To the Editor: Medical education faces a number of significant challenges in the coming years. The most concerning problem is that there are insufficient medical educators. To compound this problem further, clinicians with an interest in teaching lack academic recognition, funding, time for medical education, and institutional support.1

While this is already creating problems for training of medical students and junior doctors, the situation will only become worse as the number of graduates increases to meet workforce shortages. A greater number of medical students and graduates will put further pressure on an already over-stretched health system to deliver adequate medical education. Therefore, we need to consider new ways of creating effective clinical teachers and learning materials that are educationally sound and supported by research.

One way to address some of these deficits is to create specific training positions for doctors interested in pursuing a career in medical education, perhaps called “medical education registrars”. These positions could be jointly funded by hospital networks, universities and other interested groups, such as the postgraduate medical councils, and could be aimed at doctors with a strong interest in medical education, especially those at an early stage in their career, such as postgraduate year (PGY) 3 and PGY4. This joint funding would support hospitals and universities working collaboratively, and taking responsibility for making medical education “a priority, rather than an add-on”.2 The hospital appointment would maintain the registrars’ clinical knowledge, and the university appointment would allow opportunities for further study in medical education theory and research methods. Both environments would allow for academic mentoring.

These registrars would then be ideally placed to assist in the development, implementation and evaluation of education materials using the newly released Australian Curriculum Framework for Junior Doctors as a guide. While agreeing that the Framework provides a “unique opportunity to improve the quality of medical training in Australia”, Gleason et al expressed concerns about how the Framework would be implemented.3 Medical education registrars could play a pivotal role in this process, and would be strong advocates for junior doctors.

Medical education registrar positions are a simple, cost-effective way to encourage clinicians, especially those early in their careers, to pursue medical education as a serious and satisfying career path. Urgent action is required now to avert certain disaster in a few years, when hospitals are full of medical students and junior doctors, and there is no one to supervise and train them.

In reply: A teaching registrar position is a great idea. It could foster development of knowledge and skills in interested clinicians, and perhaps higher degrees in learning and teaching, as well as serving as the start of a career pathway.1 The United Kingdom allows specialist trainees to take a year out to develop skills in education or research. Here, however, it is doomed to fail, unless there is a receptive environment for these registrars to work in or a career path that is attractive.

What kind of educational environment is needed? We need leaders with vision, knowledge, new ideas and resources to lead the development of programs and assessment. We need teachers whose main focus is to teach and implement programs. And we need to support all clinicians to continue to supervise and teach. Not all these roles need to be performed by a medical practitioner.2 Without all of this, someone who is “interested in teaching” may be burdened with an unsustainable level of teaching and administration.

Better integration at a local level across undergraduate and prevocational training3 (not to mention linking with other professional groups) and a culture of teaching are needed. Importantly, we need coherent and visionary leadership at national and state levels to underpin these endeavours.3,4