Clinical Teaching Doesn't Need More Time, It Needs Better Design

Better clinical teaching isn’t a time problem. It’s a design problem. We care about learners, yet many of us still finish rounds, clinic, or a day in the operating room, sensing that the team worked hard, but the learning was not as intentional as it could have been.  Patient care is fast, fragmented, and cognitively demanding, and teaching moments may slip past when clinical care needs dominate attention. Systematic reviews of education during ward rounds describe the same barriers again and again, including workload, competing priorities, hierarchy, and missed chances to engage learners.

Design thinking is a human-centered, iterative approach that helps educators develop creative solutions in medical education, and it moves through five practical steps: empathize, define, ideate, prototype, and test. Although the steps are numbered, they loop in practice. You may test a teaching approach, learn from it, and realize you defined the problem poorly the first time. For busy clinical educators, the appeal is practical. It gives us a simple, repeatable way to make individual teaching moments more deliberate, one encounter at a time.

Empathize. Clinical educators often jump straight to content. We hear a learner struggle and immediately want to teach the diagnosis, the operation, or the next step in management. Sometimes that is exactly right. But design thinking asks us to pause and ask a less obvious question. What might this learner be struggling with right now? Recently, in my own clinic, a student arrived late, appearing disengaged and uninterested.  Only after probing did I understand that the student had witnessed a patient’s cardiac arrest during rounds and was struggling to process the event. At any moment, the learner may be facing uncertainty about their role, pressure to perform, or simply have no spare cognitive bandwidth. Cognitive load theory reminds us that working memory is limited, and authentic clinical work can overwhelm a novice when too many elements must be processed at once. Empathy here is a form of diagnosis. Before deciding what to teach, we have to know whether the barrier is knowledge, confidence, role clarity, or overload.

Define. Once we understand the learner, we can then define a single teachable problem. This is where well-meaning teaching moments can become too diffuse. We try to improve presentation skills, reasoning, communication, and confidence all in one encounter, and the learner leaves with a blur instead of a next step. A sharper approach is to ask a how-might-we question, the signature design thinking question. How might we help this student build a one-sentence problem representation without lengthening rounds? Asking the student to state that representation and justify two cannot-miss diagnoses is teachable. Teaching about ‘abdominal pain’ or ‘colon cancer’ is simply too broad. A specific target also shows the learner what good performance looks like.

Ideate. Under pressure, we default to our favorite teaching approach, such as asking a string of questions or giving a pearl. These can work, but design thinking asks us to diverge our thinking before we converge. Generate at least three options, then pick the one that best fits the learner and the goal in front of you. The menu does not need to be elaborate. A 30-second prebrief can clarify a learner's role before they see a patient. A think-aloud can make expert reasoning visible. The One-Minute Preceptor walks an educator through getting a commitment, probing reasoning, teaching a general rule, reinforcing what was done well, and correcting a single point. A short debrief can help learners name what surprised them and what they will try next.

Prototype. A prototype is a low-fidelity version of an idea you can try and improve. In clinical teaching, the simplest prototype is a short teaching script. Instead of saying that you will be more intentional today, write the words you will actually say. Before a case in the operating room, that might sound like this. “Before we make an incision, give me the one step you are most worried about and how we will know if it is going wrong, and I will add one point before we start.” On rounds, it might sound like this. “After the next presentation, give me a one-sentence problem representation and the two diagnoses you most need to rule out, and I will give you one coaching point before we move on.” Each is small enough to use and specific enough to make expectations visible. Vague intentions disappear under clinical pressure, but a concrete script has a much better chance of surviving the other demands of the day.

Test. Finally, decide how you will know whether the approach helped. Testing does not require a formal study. One observable metric and one feedback question are enough. The metric might be a clearer next presentation, a learner naming uncertainty earlier, or a learner flagging one system issue affecting care. The feedback question might be asking the learner what part of that structure helped most, or what they would keep or change next time. Pairing feedback with reflection works better than reflection alone. Testing turns teaching into a learning loop for both learner and teacher.

None of this requires becoming a perfect teacher. It requires running one small experiment. This week, pick one setting, one learner, one teachable problem, a prototype approach, and a way to test whether it helped. For me, that means trying a single 30-second prebrief with my sub-intern before our first case next week and asking one question afterward. That is the whole change. One better learning moment, designed intentionally.

Did you know that the Harvard Macy Institute Community Blog has had more than 450 posts? Previous blog posts have explored topics including anatomy e-learning modules, quantum thinking, and utilizing digital recordings to enhance clinical performance.

Farrell Adkins, MD, FACS, FASCRS (Technology ‘24; Educators ’25), is Director of Clinical Clerkships and an Associate Professor of Surgery at Virginia Tech Carilion School of Medicine, as well as a colon and rectal surgeon at Carilion Clinic. HMI has made an impact on Farrell's career by strengthening his commitment to community, educational scholarship, and the intentional design of clinical learning environments. Farrell's areas of professional interest include clinical teaching, surgical education, and educational technology. Farrell can be contacted via email or followed on LinkedIn.