Behavioural Dynamics in Observership and Fellowship Programmes: An Integrated Analysis Combining ADN CoE Data and International Literature

International clinical training programmes exhibit distinct behavioural patterns, expectations, and learning ecosystems. Behavioural data collected by ADN CoE between 2022 and 2025 demonstrate consistent differences between participants in observership and fellowship programmes. Observers typically exhibit low communication intensity, flexible expectations, and passive, observation-based learning styles, whereas fellows show high goal orientation, proactive communication, administrative discipline, and a structured approach to learning. These behavioural patterns influence not only learning outcomes but also participants’ adaptation to the clinical environment once the programme begins.

Although ADN CoE conducts structured pre-programme virtual meetings—such as introductory sessions with mentors—to support participants before arrival, the literature shows that virtual interactions cannot reliably assess deeper behavioural or interpersonal fit. The CHEST (2021) analysis highlights that organisational fit, team fit, and mentor–learner compatibility can only be assessed effectively through in-person exposure, real-time workflow observation, and natural interpersonal dynamics. As a result, participants who appear highly compatible in online meetings may struggle with expectations, clinical pace, or team culture once onsite. Such adaptation challenges reflect the inherent limitations of virtual pre-assessment, rather than incorrect programme placement.

Similarly, the evolution of Fellowship (1.0 → 2.0 → 3.0) within the College of Family Physicians of Canada (CFPC) highlights a global shift toward defining fellowship as a behaviour-based and engagement-driven professional designation. The modern fellowship model emphasises leadership, accountability, contributions to the learning environment, teamwork, and long-term professional commitment—qualities that extend far beyond procedural competence. This framework aligns strongly with ADN CoE’s behavioural observations: fellows consistently demonstrate preparedness, clarity of goals, proactive engagement, and responsibility, all of which predict onsite performance. Observership programmes, by contrast, are inherently more flexible and observational, and do not rely on the same behavioural demands.

Evidence from surgical training further reinforces these distinctions. Fleming et al. (2019) show that fellowships are designed not only for skill acquisition but also for meaningful participation in high-volume, complex clinical environments, requiring a higher level of readiness, professional behaviour, and sustained engagement. The study also notes that international fellowships present adaptation challenges—such as language, cultural differences, clinical workflow intensity, and team dynamics—that cannot be fully assessed through virtual interaction alone. This perspective provides a strong scientific explanation for the occasional adaptation difficulties observed among ADN CoE fellows despite positive virtual pre-meetings.

Together, these findings demonstrate that observership and fellowship programmes represent two fundamentally different behavioural, cognitive, and operational ecosystems:

• Observership → flexible, low-pressure, observation-based

• Fellowship → structured, responsibility-driven, performance-oriented

Recognising these differences is essential for designing effective international medical training. ADN CoE is therefore continuing to develop structured, data-informed, and scientifically grounded educational approaches tailored to the behavioural requirements of each programme type. Aligning programme design with participant behaviour enhances learning outcomes, strengthens institutional matching, and supports sustainable excellence in global clinical education.

As the global landscape of medical training continues to evolve, one truth becomes increasingly clear: meaningful education is built not only on technical mastery, but on behaviour, curiosity, engagement, and the human capacity to adapt and grow. At ADN CoE, our mission is to honour these principles by designing training ecosystems that recognise individual potential, respect institutional complexity, and elevate clinical excellence across borders. Observerships and fellowships will always remain distinct worlds of learning — and our responsibility is to guide each participant into the environment where they can truly thrive.

Our commitment is simple:to build learning experiences that transform not only skills, but futures.

Warm regards,

Nazire Çavuş, PhD(c)

Founder & Chief Executive Officer

ADN Center of Excellence® (ADN CoE®)