Evidence for Good Teaching
What Does the Research Actually Say?
Because "we've always done it this way" is not a teaching strategy — it's a habit in a lab coat.
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path: EFFECTIVE TEACHER/TEACHING - based on research and evidence
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
Core Evidence & Research
Evidence-Based Teaching Strategies
Medical & GP Education Focused
Further Reading
Effective teaching is not about talking confidently at people who happen to be in the same room. It is about creating conditions where real, lasting learning actually happens.
A working definition
Effective teaching is any approach that consistently leads to meaningful, durable learning outcomes — knowledge and skills that the learner can retrieve, apply, and adapt in new and unfamiliar situations.
The effective teacher is someone who can select, adapt, and deploy a range of strategies to make this happen — for different learners, in different contexts, on different topics.
Pedagogy vs Andragogy
In older usage, pedagogy meant teaching children. Andragogy (Knowles, 1968) focused on adult learners, who are more self-directed, bring more experience, and learn best when material connects to real-world needs.
Today, pedagogy is used broadly to mean the theories and methods used in teaching — for learners of any age. You will see this word throughout educational literature.
This matters enormously in GP training. Supervisors who are gifted clinicians are not automatically gifted teachers. Teaching is a distinct skill — and like any skill, it can be learned, practised, and improved with the right evidence and reflection.
⚡ Quick Summary — If You Only Read One Section
Creates lasting change — not just information transfer. It transforms how learners think, feel, and practise.
Retrieval practice, spaced repetition, interleaving, dual coding, elaboration, and concrete examples.
Collective teacher efficacy (effect size 1.57), formative assessment (0.90), and feedback (0.70) top the list.
Learning styles have NO evidence. Re-reading is ineffective. Discovery learning without structure fails. Growth mindset alone is insufficient.
Prior knowledge activation, active practice, desirable difficulties, feedback, and a psychologically safe learning environment.
Small steps, active practice, checking understanding, scaffolding, and systematic feedback — every session, every time.
Being a good teacher is not about being the most knowledgeable person in the room. Research consistently shows it is about how you create conditions for learning. Here are the five pillars.
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1Subject Knowledge — but not in isolation HIGH IMPACT
Deep knowledge of what you are teaching is necessary — but not sufficient. Research shows that expert teachers also understand how learners typically misunderstand their subject (Shulman, 1986 — Pedagogical Content Knowledge). Knowing your subject and knowing how to teach your subject are distinct skills.Practical ImplicationAsk yourself not just "do I know this topic?" but "what are the most common misconceptions my trainee might have, and how will I anticipate and address them?" -
2Teaching Methods that Build on Prior Knowledge (Scaffolding) HIGH IMPACT
Effective teaching connects new learning to what the learner already knows. This is called scaffolding. Information that connects to existing knowledge is processed more deeply and retained longer. Active practice and time for reflection are essential companions to any new content.Practical ImplicationStart every teaching session by asking what the trainee already knows. Build from there. Never assume an empty vessel. -
3Creating a Safe and Respectful Learning Climate MODERATE IMPACT
Psychological safety is the single most important determinant of whether a learner will take the risk of saying "I don't know." Without it, trainees mask their gaps. Good climate means: respect for every learner's contribution, warmth, enthusiasm, sensitivity to needs, and genuine curiosity about the trainee's perspective.Practical ImplicationModel intellectual humility. Say "I don't know" when you don't. Celebrate mistakes as learning opportunities. Notice if a trainee seems reluctant to speak up — and create the conditions that remove that reluctance. -
4Passion, Enthusiasm, and Authenticity
Enthusiasm is genuinely contagious. Learners who observe a teacher who finds their subject genuinely exciting are more likely to engage with it, persist with it, and remember it. This is not performance — performed enthusiasm is easily detected and counterproductive. Genuine passion for what you are teaching remains one of the most powerful and under-rated teaching tools available.Practical ImplicationIf you have lost enthusiasm for a topic, be honest about why. Exploring that disengagement openly with your trainee can itself become a valuable teaching moment. -
5Reflective Practice and Ongoing Development SOME IMPACT
The most effective teachers are deliberate about improving their own practice. This means seeking feedback after teaching sessions, reviewing recordings of your own teaching, engaging with educational research, and participating in a professional learning community. Research shows that deliberate practice of teaching skills — not just years of experience — drives genuine improvement.Practical ImplicationAsk your trainees for honest feedback after tutorials. Not "how did I do?" but specific: "Was there a moment where I lost you? Was the pace right? What would have helped more?"
One of the most important contributions of educational research is telling us what doesn't work. Stopping ineffective practices frees up time and energy for things that genuinely make a difference. Here are the biggest offenders.
| The Myth | What It Claims | What the Evidence Says | Key Research | Status |
|---|---|---|---|---|
| Learning Styles (VAK) | Match teaching to visual/auditory/kinaesthetic preferences for better outcomes | No measurable benefit from matching instruction to preferred style. All learners benefit from multimodal approaches. | Pashler et al. 2008; Riener & Willingham 2010; Howard-Jones 2014 | Debunked |
| The Learning Pyramid | We remember 10% of what we read, 20% of what we hear… 90% of what we teach others | These precise percentages have no empirical basis — they are entirely fictitious. Originated as a theoretical framework (Edgar's Cone of Experience) and was never a learning model. | Willingham 2008; Brown et al. 2014 | Debunked |
| Re-reading & Highlighting | Re-reading and highlighting are effective revision strategies | Both give a deceptive sense of familiarity — but produce poor long-term retention. Self-testing, retrieval practice, and spaced intervals are far superior. | Dunlosky et al. 2013; Brown et al. 2014 | Debunked |
| Discovery Learning | Learners should discover key ideas for themselves — it's more memorable | Unstructured discovery learning is consistently outperformed by direct instruction, especially for novice learners. Guided discovery can work — but free discovery without structure usually doesn't. | Kirschner, Sweller & Clark 2006 | Debunked |
| Ability Grouping | Grouping by ability allows better-targeted teaching | Makes very little difference to outcomes. Can create falsely homogeneous groups, causing teachers to go too fast with high-ability groups and too slow with others. | Higgins et al. 2014; Stipek 2010 | Debunked |
| Fix Motivation First | Address low confidence before attempting to teach content | Attempts to boost motivation before teaching content do not work. Poor motivation in low-performing learners is usually a logical response to repeated failure — not its cause. Good teaching that produces success builds motivation. | Gorard, See & Davies 2012 | Debunked |
| Lavish Praise | Frequent positive praise boosts confidence and performance | Indiscriminate praise — especially for easy tasks — can signal low expectations and actually reduce confidence. Specific, process-focused feedback is far more powerful. | Dweck 1999; Hattie & Timperley 2007; Stipek 2010 | Debunked |
| Growth Mindset Interventions | Brief growth mindset interventions reliably improve academic performance | The underlying belief (intelligence can grow) has robust support. But standardised growth mindset programmes show weak and inconsistent effects. A classroom culture of growth mindset, modelled by the teacher, is more powerful than a one-off intervention. | Macnamara & Burgoyne 2023; Yeager et al. 2022; Sisk et al. 2018 | Nuanced |
This section draws on the most robust evidence from cognitive psychology about how human memory works — and how teaching can align with it rather than fight against it.
The Six Evidence-Based Cognitive Strategies
Weinstein, Madan & Sumeracki (2018), Cognitive Research: Principles and Implications — perhaps the most practically useful paper in modern educational psychology.
Cognitive Load Theory — Sweller (1988), updated for medical education
Working memory can only hold 4–7 pieces of information at one time. Long-term memory is effectively unlimited. The challenge of teaching is to move information from working memory into long-term memory efficiently — without overloading the working memory in the process.
Intrinsic Load
The inherent complexity of the material itself. You cannot reduce this — but you can chunk information into smaller steps, and sequence it so that simpler elements are mastered before more complex ones are introduced.
Extraneous Load
The cognitive effort created by how something is taught — cluttered slides, irrelevant information, unclear explanations. This load adds nothing to learning. Reduce it aggressively. Clean, clear, well-sequenced teaching reduces extraneous load.
Germane Load
The cognitive effort directed towards building new schemas — actually connecting new information to existing knowledge. This is the "good" load. Your teaching should aim to maximise germane load while minimising extraneous load.
The Teaching Session Itself — Four Practical Principles
Engagement starts with relevance. Connect the topic to real patients, real situations, or real anxieties the trainee has expressed. If the learner sees why this matters to them, they are already halfway there.
Active learning beats passive listening — not because of activity per se, but because activity that generates thinking (questions, discussion, problem-solving) leads to deeper processing and better retention.
Match your method to what you are trying to teach, and adapt as you go. Be willing to abandon your lesson plan if a more fruitful direction opens up. Rigidity in teaching often serves the teacher's comfort, not the learner's needs.
"Assessment drives learning" is one of the most robustly supported findings in educational research. Knowing they will be tested motivates learners to engage more deeply. Low-stakes quizzes embedded within teaching sessions are not just assessment — they are learning.
Professor John Hattie of the University of Melbourne has synthesised more than 2,100 meta-analyses involving over 300 million students worldwide into a single framework: Visible Learning (2009, updated 2023). His central question: which teaching strategies have the greatest measurable effect on learning outcomes?
Top-Ranked Influences on Learning (Hattie's Visible Learning, updated 2023)
💡 The single most important finding from Visible Learning
Collective Teacher Efficacy — the shared belief among a group of teachers or supervisors that together they can make a meaningful difference to learner outcomes — has an effect size of 1.57. This is almost four times the threshold for meaningful impact. It means that how you and your fellow trainers believe in your collective ability to develop your trainees matters more than almost any individual technique.
For GP training schemes: building a culture where trainers genuinely believe in their collective impact on trainee development is not a nice-to-have — the evidence suggests it is one of the highest-leverage investments a scheme can make.
Barak Rosenshine (2010, 2012) synthesised 40 years of research on effective instruction into 17 specific principles. They are grounded in three complementary fields: cognitive science (how memory works), classroom observational research (what effective teachers actually do), and studies of cognitive supports in learning.
Rosenshine, B. (2012). Principles of Instruction: Research-Based Strategies That All Teachers Should Know. American Educator, 36(1), 12–19.
- 1Begin with a short review of previous learning. This activates prior knowledge, which is the scaffolding on which new learning is built. Without it, new content floats without anchoring.
- 2Present new material in small steps, with practice after each step. Working memory is easily overloaded. Small steps prevent cognitive overload and allow each element to be consolidated before the next is introduced.
- 3Limit the amount of material given at any one time. Related to cognitive load: the learner's working memory is a bottleneck. Restrict new information to what can realistically be processed in one session.
- 4Give clear, detailed instructions and explanations. Vague instructions generate extraneous cognitive load — the learner wastes working memory trying to decode what is expected of them.
- 5Ask a large number of questions and check the responses of all learners. Frequent low-stakes questioning is both a formative assessment tool and a learning strategy. It forces active retrieval and reveals misconceptions early.
- 6Provide a high level of active practice for all learners. Simply observing or listening is insufficient. Learners need to actively engage with material — through doing, generating, explaining, or applying — to develop durable understanding.
- 7Guide learners as they begin to practise. Initial practice with guidance prevents the formation of bad habits or misconceptions that become hard to unlearn later.
- 8Think aloud and model steps. Making your reasoning visible — thinking aloud as you work through a problem — allows the learner to see the expert thought process, not just the final answer.
- 9Provide models and worked examples. Worked examples significantly reduce extraneous cognitive load for novice learners and help them build mental models of successful problem-solving approaches.
- 10Ask learners to explain what they have learned. Self-explanation forces active processing and reveals gaps in understanding that passive review conceals.
- 11Check the responses of all learners. Do not assume that silence means understanding. Specifically check every learner's understanding — not just the most confident one in the room.
- 12Provide systematic feedback and corrections. Feedback is most effective when it is specific, timely, and actionable. Generic feedback ("good job") has minimal impact. Specific feedback on a specific error with a clear correction strategy has high impact.
- 13Use more time for explanations. Do not rush through explanation to get to activities. Deep understanding built through careful explanation reduces the need for re-teaching later.
- 14Provide many examples. Multiple examples from different contexts strengthen generalisation and transfer of learning to new situations.
- 15Re-teach material when necessary. If a learner has not understood, the solution is to reteach — differently, not just more loudly or more slowly.
- 16Prepare learners for independent practice. Before setting a task to be completed independently, ensure learners have the foundational understanding to succeed. Premature independent practice breeds frustration and errors.
- 17Monitor learners during independent practice. Regular review — weekly and monthly checks — reinforces spaced practice and ensures that gaps do not go undetected for long periods.
The Dynamic Model (Creemers & Kyriakides, 2006, 2011) is grounded in a large body of empirical research and identifies 21 teaching practices associated with high learning outcomes, grouped under eight headings. Unlike simpler frameworks, it recognises that teaching is not linear — teacher behaviour, student behaviour, and the learning environment interact dynamically.
Creemers, B. & Kyriakides, L. (2011). Improving Quality in Education: Dynamic Approaches to School Improvement. Routledge.
- State objectives at the outset
- Challenge learners to identify why the activity is happening
- Begin with overviews and objective reviews
- Signal transitions between topics
- Draw attention to main ideas
- Use different question types at appropriate difficulty
- Give adequate time to respond
- Respond thoughtfully to answers
- Show problem-solving strategies in action
- Invite learners to develop their own strategies
- Promote the idea of modelling as a tool
- Use tasks to provide practice and application opportunities
- Use outcomes as starting points for the next step
- Foster constructive teacher–learner interaction
- Establish clear rules and manage disruption calmly
- Organise the learning environment efficiently
- Maximise time on task and engagement rates
- Use appropriate techniques to assess knowledge and skills
- Analyse data to identify learner needs
- Evaluate your own teaching practices
Teaching practice needs to evolve as evidence evolves. Here are the most significant research developments from the last decade and the practical implications for GP education.
The "testing effect" — known since Ebbinghaus (1885) — has been extensively revalidated in modern research. Dunlosky et al. (2013) rated retrieval practice as high utility — one of only two strategies to receive this rating (the other being spaced practice). Since then, its application in medical education has grown substantially.
Madan (2023) reviewed evidence-based learning strategies specifically in medical education and confirmed that retrieval practice, spaced practice, and interleaving all have robust support in health professions training. Importantly, retrieval practice requires effort — and that effort is precisely what makes it effective.
- Replace "let me explain that again" with "tell me what you remember from last time"
- Use low-stakes quizzes at the start and end of every tutorial
- Encourage trainees to test themselves before reading — not after
- Ask "why do you think that?" not just "what do you know?"
References: Dunlosky et al. (2013) Psychological Science in the Public Interest; Madan (2023) Medical Science Educator
Carol Dweck's growth mindset concept (2006) — the idea that intelligence and ability can grow with effort and good strategies — has genuine theoretical grounding and is supported by multiple studies. The National Study of Learning Mindsets (Yeager et al., 2019) found meaningful improvements in GPA and advanced course enrollment, particularly for low-achieving students, following a brief online intervention.
However, a 2023 meta-analysis by Macnamara and Burgoyne (Psychological Bulletin, 2023) raised serious methodological concerns: 94% of growth mindset intervention studies contained confounds; studies by researchers with financial ties were more than twice as likely to report positive effects; and higher-quality studies showed smaller or no effects.
Yeager et al. (2022) added an important nuance: growth mindset interventions work better when teachers themselves model a growth mindset and create a classroom culture that supports it. A one-off programme cannot substitute for an ongoing culture.
References: Dweck (2006) Mindset; Yeager et al. (2019) Nature; Macnamara & Burgoyne (2023) Psychological Bulletin; Yeager et al. (2022) Psychological Science
Collective Teacher Efficacy (CTE) — the shared belief among a group of educators that they can collectively make a positive difference to learner outcomes — has an effect size of 1.57 in Hattie's updated Visible Learning research. This is the highest-ranking influence in his entire database.
This is not about individual confidence. It is about what a whole team believes together. When trainers in a VTS scheme share the belief that their collective effort genuinely shapes the development of their trainees, and they behave accordingly, the impact on learning outcomes is transformational.
- Trainers' workshops should spend explicit time building a shared sense of collective purpose and impact
- TPDs should regularly share evidence of the training scheme's positive impact on trainee outcomes
- Challenge a culture of "I just do my bit" — replace it with collective ownership of trainee development
- Create opportunities for trainers to learn together, observe each other's teaching, and build shared standards
Rohrer, Dedrick, and colleagues (2015–2020) have consistently shown that interleaved practice — alternating between different topics or problem types — produces substantially better long-term performance than blocked practice, despite feeling less productive and generating lower short-term scores.
This matters because both teachers and learners naturally prefer blocked practice. It feels more organised, more manageable, and produces better immediate performance — creating a false impression of mastery. The learning then fades rapidly without the challenge of interleaving.
References: Rohrer et al. (2015, 2020) Journal of Educational Psychology
Technology in medical education has grown dramatically, accelerated by the COVID-19 pandemic. The evidence shows a nuanced picture:
- Technology for retrieval practice (flashcard apps such as Anki, spaced repetition software) has strong evidence behind it — because the active mechanism (retrieval) is the effective ingredient, and technology just schedules it reliably
- Technology for passive learning (watching videos, re-reading slides) does not improve outcomes over traditional passive methods — because the passive mechanism is the same
- Flipped classroom approaches (learners engage with content before sessions, then use session time for active practice) show promise in medical education when designed around cognitive load principles
- AI-assisted teaching tools are an emerging area. Early evidence suggests AI tutors can be effective for knowledge delivery — but cannot replicate the human elements of psychological safety, modelling, and relational trust that are central to clinical supervision
References: Mälkki et al. (2022) British Journal of Educational Technology; McClain (2024) New Directions for Adult and Continuing Education
👩🏫 The Educational Research Lead — A Practical Idea Worth Implementing
Medical educators need to be research-informed — but workload makes keeping up with literature nearly impossible. One practical solution: designate a research lead within your deanery, GP school, or VTS scheme. This person's role is to curate, filter, and summarise the most robust and relevant educational research — sharing highlights once or twice per year, at trainers' workshops, or through a simple periodic summary.
Some schools already do this well. The result: educators stay current, trainees benefit from evidence-based teaching methods, and the scheme builds a genuine culture of educational quality improvement.
Common Learner Blind Spots in GP Training
Many trainees revise by re-reading notes or guidelines. This feels productive and produces a false sense of familiarity — but produces poor long-term retention. Help trainees replace this habit with self-testing and retrieval-based revision.
A trainee who answers questions fluently in a tutorial immediately after teaching is not necessarily learning — they are performing. The test of learning is performance 2–4 weeks later, in a different context. Help trainees understand this distinction explicitly.
Trainees naturally gravitate towards topics they already know reasonably well — because studying familiar material feels more productive and comfortable. Encourage them to identify and deliberately study their weak areas, using desirable difficulties principles.
Tutorial Ideas Grounded in Evidence
- The Opening Quiz: Start every tutorial with 3–5 retrieval questions from the previous session. No notes allowed. Discuss answers before moving on. This activates prior knowledge AND provides spaced retrieval practice simultaneously.
- The Think-Aloud Case: Work through a clinical case by thinking aloud — verbalising your reasoning, uncertainties, and decision-making. This makes expert reasoning visible and is one of the most powerful tools available to a clinical supervisor.
- The Misconception Hunt: Before teaching a topic, ask your trainee what they already believe about it. Identify misconceptions explicitly and address them directly — misconceptions that are not challenged often persist despite new teaching.
- The Interleaved Tutorial: Instead of covering one topic exhaustively, move between 2–3 related topics within a single session. This feels less tidy but produces better long-term retention through interleaving effects.
- The Reflective Closer: End every tutorial with "What challenged your thinking today?" and "What are you going to do differently as a result?" These questions promote transformative rather than merely informative learning.
Reflective Questions for Tutorials
- What do you already know about this topic — and what are you uncertain about?
- Why did you make that clinical decision? What else were you weighing up?
- What would you do differently if you saw that patient again?
- What did this consultation teach you about how patients experience illness?
- Is there an assumption you held before this case that you are now questioning?
- What part of this topic makes you uncomfortable — and why?
💡 The Most Important Thing a GP Trainer Can Do
Create a learning environment where your trainee feels safe to say "I don't know" — and then help them figure it out together. Psychological safety is not a soft concept. It is, according to Google's landmark research on team effectiveness (Project Aristotle, 2016), the single most important determinant of team and learning performance. Every clever teaching strategy fails in an environment where the learner is afraid to be wrong.
Educational research tells us what should work. But there is a second kind of wisdom — quieter, harder to measure, and often missing from textbooks. It comes from the lived experience of UK GP trainees and their trainers. The insights below have been gathered from UK GP training discussions, deanery educator accounts, trainer testimonials, and the genuine voices of registrars reflecting on their training. Only those consistent with RCGP and GMC guidance have been included.
The Five Things That Trainees Say Made the Biggest Difference
When UK GP registrars reflect on their training, five themes come up again and again. Here they are — visualised.
Source: Synthesised from UK GP training forum discussions, deanery trainee feedback reports, GPonline registrar accounts, and published qualitative research on GP training experience (UK, 2013–2024).
What Trainees Wish Their Trainers Knew
These are the things that registrars consistently say — often after qualifying, when they feel safe to be honest. Trainers who understand these points tend to be the ones that trainees remember for years.
One of the most consistent themes from UK registrar accounts is the fear of appearing incompetent. Many trainees sit through explanations they do not fully follow, nodding along — and then go home to Google it. This is not laziness. It is the entirely predictable result of a learning environment where asking for clarification feels risky.
Research by Piercy and Dale (2002, Education for Primary Care) found that registrars who felt able to express uncertainty to their trainers made faster progress than those who masked gaps. The relationship was more predictive than any specific teaching technique.
- Begin sessions with: "Stop me any time something doesn't make sense — that's useful information for both of us"
- Normalise not knowing: share your own genuine uncertainties openly
- After explaining something, pause and say: "What parts felt unclear?" — not "Does that make sense?" (people almost always say yes)
- Reward questions. The trainee who asks the most might actually be the most engaged, not the least prepared
Hypothetical cases can feel remote. A trainee can engage with them intellectually without anything really landing. But when the teaching moment connects to a real patient the trainee saw that morning — someone they cared about, someone who confused them, someone they got slightly wrong — the learning becomes vivid and personal.
UK trainee accounts consistently describe "picking apart a tricky case from my own clinic" as among the most valuable tutorial experiences. This aligns perfectly with what cognitive science says about concrete examples and elaboration — the more personally meaningful the example, the deeper the processing.
- Start every tutorial: "Which patients this week have you been thinking about since the surgery ended?"
- Build the teaching around those cases — not a pre-planned topic that ignores what just happened
- Use the trainee's own words to describe the patient — this strengthens their ownership of the learning
- Connect clinical cases to the broader principle you want to teach, rather than the other way round
Registrars who were given opportunities to observe their trainer's consultations — not just their own being observed — consistently rate this as one of the most formative experiences in their training. This is not because the trainer was perfect. It is because seeing expert clinical reasoning in action, including uncertainty, the occasional wrong turn, and recovery from difficulty, made the process of clinical thinking visible and learnable.
The key is the debrief. Watching without discussion is passive. Watching followed by "what were you thinking when you said that?" transforms observation into active learning.
- Invite your trainee to sit in on one of your consultations each week — brief them first on what to watch for
- Debrief immediately after: "What did you notice? What surprised you? What would you have done differently?"
- Be willing to think aloud during tutorials: "When I see this presentation, my first thought is... and here's why"
- Do not hide your uncertainty — model how an experienced GP navigates not knowing
UK registrar accounts reveal a frustrating pattern: trainers who consistently gave feedback like "that was fine," "good effort," or "just keep practising" left trainees feeling unsupported and unclear about how to improve. Some trainees described feeling as though their trainer was trying to be kind — and accidentally being unhelpful.
Specific, actionable feedback is kinder than vague reassurance. A trainee who knows exactly what to change can act on it. A trainee who is told they were "mostly good" is left to guess — and often assumes the worst.
- Use a simple structure: "What worked well was... specifically because... What to try differently is... here's why that would help"
- Be concrete: "When you said X, the patient's face changed — did you notice that?" beats "your communication could be better"
- Invite self-assessment first: "How did you feel that went?" — trainees who identify their own gaps are more likely to address them
- Give feedback in a private, unhurried space. Rushed feedback rarely lands well
Several UK GP trainer accounts (including through GPonline and deanery reflections) describe an unexpected problem: trainees who felt coddled by overly protective teaching. When a trainer repeatedly smoothed over difficulties, provided answers before the trainee had time to struggle, or avoided challenging topics to keep things comfortable, trainees often felt their development plateaued.
This maps directly onto the research concept of desirable difficulties. A trainee who is never allowed to struggle productively never builds the cognitive resilience needed for independent practice. Excessive scaffolding can become a ceiling rather than a ladder.
- Notice if you are regularly supplying answers before the trainee has had time to think — wait longer than feels comfortable
- Increase complexity gradually: move from supervised to semi-independent to fully independent decision-making over the training year
- Introduce complexity towards the ST3 year in particular — complex multi-morbidity cases, heartsink patients, ethical dilemmas
- Reassure, but also challenge: "I think you're ready for something harder — let's try this"
UK registrars who described their best tutorial experiences almost always used the word "conversation." Not a lecture. Not a presentation. Not a trainer talking at them for 45 minutes with a prepared set of slides. A back-and-forth exchange where both people were thinking together — discovering something, disagreeing occasionally, following a thread wherever it led.
This is not a call to abandon structure. It is a call to hold structure lightly. The tutorial that meanders productively because a trainee asked an unexpected question is often more valuable than the one that dutifully covers every bullet point on a pre-planned topic sheet.
- Plan your tutorial topic — then be willing to set it aside if a better thread emerges
- Ask more than you tell: "What do you think the options are here?" before giving your own view
- Express genuine curiosity: "I hadn't thought of it that way — tell me more"
- Balance teacher and trainee activity. If you have been talking for more than 5 minutes straight, that is a prompt to ask a question
These patterns emerge consistently from UK GP trainee accounts — published reflections, deanery feedback, and registrar-focused educational research. They cover what genuinely helps and what consistently frustrates. They are presented here as teaching intelligence, not criticism.
What Makes a Great GP Tutorial — a Trainee's View
A visual walkthrough of what UK GP trainees consistently describe as the anatomy of a great tutorial.
What Do Trainees Find Most Challenging About Learning in GP?
Based on UK GP training research and trainee feedback, these are the most commonly cited challenges — and what trainers can do about each one.
Feeling like everyone else knows more — especially for IMGs joining mid-training or moving from hospital to GP.
Hospital training gives clear answers. General practice specialises in "I'm not sure — here's how I'll manage it safely." This is genuinely disorienting at first.
Many trainees cannot reliably identify their own knowledge gaps — so they are not sure what to revise. The gaps that catch people out are often the ones they did not know were there.
Many trainees feel torn between becoming a good doctor and passing the MRCGP. The best trainers help them see these as the same project, not competing ones.
Learning to think deeply while working quickly is a skill that takes time to develop. Many trainees feel they cannot think properly when the pace is high.
Many trainees — especially IMGs — find the shift from protocol-driven hospital medicine to the organised uncertainty of general practice genuinely disorienting. The skills feel different; the pace feels different; even the relationship with patients feels different.
Insider Tips from the UK GP Training Community
These are the practical, honest pieces of advice that experienced UK GP trainers share among themselves at trainers' workshops, deanery days, and in informal conversations. They do not appear in educational theory textbooks — but they work.
💡 The two-minute debrief
After your trainee sees a patient, take just two minutes before the next one arrives: "How did that feel? What went well? What nagged at you?" This immediate micro-reflection is more powerful than a long retrospective discussion at the end of the session — because the detail is still fresh and emotionally alive. Many experienced trainers say this habit, done consistently, is worth more than any formal tutorial technique.
💡 Use the FourteenFish ePortfolio as a learning tool, not an admin task
Many trainees experience their 14Fish ePortfolio as a bureaucratic burden — something to "fill in" rather than learn from. Trainers who reframe it as a reflective diary rather than a compliance form find that trainees engage with it much more meaningfully. Encouraging trainees to record their own learning questions in their entries — not just summaries of what happened — is a simple habit that transforms the portfolio from a record of the past into a plan for the future.
💡 The "learning from the edges" principle
The most educational cases are rarely the most straightforward ones. They are the consultations where something unexpected happened, where the trainee felt lost, where a patient's emotion caught them off guard, or where the textbook answer did not quite fit the real person in front of them. Trainers who make a habit of seeking out these "edge cases" in debriefs — rather than skipping over them as anomalies — help their trainees develop clinical wisdom, not just clinical knowledge.
💡 Let your trainee teach you something
Several UK GP educators describe a simple but powerful habit: regularly asking their trainee to teach them something from the week. A recent guideline update. A clinical question the trainee looked up. A patient experience that gave the trainee new insight. This creates a genuine two-way learning relationship, builds the trainee's confidence, and also — honestly — sometimes teaches the trainer something genuinely useful. It signals that the trainer respects the trainee as a co-learner, not just a recipient of wisdom. Research from East of England educator accounts confirms this two-way learning is consistently reported as a highlight of the training relationship by both parties.
💡 Trainers' workshops are undervalued
Experienced UK trainers consistently describe local trainers' workshops as one of the most valuable professional development experiences available to them — not because of the formal content, but because of the conversations that happen in the breaks, the sharing of difficult situations, and the realisation that other trainers face exactly the same challenges. If you are not attending them, you are missing something that cannot be replicated by reading about teaching theory. Bradford VTS explicitly recommends these as a source of collegial renewal and practical teaching ideas.
💡 The "teach it yourself" challenge
UK GP training resources (including HEE North East guidance) recommend that trainers encourage their trainees to teach medical students, foundation year doctors, or colleagues on topics that are also personal learning needs. Teaching something is one of the most effective ways of consolidating understanding — because it forces the learner to organise their knowledge, anticipate questions, and fill in gaps they did not know were there. Arrange this early, not late — trainees who teach in ST1 and ST2 often arrive at ST3 with noticeably deeper understanding of the topics they taught.
What Is Transformative Learning?
Transformative Learning Theory, developed by Jack Mezirow (1978, 2000) and enriched by subsequent researchers including Paulo Freire, refers to the kind of learning that creates fundamental changes in a person's frame of reference — their beliefs, assumptions, values, and habitual ways of thinking and acting.
This goes far beyond information transfer. It is about changing how someone sees the world, their role in it, and what they believe is possible.
Informative Learning
Adding new facts and skills to an existing framework. The learner knows more but thinks the same way. "I now know the dose of metformin."
Necessary — but not sufficient for great GP practice.
Transformative Learning
Fundamental change to how the learner thinks, feels, and acts. A shift in paradigm. "I now understand what the patient's experience of illness actually is — and that changes how I practise."
This is what great GP educators aim for.
Teacher or Facilitator?
The word teacher implies an oracle of wisdom with a body of knowledge to impart to attentive recipients. The word facilitator suggests someone who helps learning emerge — through dialogue, reflection, and honest exchange.
In reality, both roles matter. There are moments when direct instruction is exactly what the learner needs. There are other moments when the most powerful thing you can do is create the conditions for discovery. The skilled educator knows which role to inhabit at which moment — and is comfortable moving between them.
What Recent Research Adds (McClain, 2024; Mezirow updated)
The bibliometric analysis by Zaiden et al. (2024) found that transformative learning as a research field has grown substantially over the last 15 years, with increasing focus on three updated themes:
Virtual reality, digital storytelling, and AI tools can support transformative-oriented critical reflection — but research (Smith, 2012; Wang et al., 2021) consistently shows that technology is secondary to pedagogy, course design, and instructor involvement. The human relationship remains the essential ingredient.
Transformation happens through critical reflection — specifically, the kind that challenges underlying assumptions, not just surface behaviours. This is why asking "why did you do it that way?" is more transformative than asking "what did you do?"
Recent research emphasises that transformation is not purely cognitive — it is emotional and relational. Dirkx (2006) showed that emotional engagement is essential for deep perspective change. Learning that only engages the intellect rarely transforms practice.
Everything on this page — the cognitive science, the research evidence, the trainee voices, the insider wisdom — can be distilled into a single practical framework for designing and running great GP training tutorials. Here it is.
The Three Levels of a Great Tutorial
Think of a great tutorial as three nested layers. Each layer depends on the one beneath it. Get the foundation wrong and the rest cannot work properly.
What Good Looks Like vs Common Pitfalls — Side by Side
| ✅ What Good Teaching Looks Like | ⚠️ Common Pitfall to Avoid | Evidence Basis |
|---|---|---|
| Start with 3–5 retrieval questions from last time before teaching anything new | Jumping straight into new content with no link to prior learning | Rosenshine Principle 1; Retrieval practice research |
| Build teaching around a real case from the trainee's own clinic this week | Using the same hypothetical case examples every year | Concrete examples strategy; Elaboration theory |
| Ask "What are you thinking?" more often than "Let me explain..." | Lecturing for extended periods before asking any questions | Creemers Dynamic Model — Questioning heading |
| Give specific, immediate feedback: "When you said X, here's what I noticed..." | Giving vague reassurance: "Yes, that was fine, keep going" | Hattie — Feedback effect size 0.70–0.73 |
| Mix 2–3 topics within a session (interleaving) | Covering one topic exhaustively before moving on | Interleaving research (Rohrer et al., 2015–2020) |
| Let the trainee struggle briefly before stepping in to help | Supplying answers before the trainee has had time to think | Desirable difficulties; Generation effect (Bjork 2011) |
| End with: "What's shifted for you today? What will you do differently?" | Running out of time and skipping the close entirely | Transformative learning theory (Mezirow); Reflection research |
| Model uncertainty openly: "I'm not completely sure here — here's how I'd think about it..." | Projecting certainty you don't have, or avoiding difficult topics | Psychological safety; Growth mindset culture (Yeager et al. 2022) |
| Use the 14Fish ePortfolio as a reflective learning diary, not a compliance exercise | Treating the ePortfolio as a box-ticking administrative task | RCGP portfolio guidance; Reflective practice research |
| Plan the tutorial topic — and then be willing to change direction if a better thread emerges | Rigidly sticking to a pre-planned agenda regardless of what the trainee needs that day | Learner-centred teaching; GPonline trainer guidance |
A Memory Aid for the Whole Page — TEACHER
If you want to carry the essence of this page into every tutorial, this mnemonic pulls it all together.
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1Effective teaching is not about being the most knowledgeable person — it is about creating the conditions for lasting learning. Subject expertise and teaching skill are distinct. Both can be developed.
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2Learning styles have no evidence. The learning pyramid is fiction. Re-reading is among the least effective revision strategies. Stop spending time on these and redirect that energy towards what works.
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3The six most evidence-based cognitive strategies are: spaced practice, interleaving, retrieval practice, elaboration, concrete examples, and dual coding. Incorporating even two or three of these will noticeably improve your tutorials.
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4Desirable difficulties work. Teaching that feels harder in the short term often produces better long-term retention. This applies to your trainees — and to your own professional development as an educator.
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5Hattie's highest-ranked influence on learning is Collective Teacher Efficacy (effect size 1.57). Building a shared sense of purpose and belief among the trainers in your VTS scheme may be the highest-leverage investment you can make.
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6Rosenshine's 17 principles can be applied directly to GP training tutorials. Start with a short review, present in small steps, ask frequent questions, model your reasoning, and provide systematic feedback. That is a Rosenshine tutorial.
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7Psychological safety is not optional. It is the foundation on which every other teaching strategy rests. If your trainee is afraid to say "I don't know," nothing else you do will work as well as it should.
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8Growth mindset as a culture — modelled by the teacher, embedded in daily interactions — has more support than growth mindset as a programme. Model intellectual humility, embrace uncertainty, and reward effort and strategy over natural ability.
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9Aim for transformative learning — not just information transfer. Ask not only "what do they know now?" but "how has their thinking changed?" and "how will this affect their consultations tomorrow?"
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10The most practical change you can make today: start your next tutorial with a 3-question quiz from last time. Do not teach anything for the first 5 minutes. Just retrieve. The evidence strongly supports this simple practice.
Cognitive Principles of Effective Teaching Videos
These are simply excellent. Presented by Professor Chew of Samford University. Although the videos are short, there’s a lot in each one – so think about replaying them or mind-mapping them out.
1: Beliefs about Teaching
2: The 9 Cognitive Factors to Learning
3: Prior knowledge, misconceptions, ineffective learning strategies and transfer
4: Constraints of Selective Attention, Mental Effort, and Working Memory
5: Teachable Moments, Formative Assessment, and Conceptual Change
Beware of Cognitive Overload
The Science of Teaching