Didactic training v clinical training—how each serves the medical fellow

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published June 23, 2023

Key Takeaways

  • Patient care, didactics, and clinical teaching comprise fellowship.

  • Clinical duties are intended to prepare fellows to provide high-quality care to their future patients.

  • Fellows are more autonomous in their responsibilities than residents and can practice in their core specialty.

Medical fellows can expect to receive both clinical (treating patients) and didactic (instructor-led lectures) training during their fellowship tenure, and these vastly different learning experiences can set them up for serving the public in various capacities. 

Besides patient care, future roles may include serving as an expert community resource, synthesizing new knowledge as a researcher, or educating future physicians. Accreditation requirements, such as those provided by the Accreditation Council for Graduate Medical Education (ACGME), outline these diverse responsibilities.

Clinical vs didactic requirements

The ACGME provides inclusive guidelines on the clinical and didactic requirements of fellowship in its Common Program Requirements.[]

Both the clinic and the lecture hall represent environments of learning that function to prepare the fellow for future practice. 

The specific didactic and clinical responsibilities vary by subspecialty and institution, but overall, the learning objectives of any program must incorporate supervised patient care responsibilities, didactics, and clinical teaching.

Related: What does it mean to be a leader in fellowship—and how do you get there?

Clinical responsibilities

During fellowship, the care of patients occurs day or night and is continual. The goal of these clinical responsibilities is to train the fellow to provide high-quality care.

“Patients have the right to expect quality, cost-effective care with patient safety at its core. The foundation for meeting this expectation is formed during residency and fellowship,” according to the ACGME.

Quality patient care is defined as care that is safe, effective, equitable, timely, efficient, and patient-centered. It is intended to enhance a population’s health while decreasing per-capita costs.

One key difference between clinical experiences during fellowship and residency is autonomy, according to the ACGME, noting that residency prepares physicians to be competent within a core specialty, and fellowship training will “enhance fellows’ maturation and competence.”

"This enables fellows to occupy a dual role in the health system: as learners in their subspecialty, and as credentialed practitioners in their core specialty."

ACGME’s Common Program Requirements (Fellowship)

Didactics/instructor-led lectures

The ACGME writes that patient care-related educational activities should provide fellows with the opportunity to acquire knowledge that is directly relevant to their patient populations. Such activities include morbidity and mortality conferences, surgical planning conferences, tumor boards, and case discussions. Programs define these educational activities in which fellows must participate and set up protected time. 

Didactics during fellowship often include lectures that aim to boost medical knowledge, according to the authors of an article published in the Journal of Pediatric Urology.[] Although small-group discussions are more effective for learners of evidence-based medicine, they are harder to organize.

Related: How to stay up-to-date with medical literature—for free

The authors noted that, although it would be best to tailor teaching to either residents or fellows, this is not always possible.

“A difficulty in creating a didactic education program for training programs is the variable knowledge of the target learner. Both residents and fellows attend didactic sessions, but fellows usually have more advanced knowledge about the topic of interest. Teaching directed towards residents may lead to disengagement of the fellow,” the authors stated.

A way to keep fellows engaged during didactics could entail active learning techniques, which are being increasingly adopted at training programs.[]  

This technology has advanced from the earlier “iClicker” technology, to phone apps replete with multiple-choice questions, live word clouds, open response, clickable images, up- and down-voting, and rank order items. Active-learning techniques are associated with increased learner satisfaction, increased engagement, and better assimilation of information. 

What this means for you

Patient care, didactics, and clinical teaching make up the essence of fellowship. Clinical responsibilities enable fellows to learn how to provide high-quality care when they finish training and begin clinical practice. A major shift in clinical responsibilities during fellowship is that fellows practice autonomously in their core specialty, which adds further acumen. Didactics come in a variety of forms but are intended to provide fellows with the knowledge needed to treat their future patient population. 

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