Rheumatology, as a specialty, presents the education and training process with particular challenges. The rheumatology trainee is likely to spend more time alone seeing patients in an outpatient clinic than on ward rounds with bedside teaching. Whereas the teaching ward round is still a familiar phenomenon in hospital medicine, true ‘teaching clinics’ are still in their infancy. With heightened patient expectations, financial constraints, and increasing workloads, there is a growing concern of how an appropriate balance between training and service will be maintained for rheumatology trainees in the outpatient ‘classroom’.

In contrast with inpatient teaching, time is more limited in outpatient clinics for in depth discussion, opportunity to probe the trainee’s knowledge of cases, and to observe the patient-trainee interaction. Furthermore, there is limited time to demonstrate clinical skills, to reflect upon the experience, and for assessment and feedback. A recent North American review of research literature on education in the outpatient setting for both medical undergraduates and graduates during the period 1980–1994, reported it to be characterised by variability, unpredictability, immediacy, and lack of continuity with comparatively few cases discussed with the attending physician and even fewer examined by them.1

Rheumatology education has been discussed in this journal from various viewpoints.2-4 The aim of this editorial is specifically to consider the issues implicit in teaching in outpatient departments, which is where most future clinical specialist rheumatology training will take place. Hopefully discussion will thus be stimulated and imagination ‘fired’ in this most important area of postgraduate education. For the remainder of the text ‘trainee’ will refer to the specialist registrar grade and ‘trainer’ to the consultant grade.