Senior staff often think at the last moment about what they can teach and students are often asked “what do you want to learn about today” (not uncommonly leading to an awkward silence). We less often consider what a learner should leave the attachment knowing or be capable of doing, be it over 2 weeks or 12 months. As a teacher, you will receive the guidebooks for the clinical rotation, from the University for your students, the hospital for prevocational trainees and Colleges for specialist trainees, and job descriptions for new staff, outlining expected learning outcomes, learning activities and assessment or performance expected [21]. Often lengthy and complicated , these need to be turned into something manageable for yourself and useful for learners, which can provide guidance on a week to week basis but ensure comprehensive coverage on a term basis [21, 22].

Learning outcomes are explicit statements that refer to what a learner needs to know or be able to do at a given point in time.

Frequently based around clinical competence (knowledge and procedural skills), communication and professional skills , they are to guide the learning and are linked to assessment [21]. To tackle outcomes by aiming to tick each one off, makes for an impossible task for the teacher. The beauty of learning in the clinical environment is that multiple outcomes are fully integrated in activities or skills we use on a daily basis; such as talking to patients and colleagues, making a diagnosis or choosing a treatment . By encouraging activities that include multiple clinical, communication and professional outcomes, such as clerking patients, and then ensuring presentation to you and others is combined with discussion of a range of issues (not just the diagnosis), guidance to further learning and importantly provision of feedback on the learners performance, we can feel comfortable as to the breadth of learning. Ideally this is supplemented by highlighting difficult or complex topics in tutorials or grabbed moments during work.

Although as noted stated outcomes are often extensive and learning around a patient very integrated, so it is useful to personalise the outcomes and activities for your own setting, knowing what conditions are common, opportunities the practice provides, degree of supervision required and extent of risk if learners are unsupervised and your personal style. A suggested step by step approach to develop your own Plan is outlined below, with examples as to how outcomes can link to learning activities and how they may differ for a student or a senior trainee (Table 14.1).

The key principles behind well written outcomes, are that they are SAM;

Specific Worded clearly so they know what is to be achieved (“take a history”) and at what level (“patients with common conditions”).

Achievable How long will it take to reach the set standard (is the term long enough)? Are there sufficient cases and opportunity to practise? Do they have the basic skills to tackle the outcomes (passed basic surgical skills course prior to attempting an appendectomy)?

Measurable The learner (through reflection) and you (by assessing) can determine if competence has been reached (i.e. 80 % of cannula in first time).

Even with extensive experience and learning, gaps may still be significant. These need to be identified, through regular review of the outcomes by both the learners and supervisor and supervisor reflection on whether performance is matching the expected outcomes for that learner.

Familiarity with expected outcomes provides you with the guidance as to what needs to be learnt. The previous section also touched on how learning can be encouraged, for example through learners interacting with patients and discussion encourages reflection on important topics. However, when it is busy, things often fall apart. For students, the complaint is often they feel in the way, and have no real role. Under stress, junior or new staff tend to focus on tasks and or mainly learn how to survive. Therefore you need a range of strategies to ensure learner engagement which will push learners out of their comfort zone, while allowing you to cope with the workload and still provide safe patient care [1, 3, 5, 23, 24, 25]. Much has been written about this area, including frameworks for couching a teaching session [25]. Important tips are to avoid trying to cover too much, ensuring the topic and questions are pitched at the correct level and, use questions to explore what learners do NOT understand (rather than reinforcing what they do know) [25, 26, 27] and provide guidance at the end to what further reading they should do or resources they should look at. Table 14.2 provides a range of practical ideas for different settings .