1. Peyton JWR. The learning cycle. In: Peyton JWR, editor. Teaching and learning
   in medical practice. Rickmansworth: Manticore Europe Ltd. 1999; 13–9.

1. Farrell L, Bourgeois-Law G, Buydens S, Regehr G. Your goals, my goals, our goals: the complexity of conconstructing goals with learners in medical education. Teach Learn Med. 2019;31(4):370-7. doi: 10.1080/10401334.2019.1576526.
2. Telio S, Ajjawi R, Regehr G. The “Educational Alliance” as a framework for reconceptualizing feedback in medical education. Acad Med. 2015 May;90(5):609-14. doi:10.1097/ACM.0000000000000560.
3. Brown MEL, Coker O, Heybourne A, Finn GM. Exploring the hidden curriculum’s impact on medical students: professionalism, identity formation and the need for transparency. Med Sci Educ. 2020;30(3):1107-21. doi:10.1007/s40670-020-01021-z.
4. Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review. Acad Med. 2009 May;84(5):551-8. doi: 10.1097/ACM.0b013e31819fbaa2.
5. Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. Defining professionalism in medical education: a systematic review. Med Teach. 2014 Jan;36(1):47-61. doi: 10.3109/0142159X.2014.850154.
6. UBC Equity & Inclusion Office. Building inclusive UBC: an inclusion action plan [Internet]. Vancouver: University of British Columbia; 2020 Jan [cited 2025 June 14]. Available from: https://equity3.sites.olt.ubc.ca/files/2020/01/UBC-IAP-Web-Jan2020.pdf
7. VanderKaay S. Trauma-informed pedagogical strategies. Hamilton: McMaster University; 2023 [cited 2025 June 10]. Available from: https://doitanyway.ca/infographic/
8. Office of Faculty Development. First, do no harm: Developing trauma-informed medical and health professions education practice. [Internet] Vancouver: University of British Columbia; 2024 [cited 2025 Nov 26]. Available from: https://facdev.med.ubc.ca/wp-content/uploads/2024/06/RRSeries_TraumaInformedEducation_May23_2024.pdf
9. Souza, TJ. Responding to Microaggressions in the Classroom: Taking A.C.T.I.O.N. Online article in Faculty Focus Premium. Madison, WI: Magna Publication; 2018.

Year 1, Term 1

In the first term, learners are embarking on their medical learning journey. They have just started to learn how to have a professional conversation with a patient and how to take a history. They need to:

• • Increase their skill in history-taking;
  • Increase their understanding of the patient in the whole context of their life and the effect that life events and social determinants can have on physical health;
  • Begin to carry out basic clinical examinations.

How Can You Best Support Learners at This Stage?

• • Feedback on history-taking and how to take one in an organized and respectful manner is helpful
  • Learners at this stage will also be very grateful for opportunities to conduct basic examinations, and to have your guidance on how to improve their clinical skills
  • Learners will greatly benefit from your clinical assessment of patients and a discussion of how you arrived at your differential diagnosis and what tests you think will be most appropriate as a next step
  • Probing learners to encourage clinical reasoning towards diagnosis helps build strength in this area.

Please note that education on clinical examination of systems starts in the second term of Year 1 and continues throughout Year 2. Check in with your learner that they have been taught to examine the system concerned in the patient complaint. Demonstrating the examination for them and with them would be very helpful if they have not been taught in this system yet.

Year 1, Term 2

At this point, the learner's SOAP format of history-taking should be improving. They should be:

• • Progressing towards a more concise history (be able to evaluate a patient's complaint and summarise their concerns);
  • Becoming more proficient in basic clinical examination.

How Can You Best Support Learners at This Stage?

• • Check in with your learner that they have been taught to examine the system concerned in the patient complaint
  • The learner will not be proficient at integrating examination of several systems at this point, but it will be helpful for them to have you demonstrate how this is done in clinical practice (e.g. CVS, respiratory and vascular systems in the same patient)
  • Checking in with the learner about areas they need more experience in is always helpful

Quick Tip:

Try to choose patients requiring different elements of clinical examination where possible. Have a learner practice summarizing their case briefly for you. It is good learning for learners to check in with you after the presentation with the patient to see if this history reflects the patient's main concerns. Feedback from patients is always great coaching for the learner.

• • “Does that history clearly reflect your main concerns?”
  • "Is there anything you feel I should have done differently?”

Year 2

In Year 2, the learner should be able to:

• • Take an adequate and organized history
  • Conduct an appropriate physical exam
  • Begin to suggest general differential diagnosis
  • By the end of second year, discuss the initial investigation of a problem and start to think about management plans - this will help them prepare for clerkship

How Can You Best Support Learners at This Stage?

Learners at this stage can complete most of the visit on their own but still require a review of all the findings and supervision in all settings.

Demonstrate for the learner how clinical practice integrates the examination of several systems, while keeping in mind that learners have not yet learned how to do this for themselves (e.g., cardiac, respiratory and vascular systems in the same patient)

Year 3

This is clerkship year. Learners are functioning with more independence, but they still need all their cases reviewed and findings checked prior to any patient being discharged, regardless of the stage of learning in Year 3. They should be able to:

• • Take a focused history, summarize it and discuss concerns with the patient, share information with a patient, and provide some health education to the patient about their illness;
  • Document the most likely differential diagnosis and support this diagnostic list from the history and other findings;
  • Form a plan for the appropriate next steps e.g., investigation or consultation;
  • Suggest and discuss common and basic management plans.

How Can You Best Support Learners at This Stage?

It is always good practice to check in with a learner at the start of their time with you, to inquire about their experiences to date and co-create learning goals. Mid-term evaluation of the students is very important and feedback that is timely and focused will be very helpful.

Year 4

This is a learner's pre-graduation year. While the next step is their residency, they are still not independent. By now, they should be proficient to take a complete or focused history and physical, as well as counselling and discussing health issues with patients (they should also be aware of some potential community resources for the patient).

Final year learners should be able to:

• • Establish appropriate orders for investigation to confirm their differential diagnosis or follow up on the status of the patient’s disease
  • Interpret laboratory tests investigations and imaging reports
  • Construct a management and follow-up plan in less complex cases
  • Demonstrate the ability to understand and dialogue with the patient as a whole person in the context of their life (the ability to interpret verbal and nonverbal cues should be obvious)

How Can You Best Support Learners at This Stage?

• • Supervise learners, as though they are progressing towards residency and more independence, they still require regular feedback and supervision
    • Look for good opportunities to offer feedback and additional learning tips
    • Observe learners for portions of clinical encounters with patients and while performing any procedures
  • Guide any areas where the learner may lack of attention to detail or proper procedures, as they are likely to continue if not corrected
  • Help learners through mentorship and guidance to encourage appropriate levels of clinical confidence, competence, and good learner insight where there may be deficits in knowledge or skills
  • Offer learners opportunities to go beyond basic procedural skills, which at this stage they should be proficient in

Reviewing Findings and Treatment Plans

• • Early on in residency it’s very important to review a resident’s findings and plans for patients
  • This allows you to gain more knowledge on their comfort level, as well as check in on the accuracy of their differential diagnosis and treatment plan for patients
  • Reviewing their clinical findings intermittently will help them build their confidence and competence

For example, given a patient with chest pain the resident may not interpret the pain as cardiac, but the preceptor may say that in consideration of the patient’s age and multiple comorbidities, a cardiac cause needs to be excluded rather than dismissed, or another more probable diagnosis needs to be established.

Applying Theory to Practice

The preceptor as an experienced physician has more pattern recognition, more of a ‘nose’ for the less common diagnosis or that ‘something is just wrong’ feeling because they know the patient well. The resident’s academic learning is perhaps fresher than yours, but helping them apply their knowledge practically is a large part of residency training.

Incorporating Feedback and Discussion

• • Encourage a positive learning environment by
    • Openly discussing mistakes, recognizing that learners who feel persistently criticized can tend to shutdown and withdraw from learning opportunities
    • Responding to lack of knowledge in a specific area with welcomed dialogue - if a resident is afraid to ask questions, they cannot recognize or learn from their mistakes
    • Encouraging residents to learn to be open to feedback and discussion as part of their professional training

Facilitating Supervision and Hands-On Experience

• • How much supervision and hands-on experience is required for the resident is very much dependent on their level of competency and confidence. Even as they grow to be able to function more and more independently towards the end of Y1 and Y2, they should never feel that they are working in isolation or have no back up.
  • Check in intermittently on their cases and follow through with them on decisions made to verify therapeutic and management knowledge
    • Help the resident dialogue through the differential diagnosis and proposed management plan
    • Incorporate appreciative inquiry to help learners gain more insight as to why they made a particular choice
  • Confidence should not be confused with competency — that is why it is important to check in regularly on their case management
  • Where possible, every effort should be given to allow the resident to have as much procedural and clinical experience as possible

1. Weed, L.L. (1991). The Progress Notes. In: Knowledge Coupling. Computers in Health Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-3150-9_5
2. Podder, V., Lew, V., & Ghassemzadeh, S. (2021). SOAP Notes. Ncbi.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482263/
3. Weston WW, Brown JB, Stewart MA. Patient-centred interviewing part I: understanding patients’ experiences. Can Fam Med. 1989 Jan;35:147-51.
4. Farrell L, Bourgeois-Law G, Buydens S, Regehr G. Your goals, my goals, our goals: the complexity of conconstructing goals with learners in medical education. Teach Learn Med. 2019;31(4):370-7. doi: 10.1080/10401334.2019.1576526.

Additional resources:

Guidance on Using Emerging Digital Tools with Electronic Medical Records (EMRs)

• How to choose, implement, and train yourself and staff to use an EMR in your clinic (Doctors of BC)
• EMR Orientation Videos (Doctors of BC)
• Practical Considerations for Using AI Scribes (Doctors of BC)

1. Graffam B. Active learning in medical education: Strategies for beginning implementation. Med Teach. 2007;29:38-42. doi: 10.1080/01421590601176398
2. Posel N, Mcgee JB, Fleiszer DM. Twelve tips to support the development of clinical reasoning skills using virtual patient cases. Med Teach. 2015; 37(9): 813–8. doi: 10.3109/0142159X.2014.993951
3. Kassirer JP. Teaching Clinical Reasoning: Case-Based and Coached. Acad Med. 2010;85(7):111824. doi: 10.1097/ACM.0b013e3181d5dd0d
4. Tofade T, Elsner J, Haines ST. Best practice strategies for effective use of questions as a teaching tool. Am J Pharm Educ. 2013;77(7):155. doi: 10.5688/ajpe777155
5. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 1992;5(4): 419-24.
   
6. Burgess A, van Diggele C, Roberts C, Mellis C. Tips for teaching procedural skills. BMC Med Educ. 2020;20(Suppl 2):458. doi: 10.1186/s12909-020-02284-1

This page provides key tips on what to do before, during, and after observing your learner, to make the most of your time together.

View the webpage: Quick Tips for Teaching – Direct Observation

This module looks at how direct observation and feedback can serve as a guide to help learners improve clinical skills.

Open the module: Direct Observation and Feedback

Policy 031B outlines key responsibilities of clinical supervisors in the MD Undergraduate Program. The clinical environment should support students to achieve the goals of their educational program, rather than fulfilling service requirements. Matching medical students with clinical responsibilities at their level and gradually increasing responsibilities under your guidance is key to progressing educational goals while ensuring patient safety.

Access the PDF: What Clinical Supervisors and Preceptors Need to Know (Policy 31B)

This module aims to help you engage in effective feedback conversations with your learner by creating an educational alliance and incorporating reflection.

Access the module: Reflection and Feedback Conversations

This resource provides language examples and advice for preceptors offering constructive comments to residents in the Competency By Design (CBD) coaching model.

Access PDF: How to Give Constructive Coaching Feedback (PDF)

This resource provides approaches to address common challenges with engaging in feedback conversations.

Visit the webpage: Quick Tips for Teaching - Common Challenges in Feedback Conversations (Interactive and PDF infographic)

The programmatic assessment system provides valid, reliable and timely assessments of the competence of trainees to guide progress and promotion decisions and to motivate, direct and support learners.

Learn more about Assessment of Learners

This module will provide an overview of Workplace Based Assessment (WBA) in Years 3 & 4 of the MD Undergraduate Program (MDUP). It provides an overview of programmatic assessment modalities used in the MDUP Program and then looks at specific aspects of WBA including filling out a Direct Observation from.

Access the module: Years 3 & 4 Workplace Based Assessment (WBA) Orientation

If your learners may benefit from additional resources or support, connect them to their respective support offices.

MD Undergraduate Program (MDUP) Supports

• • Student Accommodations Procedure (Policy 033)
  • Student Affairs on Entrada (soon to be Elentra) provides nonjudgmental, holistic support to enable the well-being, safety, and success of all our medical students
    • UBC MDUP-specific counseling: Email at md.counsellor@ubc.ca or find the Calendly links for counsellors on Entrada to book directly

Postgraduate Medical Education Program (PGME) Supports

• Supporting Residents in Difficulty - A Concise Guide for Program Directors (PDF) - Contact Derek Reynolds, PGME Communications, to be provided access
• Resident Support Contacts, including:
  • Doctors of BC - Physician Health Program, or contact at 1.800.663.6729 for 24-hour confidential Support
  • Resident Counselling and Peer Support Office or contact at pgme.rcaps@ubc.ca or 1.855.675.3873

MD Undergraduate Program (MDUP) Supports for Learners in Difficulty:

• • Student Accommodations Procedure (Policy 033)
  • Learner Mistreatment help and reporting portal
  • Student Affairs on Entrada (soon to be Elentra) provides nonjudgmental, holistic support to enable the well-being, safety, and success of all our medical students
    • UBC MDUP-specific counseling: Email at md.counsellor@ubc.ca or find the Calendly links for counsellors on Entrada to book directly
  • Academic Advising (Policy 015) – reassure students that conversations are confidential

Postgraduate Medical Education Program (PGME) Supports for Learners in Difficulty

• Supporting Residents in Difficulty - A Concise Guide for Program Directors (PDF) - Contact Derek Reynolds, PGME Communications, to be provided access
• Resident Support Contacts, including:
  • Resident Counselling and Peer Support Office or contact at pgme.rcaps@ubc.ca or 1.855.675.3873
  • Learner Mistreatment help and reporting portal, or contact at professionalism.office@ubc.ca
  • Doctors of BC - Physician Health Program, or contact at 1.800.663.6729 for 24-hour confidential Support

This resource helps you identify and differentiate the severity of a student’s distress and enables you to guide them to the most appropriate resources and supports.

View the PDF: Recognize and Respond to a Student in Crisis

1. Weston WW, Brown JB, Stewart MA. Patient-centred interviewing part I: understanding patients’ experiences. Can Fam Med. 1989 Jan;35:147-51.
2. Telio S, Ajjawi R, Regehr G. The “Educational Alliance” as a framework for reconceptualizing feedback in medical education. Acad Med. 2015 May;90(5):609-14. doi:10.1097/ACM.0000000000000560
3. Farrell L, Bourgeois-Law G, Buydens S, Regehr G. Your goals, my goals, our goals: the complexity of conconstructing goals with learners in medical education. Teach Learn Med. 2019;31(4):370-7. doi: 10.1080/10401334.2019.1576526
4. French JC, Colbert CY, Pien LC, Dannefer EF, Taylor CA. Targeted feedback in the Milestones Era: Utilization of the Ask-Tell-Ask feedback model to promote reflection and self-assessment. J Surg Educ. 2015;72(6): e274-9. doi: 10.1016/j.jsurg.2015.05.016