{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:59:56Z","timestamp":1790341196565,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["asmepublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Clinical Teacher"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical teaching occurs where patient care and education coexist. Within the United Kingdom's National Health Service, workforce pressures constrain teaching and supervision. Clinical Teaching Fellow (CTF) roles have expanded in response but are often viewed as discrete posts rather than practices situated within complex clinical\u2013educational systems. This study examined how tensions within and across these systems shaped CTF practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This theory\u2010informed exploratory qualitative case study used third\u2010generation Activity Theory. All 10 members of a hospital medical education team were invited to a semistructured group interview; eight participated. An Activity Theory\u2010informed thematic approach was used to map the focal undergraduate clinical education activity system and examine tensions within it and at its intersections with adjacent systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Participants included three CTFs, two education facilitators and three administrators. CTF practice involved teaching, programme coordination and administrative work within a multiprofessional team. Differing understandings of the activity's purpose and outcomes shaped practice. Professional language, continuity, experience and blurred divisions of labour influenced participation and work organisation. Relationships with clinical services, the medical school, postgraduate medical education and university\u2010based postgraduate study introduced competing demands. Participants negotiated tensions through communication, redistribution of responsibilities and closer working across professional roles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CTF roles are embedded within systems where educational, clinical and organisational priorities intersect. Third\u2010generation Activity Theory makes visible how relationships within and across these systems shape practice. Supporting CTF roles requires attention to how educational work is organised, coordinated and prioritised.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tct.70534","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:02:52Z","timestamp":1790337772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Teaching Fellow Practice Within Complex Clinical\u2013Educational Systems: An Activity Theory\u2013Informed Case Study"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-4705","authenticated-orcid":false,"given":"Nicola","family":"Jones","sequence":"first","affiliation":[{"name":"Royal Papworth Hospital  Cambridge UK"},{"name":"University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zilley","family":"Khan","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsteen","family":"Watson","sequence":"additional","affiliation":[{"name":"University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2019.1566601"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102929.2005.02371.x"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.edurev.2014.01.002"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/13639080.2012.644901"},{"key":"e_1_2_13_6_1","unstructured":"NHS England \u201cNHS Long Term Workforce Plan 2023 \u201dhttps:\/\/www.england.nhs.uk\/long\u2010read\/nhs\u2010long\u2010term\u2010workforce\u2010plan\u20102\/."},{"key":"e_1_2_13_7_1","unstructured":"GMC \u201cOutcomes for Graduates \u201d2025 accessed November 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