Non-training clinical fellowships.

Abstract

Editor – We read with interest the paper by Jalal et al.1 Sherwood Forest Hospitals, has provided non-training clinical fellowships since 2002.2 An account of how it addresses the issues raised in the paper by Jalal et al has been reported.3 Many overseas doctors are trained through traditional undergraduate medical curricula which do not emphasise communication and leadership skills, in contrast to significant emphasis on communication and leadership skills in the UK. It is a significant cultural shift for them to make the transition to settings where skills of communication and teamwork are given high priority in the clinical setting and assessed through work place based assessments using an electronic portfolio. Our programme addressed this challenge through 8 weeks of a supervised supernumerary period in a supported environment, designed to expose the clinical fellows gradually to the work environment through an extended period of induction mentoring and coaching with a gradual transition to the new work environment to enable the fellows overcome language, communication, clinical and work-cultural challenges and adapt to the UK healthcare system. Overseas doctors, who are employed in non-training positions, do not by right receive the training and educational opportunities offered to trainees in the National Training Programme and are not monitored by the Guardian for Safe Working Hours. Our programme addressed this issue by providing a study leave allocation, protected time for personal and professional development as well as deployment of the gripes tool.4 Leadership, management and educational governance of the Clinical Development Fellowship Programme is through a committee comprising the executive medical director, director of postgraduate medical education and senior human resources staff. The success of the programme was reflected in the programme outcomes which showed that 49% of fellows gained a training grade post and another 19% appointed to trust grade posts with responsibility at registrar grade during or at the end of the programme. The programme has also shown a reduction in variable pay costs as well as overall costs of employing non-training grade junior doctors. Introduction of the programme has resulted in a fall in both the total spend and spend on agency employed locum doctors.