To the Editor: Learning in the clinical setting remains central to the development of well trained health care professionals. The issue is whether that learning should occur through formal or informal learning opportunities. Westbrook and colleagues define “supervision or education” in a way that focuses mainly on formal experiences,1 possibly because trained observers could accurately classify such experiences. As noted by Brown and Arnold, much learning in the hospital setting is largely informal in nature.2 Although learning is likely to be occurring during the many discussions that junior doctors have with consultants or during the procedures they perform in an emergency department,3 it can be difficult to describe, and may not be recognised as learning by the individuals involved.4

There is a divide between the perceptions of teachers and trainees about how much learning is occurring, whether teaching has occurred and feedback has been given. Consultants believe they are providing a great deal, but junior doctors do not recognise it. Although junior doctors perceive they have adequate informal contact with registrars, and some (but not enough) with consultants, what they want is more teaching in “formal” sessions.5 Additionally, supervisors think they give detailed feedback, but junior doctors view it as less than adequate.6

The answer might lie in upskilling both junior doctors and teachers to make teaching and learning more effective, in part by making it more explicit to all involved.

At Sir Charles Gairdner Hospital in Perth, an innovation has been to create new positions known as “medical education registrars” who, as supernumerary staff at a senior registrar level, have time to advise on patient management, supervise and teach skills.7 Much of this is provided at the patient’s bedside. The very nature of their job title makes it explicit that they are there to help learning during daily activities.

The staff development program, “Teaching on the Run”, developed by the Education Centre at the Faculty of Medicine and Dentistry, University of Western Australia,8 aims to make teachers more effective. More recently, we have piloted another program, “Learning on the Run”, for junior doctors and students, to provide them with the skills to recognise opportunities and drive their own learning agendas.

We agree with Brown and Arnold that learning and service are not mutually exclusive.2 By providing both junior doctors and senior medical staff with the necessary skills, many tasks within a day in the life of a new doctor could become a valuable learning experience. Whether this will ultimately translate into improved teaching and learning outcomes is a question we are continuing to explore.