Council (GMC) report [2] reinforced these concerns, highlighting absent career pathways and structured support for early-career doctors. Although the CTF role offers opportunities in medical education, inconsistencies in support may contribute to dissatisfaction rather than alleviate it. To date, no comprehensive framework defines and supports the CTF role in a standardised way. Our aim is to bridge this gap by developing a structured, quality-assured framework that defines domains of CTF activity and aligns with national and international standards for professional recognition. We introduce a draft framework undergoing piloting and consultation, with the intention of improving role clarity, satisfaction, and leadership development among early-career medical educators, contributing a practice-oriented perspective to ongoing CTF support discussions. To ground our framework in the experiences of current CTFs, we conducted informal focus groups and a short online survey of CTFs and supervisors. Drawing on this input, we structured the framework around four core domains: induction, training, professional development, and performance appraisal (Table 1). These domains were refined in alignment with standards specific to medical educators. The GMC's Promoting Excellence outlines expectations for effective induction, structured training, learning opportunities and developmental feedback for doctors in training. The Academy of Medical Educators (AoME) Professional Standards [7] define educator domains including planning learning, facilitating teaching, assessment and leadership. Although based in the UK, AoME is an international organisation with a growing global membership. It remains the only professional body with a dedicated standards framework specifically for medical educators. Each of the four framework domains maps onto these expectations: induction and training reflect structured preparation and skills development; professional development aligns with AoME's emphasis on scholarly activity and progression, and performance appraisal supports reflective practice and feedback, as advocated by both GMC and AoME. This structure reflects the developmental needs of early-career clinical educators and ensures compatibility with recognised standards for professional recognition. Frameworks with comparable structure and intent already exist in UK medical education. For example, the CTF scheme at St George's, University of London, includes structured induction, defined teaching responsibilities, access to a Postgraduate Certificate in Medical Education and regular performance review, all elements reflected in our proposed domains [8]. Similarly, the NHS Education for Scotland's ACT-funded CTF posts provide protected teaching time, support for formal educator qualifications and supervision aligned with AoME standards [9]. These parallels reinforce the feasibility and relevance of our framework, demonstrating that its core components are operationalised in existing programmes for early-career medical educators. Each domain includes suggested activities and goals adaptable to local contexts and experience levels. These are practical, flexible and mapped against AoME Professional Standards, allowing institutions to support medical education activity aligned with national recognition schemes. While many professional standards exist, AoME's are uniquely tailored to healthcare educators, offering a relevant benchmark for early-career doctors in clinical education. Induction introduces CTFs to their dual roles and institutional expectations. Training equips them with competencies in teaching, learning and assessment. Professional development supports engagement in educational projects and quality improvement initiatives. Performance appraisal offers structured feedback through peer observations, reflective practice, and development conversations. A distinctive feature is the emphasis on leadership development, a fundamental yet often overlooked competence for doctors in training. Research suggests that early leadership exposure enhances educational outcomes and long-term academic progression. The framework integrates leadership as a core competency, ensuring that CTFs are equipped for future academic and clinical leadership roles. Recognising variation in experience, the framework operates at two levels: for new CTFs and for those with at least 12 months' experience, offering opportunities to expand leadership and academic roles. This tiered approach supports progression in a structured yet flexible way. By clearly defining expectations and aligning activities with professional standards, the framework equips CTFs to deliver high-quality education while advancing their own careers. The framework equips clinical teaching fellows to deliver high-quality education while advancing their own careers. We anticipate three main benefits. First, it offers institutions a structured approach to supporting CTFs, encouraging consistency with scope for local adaptation. Second, it helps CTFs develop a professional identity as educators, providing clarity around expectations and progression. Third, it promotes alignment with international standards, supporting formal recognition. The demand for skilled educators is increasing, making structured development essential [2]. The framework addresses a gap by providing CTFs with a formalised development model. As education becomes increasingly driven by quality assurance standards and regulation [10], it is critical to offer training schemes that provide both structure and support. There is strong evidence that structured development enhances retention by supporting purpose and career progression [11]. A systematic review of faculty development programs based on the Harden teacher's role framework found that training improves teaching effectiveness, motivation and satisfaction [12]. Incorporating these principles into a dedicated framework supports both skill acquisition and long-term development [13]. By addressing inconsistencies, the framework aims to improve retention, satisfaction and teaching quality, ultimately enhancing education delivery. Leadership development is essential to facilitate CTFs' progression into senior academic and clinical roles. Structured development enhances retention by supporting purpose and career progression. We recognise that the CTF role may not exist internationally in the same form. However, the underlying principles, supporting early-career doctors in dual educator-clinician roles, are widely applicable. Globally, early-career doctors undertake teaching and mentoring roles and face challenges such as unclear expectations, limited support and restricted leadership access [6]. By focusing on professional identity, structured educational activity and leadership skills, the framework offers a generalisable model adaptable to various settings. Its focus on structured training and appraisal also enhances teaching quality, benefiting student learning and patient care. While developed in the UK, there is evidence that early-career doctors in other countries face similar challenges. In Australia, junior doctors undertaking Medical Education Registrar posts report a strong desire to improve teaching but lack formal pathways, mentorship and support, highlighting the need for structured frameworks [14]. In Canada and the United States, ‘Residents-as-Teachers’ programmes are widespread but often focus on isolated teaching skills rather than comprehensive professional development or leadership training [15]. These findings suggest that the framework's core components—structured induction, pedagogical training, leadership development and appraisal—address shared needs across systems. Moreover, regulatory standards published by the Australian Medical Council (AMC), the Royal College of Physicians and Surgeons of Canada (via the CanMEDS framework) and the Accreditation Council for Graduate Medical Education (ACGME) in the United States all emphasise structured educator support, faculty development and quality assurance in clinical teaching. As such, the framework offers a transferable model for supporting early-career clinician-educators internationally, especially in contexts seeking to professionalise teaching roles. The framework is in early development and currently piloted within one institution. It will require further consultation and multi-institutional piloting to ensure relevance and effectiveness. While initial feedback has shaped its design, sustained engagement with academic leaders and regulatory bodies will be vital. Key indicators of success will include improvements in retention, satisfaction and teaching quality. Longitudinal tracking of career progression will help determine whether the framework supports sustained engagement in academic and clinical leadership roles. Though formal piloting is still underway and will be reported separately, the structure draws on established standards and parallels successful healthcare education models. For example, faculty development programmes based on the Harden teacher's role framework improve teaching effectiveness, motivation and progression. Longitudinal initiatives such as Clinical Teaching Fellowships have enhanced teaching confidence, interdisciplinary collaboration and sustained engagement in education. Feedback from CTFs and academic staff has indicated strong perceived value in a structured, standards-aligned approach. Future implementation will involve broader piloting and evaluation focused on retention, development, and educational impact. This framework has the potential to reshape medical education by embedding development and leadership at the centre of the CTF role. By moving beyond ad hoc approaches to a structured model, it supports a motivated, capable educator workforce essential to delivering high-quality medical education. This framework has the potential to reshape medical education by embedding development and leadership. Nadia Lascar: conceptualization (lead), writing – original draft (lead), writing – review and editing (supporting). Claire Joanne Stocker: supervision (lead), writing – review and editing (lead). The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.