Like many readers of Canadian Family Physician, I am a community-based family doctor with learners in my clinic. Teaching in my community clinic is rewarding but also isolating at times. I do not have teacher meetings and without colleagues regularly observing my teaching, I frequently wonder: What am I doing well? What might I be missing?
Over the past decade, my curiosity about teaching has grown alongside my clinical practice. In my current role, I develop faculty education sessions for community-based preceptors. A recent project involved reviewing more than 250 anonymized learner evaluations from undergraduate medical students in community placements. Their comments were honest, insightful, and surprisingly consistent—often pointing to straightforward, fixable issues that deeply impact learning (Box 1).
Sample of medical student feedback
“My teacher took the time to understand my learning goals and gave me repeated opportunities to meet them.”
“EMR access from the start could make it easier to follow along and keep track.”
“[Dr X.] did a good job with grading responsibility, allowing for increase in responsibility over time.”
“It was largely up to me to ask questions and search for key lessons/takeaways after patient encounters.”
“It would be great to have more patient encounters with opportunities for the student to do physical exams and/or practice clinical skills.”
“I would have loved more feedback on my interactions with patients!”
“Providing a bit more context before asking questions might be helpful.”
“Maybe a little more observation for physical exams or time spent showing physical exams.”
“Ask for feedback earlier in the sessions … in case future students are shy.”
“Dr Y. had great communication skills, and always made sure I knew what was expected of me.”
“Dr Z. is very busy … there were a few times I had to wait a long time in clinic.”
EMR—electronic medical record.
Although this feedback came from undergraduate students, the themes are relevant for preceptors teaching at any level. Most importantly, it made me realize learners are telling us exactly what they need to thrive. Are we listening?
Evidence from literature and best practices
While student evaluations are widely used in medical education, their potential as tools for faculty development in community settings is underused, as institutions also need to balance learner anonymity. Recent research highlights that student feedback, when used thoughtfully, can support meaningful changes in teaching practice.1
Learner feedback can reveal blind spots in teaching that peer or self-evaluation may miss—particularly for community-based educators, who often work independently without direct observation. To support improvement, I distilled the top 10 recurring themes from learner feedback and paired each with practical tips and tools for refinement.
Summary of 10 teaching tips from learner feedback
These tips reflect common themes in learner feedback and offer practical, evidence-based strategies to improve teaching effectiveness and learner satisfaction.
1. Set clear expectations early. Establishing expectations early, even with a brief 5-minute orientation, helps students feel more confident and engaged.2
How to use tip 1: Use the R2C2 framework at the beginning of the rotation to structure your learners’ orientation (Table 1).3
The R2C2 framework for structuring learner orientation
2. Ask about learning goals and invite feedback. Effective teachers actively involve learners in shaping their experiences. Asking about goals helps tailor teaching, fosters engagement from your learners, and builds rapport.
How to use tip 2:
Ask about goals at the start and midway through the rotation.
Invite feedback on teaching approaches.
Adjust clinical opportunities or teaching topics when possible.
3. Model first, then let learners try. Throughout the evaluations, learners praised teachers who demonstrated a new skill and then stepped back. Watching first helps learners absorb techniques before trying them on their own.
How to use tip 3:
Demonstrate patient interviews, examinations, and procedures.
Think aloud—verbalize your reasoning and decision-making process.
4. Prioritize hands-on experience. Learners thrive through active participation. Even seemingly simple tasks, like developing a differential together or handing over a tenaculum, are valuable experiences that can be transformative.
How to use tip 4: Engage learners in physical examinations, charting, and procedures and consider using case-based teaching when direct care is limited. For example, teachers can use problem-based small group–style scenarios. There is also early evidence that teachers can use artificial intelligence simulation tools, such as MedSimAI or ChatGPT, to let learners practise taking patient histories4 if allowed by the university or department.
5. Use graded responsibility. Tailor responsibilities to the learners’ readiness, as students consistently express a desire to be challenged without feeling overwhelmed.
How to use tip 5:
Start by observing your learners.
Use tools like entrustable professional activities,5 intraining evaluation reports, or mini-clinical evaluation exercises6 to track progress.
Debrief after encounters and use the learners’ longitudinal relationships with their patients to better calibrate responsibilities.5,6
6. Use context when asking questions. Teachers should keep questions practical and purposeful. Help learners understand why you are asking—and use patient encounters as teaching moments.
How to use tip 6: According to the learner evaluations I reviewed, students like teachers who frame questions around real-time cases. In addition, teachers should avoid posing overly abstract or intentionally unanswerable questions to learners (especially in front of patients). A method to frame your questions around cases is the One-Minute Preceptor for structured, psychologically safe questioning (Box 2).7
One-minute preceptor
Get a commitment: “What do you think is going on?”
Probe for evidence: “What supports that?”
Teach general rules
Reinforce what was done well
Correct mistakes
Data from Neher et al.7
7. Actively teach clinical reasoning. Based on student feedback, learners value educators who articulate the rationale behind their clinical decisions.
How to use tip 7: Prompt learners to explain their diagnostic reasoning and management plans. Use guiding questions to support their thinking, especially during clinical uncertainty (Box 3).8
Taxonomy of uncertainty
What is “uncertainty” in medicine? Use this framework to guide you.8
When debriefing a case, teachers can explore the following:
Where is uncertainty coming from? For example, is this a patient with complex and multiple comorbidities?
What is the nature of the uncertainty? For example, does the nature of the uncertainty concern difficulties in treatment implementation?
Is the learner experiencing the uncertainty? Or the patient?
8. Debrief and give specific feedback. Students grow when teachers take time to reflect on and discuss their performance. They value feedback that is timely, specific, and actionable. Even a short, 1-minute debrief after a patient encounter can have a lasting impact.
How to use tip 8: Clearly label feedback so learners recognize it. Several feedback models exist in the literature; a practical option is the Pendleton rules, which offer a learner-centred structure (Box 4).9
Pendleton rules
“What do you think went well?”
“What do you think could be done differently?” (Educator asks the learner what could be improved.)
“What could be further improved?” (Educator states what the educator thinks could be improved.)
“How can this be achieved?”
Data from Orsini et al.9
9. Support communication and documentation. Students benefit from structured guidance in communication and documentation. Reinforcing expectations and modelling effective strategies helps them build strong professional habits early. In this project, learners consistently noted that outstanding teachers explicitly taught note-taking, electronic medical record use, and verbal case presentations. Clear, professional, and organized teaching helps students feel supported and confident.
How to use tip 9: Below is a checklist from the Canadian Medical Protective Association10 to guide teaching clear documentation.
Record critical or key findings and your clinical reasoning.
Document promptly and legibly using the subjective, objective, assessment, plan (SOAP) structure.
Maintain a professional tone, and assume patients may read your notes.
Include follow-up plans and any important discussions.
10. Teach efficiently within time constraints. Clinical teachers often juggle the competing demands of patient care, staff coordination, and learner supervision. Effective preceptors use brief, focused teaching moments to maximize impact, even amid time pressures. Learners consistently find value in short, focused interactions.
How to use tip 10: Be transparent about your schedule and any time constraints, as learners appreciate knowing what to expect. If delays are likely, encourage them to read around their cases while waiting. When time is tight, asking 1 or 2 targeted questions from the One-Minute Preceptor7 model can be an effective way to teach and debrief quickly.
Conclusion
Learner feedback offers a valuable, often underused but powerful tool for community-based medical educators. While formal evaluations often arrive long after a rotation ends, their messages can be surprisingly actionable and specific. Most students were appreciative—and at the same time, clear about what could be improved.
In the absence of regular peer observation, learners offer a valuable lens into our teaching. If we remain open to their insights and willing to act on them, we can continue to grow as teachers, even in the absence of formal observation.
The message is clear: learners are talking. It is up to us to listen.
Acknowledgment
I thank Vyshnave Jeyabalan for their valuable assistance with the NVivo analysis of learners’ comments.
Notes
Teaching tips
▸ Set clear expectations early; ask about learning goals and invite feedback.
▸ Model first, then let learners try. Prioritize hands-on experience and use graded responsibility.
▸ Use context when asking questions and actively teach clinical reasoning.
▸ Debrief and give specific feedback.
▸ Support communication and documentation. Teach efficiently within time constraints.
Teaching Moment articles are coordinated by the Section of Teachers of the College of Family Physicians of Canada. The focus is on practical topics for all teachers in family medicine, with an emphasis on evidence and best practice. Please send any ideas, requests, or submissions to Contributing Editor Dr Viola Antao at viola.antao{at}utoronto.ca.
Footnotes
Competing interests
None declared
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