In the clinical setting we want to enhance the learning of students, junior doctors and trainees to help them be better doctors, but not increase the time we spend making that happen. Junior doctors are adults who want to learn. If we feel that learning is not progressing as it should, we need to consider whether the style in which we teach and the style in which junior doctors like to learn are matched and whether the clinical setting is conducive to learning.

Adult learning principles are not “evidence based”, but rather, as suggested by Malcolm Knowles, should be regarded as “models of assumption about learning”.1,2 If you ask yourself or the junior doctors to think back over what have been the best learning situations, and why, the following ideas are likely to surface:

• Personal motivation. Are junior doctors interested and eager to learn (internal motivation) or do they want to learn simply to pass an exam (external motivation)?

• Meaningful topic. Is the topic relevant to junior doctors’ current work or future plans? Have you made it clear why it is important?

• Experience-centred focus. Is learning linked to the work junior doctors are doing and based on the care they are giving patients?

• Appropriate level of knowledge. Is learning pitched at the correct level for junior doctors’ stage of training?

• Clear goals. Have you articulated the outcomes for the session/attachment/year so that everyone knows where you are heading?

• Active involvement. Do junior doctors have the opportunity to be actively involved in the learning process, to influence the outcomes and process?

• Regular feedback. Do junior doctors know how they are going? Have you told them what they are doing well, as well as what areas could be improved (positive critique)?

• Time for reflection. Have you given junior doctors time and encouragement to reflect on the subject and their performance (self-assessment)?

Shifting from thinking about what you want to teach to what junior doctors want to learn (eg, asking what areas they are unclear about) shifts you from a teacher-centred to a learner-centred approach.

Adults like to have an input into their learning

Not all “moments” in the clinical setting are good teaching moments, and to enhance the moments requires you to consider the following:5

• Are the learners (or you) distracted by other duties, time constraints, tiredness, or hunger?

• Is the location busy, noisy, too public or uncomfortable?

• What is the atmosphere? Do the learners feel comfortable to demonstrate their lack of knowledge and ask questions or are they fearful of being humiliated?

• Do the learners feel as though they belong? Do they believe that their opinion is valued?

• Do the patients know what is expected? Have they agreed to be involved? Is their dignity respected?