Effective Clinical Tutorship in Healthcare Education and the Role of Feedback

Clinical tutorship plays a crucial role in shaping healthcare professionals and requires a multi-layered skill set in order to be done effectively. The influence of tutors goes beyond more direct teaching skills into aspects like student competence, patient safety, and the readiness of new graduates to enter complex and demanding professional work environments.

Many clinical tutors are selected primarily for their clinical expertise rather than their teaching abilities, but this raises an important question: Do great clinicians automatically make great tutors? Research from medical, nursing, allied health, and workplace learning fields suggests the simple answer is ‘No’. The ability to impart relevant information and nurture lifelong clinical skills extends beyond narrower considerations of clinical competency and knowledge on the part of the tutor. With this in mind, understanding what truly makes a clinical tutor effective can improve education outcomes and ultimately patient care.

What the Evidence Actually Says

Studies across healthcare education consistently show that effective clinical instructors excel in four key areas:

• Cognitive: How they think about clinical problems and decision-making;

• Relational: How they interact and build trust with learners;

• Instructional: How they structure, communicate and deliver teaching;

• Environment: How they create safe, non-judgemental and effective learning environments.

Differences across these area in practice can explain why, clinical proficiency aside, some instructors succeed better in guiding learners while others struggle.

Clinica tutor and students engaging in collaborative discussion regarding possible clinical findings during clinical teaching session.

Great Tutors Focus on Clinical Reasoning, Not Just Tasks

Tutors that demonstrate less effective teaching techniques often emphasise lists of tasks, such as by saying: "Do this, then that." This approach encourages rote or mechanical learning, but may not adequately prepare students for complex, clinical situations. In contrast, great instructors emphasise why certain actions are taken in specific contexts. They teach clinical reasoning frameworks that help learners understand decision-making processes.

Research shows that teaching decision-making strategies rather than isolated task approach leads to faster and better retaining of knowledge that is likely to be retained for longer and hence lead to better clinical proficiency. For example, a herbal medicine instructor might explain why a particular herb is chosen based on patient symptoms rather than simply instructing when to administer it.

Great Instructors Relate to Learners…

…by making their thinking visible

This is something that many tutors can find challenging as the longer you have been doing something the more automatic it becomes. This means that often the tutor has to reflect back on how they have come to do what they do and the way that they do it. This can make the reasoning invisible to the learner, and sometimes even to the tutor themselves. Effective tutors explain and narrate their thought process aloud, sharing what they notice, what they rule out, and what concerns them. This transparency helps learners develop their own clinical judgment.

For instance, during a patient assessment, a tutor might say, "I’m noticing the patient’s breathing is shallow, which could indicate respiratory distress. I’m ruling out anxiety because the oxygen levels are low and the patient appears very calm." This approach turns implicit knowledge into explicit teaching moments and is equivalent to a driving instructor deliberately emphasising aspects like looking in all relevant mirrors when driving.

…by creating psychological safety

Learners perform better when they feel safe to ask questions, admit uncertainty, and report errors without fear of judgment. Psychological safety encourages open communication and faster learning. This is likely to lead to reduced errors and improved patient outcomes.

… by supporting without rescuing

Effective instructors find the "Goldilocks Zone" of supervision. They allow learners to struggle productively, stepping in neither too early nor too late. This balance helps students build confidence and problem-solving skills while ensuring patient safety.

For example, an instructor might observe a student managing a wound dressing and intervene only if the student shows signs of confusion or risk, allowing the learner to attempt the procedure independently first.

…by setting clear expectations

Clear communication about what good performance looks like helps learners understand goals and standards. Great instructors define:

• What constitutes safe and unsafe practice

• When learners can progress to perform independently

This clarity reduces anxiety and guides focused learning. Evidence shows that learners who know expectations perform better and progress faster.

Two individuals engage in a feedback session within a clinical setting, discussing notes and patient information at a table.

The Effective Use of Feedback

Providing timely, specific, and constructive feedback is essential in the field of clinical tutorship, and ties together all the above points. Great instructors highlight strengths and areas for improvement, linking feedback to clinical reasoning and patient outcomes. This approach motivates learners and supports continuous growth. Being able to constructively accommodate the making of smaller mistakes by learners in a safe environment (for patients and learners) is an important part of the clinical tutorship role. At the end of the day, learners must develop their own proficiency for when the tutor is no longer there and they are fully exposed in professional clinical practice.

Practical Examples of Effective Clinical Teaching

• Case-Based Discussions: Instead of just showing procedures, tutors present real cases and ask learners to explain their reasoning. This encourages active thinking and application of knowledge.

• Reflective Practice: Instructors encourage learners to reflect on their decisions and outcomes, fostering deeper understanding and self-awareness.

• Role Modeling: Demonstrating professional behaviour, communication, and empathy sets a standard for learners to emulate.

Essentially being and/or becoming a clinical tutor is a rewarding and exciting path that requires skills and knowledge that extend beyond clinical competency. Taking steps towards consciously improving our proficiency as clinical tutors will ultimately enhance clinical standards, patient safety, and therapeutic outcomes, as delivered in the present and the future by the learners that pass through our tutorship.

References include:

• Buchel, T.L. and Edwards, F.D., 2005. Characteristics of effective clinical teachers. Fam Med, 37(1), pp.30-35.

• Goldie, J., Dowie, A., Goldie, A. et al. What makes a good clinical student and teacher? An exploratory study. BMC Med Educ 15, 40 (2015).

• Sutkin, Gary MD; Wagner, Elizabeth; Harris, Ilene PhD; Schiffer, Randolph MD. What Makes a Good Clinical Teacher in Medicine? A Review of the Literature. Academic Medicine 83(5):p 452-466, May 2008