Teaching with Intention in Medicine: How Clinicians Can Become More Effective Educators

Clinician educators across medicine, nursing, pharmacy, and related health professions play a central role in training the next generation of professionals, yet many take on this responsibility without formal preparation in how to teach. They bring deep clinical expertise but often lack a clear approach for helping others develop it, a gap that becomes more apparent as medicine grows more complex.

Teaching now extends well beyond explaining diagnoses or reviewing treatment plans. It requires guiding trainees as they work through clinical problems and apply knowledge in real time, where efficacy depends as much on how something is taught as on the content itself.

“Teaching has a strong evidence base,” explains Nicholas Villano, MD, a practicing hospital medicine physician at Beth Israel Deaconess Medical Center and clinical instructor at Harvard Medical School. He also serves on the faculty and as capstone director of Harvard Medical School’s Training to Teach in Medicine online certificate program. “There’s a whole foundation in learning theory and instructional design that can make teaching much more effective.”

Clinicians who build that foundation bring more clarity to their teaching. Rather than relying on instinct, they make deliberate decisions about how to guide learners, define expectations, assess progress, and shape the learning experience itself.

“You start to understand not just what you’re trying to teach, but how best to teach it,” Villano says. That deeper understanding provides structure and creates a shared language for discussing teaching. It also establishes a framework that supports continued improvement.

“Once you have that foundation, you’re able to reflect on your teaching in a much more meaningful way and continue to build on it,” he adds. 

A Blueprint for Maximizing Teaching Skills

Villano offers the following framework for clinicians who want to strengthen their understanding of effective teaching and apply it more deliberately across clinical and academic settings:

1. Focus on how learners are thinking.

Strong teaching begins with close attention to how a learner is reasoning. “You cannot just tell someone what to think,” Villano says. “You have to give them space to work through it.”

Learners do not absorb information exactly as it is presented. They interpret it through prior knowledge, and that process shapes how they respond in practice. When educators look beyond the surface and pay attention to how a learner approaches a problem, they gain a clearer sense of what needs to change.

That awareness transforms the interaction. Instead of moving quickly to the correct answer, the educator invites the learner to explain their thinking. The discussion centers on how a conclusion was reached rather than on whether it was right. Over time, this helps build the kind of reasoning that clinical work demands.

2. Look closely at moments of difficulty.

In clinical settings, small moments often carry the most meaning, particularly when a learner hesitates before making a decision or arrives at a conclusion that does not hold when applied. These are not simply mistakes to correct; they provide insight into how the learner understands the task.

“You might think you know what the issue is,” Villano says. “But if you examine it carefully, you will often be surprised.” Rather than moving immediately to correction, experienced educators take the time to observe what is happening. They consider how the learner approached the problem and where the reasoning began to break down. That distinction is important because the source of difficulty may not be what it seems.

When educators take this step, their teaching becomes more precise. They address the point where understanding shifts, which allows learners to adjust in a meaningful way.

3. Ground teaching in a defined need.

“Most educational efforts should start with a need,” Villano says, “something you have seen that isn’t working as well as it could.” That need often emerges from practice. It might be a recurring error or a pattern that suggests a gap in understanding. Identifying that pattern gives the work direction. From there, the educator defines the goal in practical terms. What should change as a result of teaching? What should the learner be able to do that they cannot do now?

“It’s easy to get excited about an idea,” Villano says. “But the real impact comes from solving the right problem.” By grounding teaching in a clear need, educators ensure that their efforts address something real and relevant rather than adding more information without purpose.

4. Make expectations explicit.

“Educators often say they want someone to improve,” Villano notes. “What is much harder is defining what that improvement actually looks like.”

Highly skilled educators translate broad aspirations into concrete, observable expectations. They start by articulating the goal in specific terms, then make that goal transparent to learners—explaining exactly what they expect to see and how it should show up in practice. They also clarify for themselves how they will recognize success: what they will measure, what evidence will signal progress, and what “better” actually means in context.

“If you can’t describe specifically what you are looking for, it becomes much harder for learners to know what their goal is—and it’s also harder for you to know when they’ve reached that goal,” he says. But when there is clarity, this shapes everything that follows. It guides how feedback is delivered and provides a clear basis for determining whether learning has occurred.

5. Align the teaching approach with the goal.

“There is a wide range of teaching approaches,” Villano says. “No one approach works in every situation.” The choice depends on the objective. In some cases, learners need to practice a skill directly. In others, they benefit more from working through a case and discussing their reasoning. The method should support the task.

For example, in clinical training, learning often unfolds through experience followed by reflection. A learner encounters a situation, considers how they approached it, and then applies that understanding moving forward. This process strengthens both knowledge and judgment because it connects ideas to real decisions.

When educators understand the pattern of experience and reflection, they can determine where on the journey their learners are and what type of learning is most appropriate. 

6. Reflect and refine over time.

Teaching improves through reflection. “The most effective educators want to be thoughtful and evidence-based in how they teach. Once you understand the fundamentals, you can continue to build on them,” Villano says.

To this end, effective educators are already reflecting on what works or doesn’t work and are growing from this, but they may not always be able to put their finger on what can be improved. However, understanding learning theory (such as what exact methods they are using, what objectives fit with their learners, and the types of issues learners face) gives educators a shared vocabulary and framework so that they can diagnose issues and grow from past experiences. “Feedback is critical to this, no matter what your level of training,” he adds.

Teaching with Intention

Building a foundation in learning science and instructional design gives clinicians a clearer way to approach their teaching and a more reliable way to understand what leads to real progress. When clinicians develop these skills, their teaching becomes more deliberate and more consistent. They are better able to translate their expertise into learning experiences that others can apply in practice.

Over time, this work does more than improve individual teaching interactions, Villano stresses. It also gives educators a framework they can use across settings to teach with greater clarity and better prepare the next generation of clinicians for the realities of care.