How to Develop Your Teaching Skills as a Doctor: From Imposter Syndrome to Confident Medical Educator

• Teaching is a skill in its own right. Clinical expertise and seniority help, but they do not automatically make someone a good teacher. You improve through practice, observation, feedback, reflection and deliberately trying different approaches.
• You do not need to wait until you feel completely confident or senior enough to start. Teach within your competence, prepare properly and begin with opportunities that match your experience. Much of your confidence will develop through actually doing it.
• Start with the learner, not the content or the PowerPoint. Think about what learners already know, where they are struggling and what you want them to be able to do afterwards. Then choose the teaching method that best helps them get there.
• Develop more than one way of teaching. Presentations are useful, but so are questioning, discussion, cases, demonstration, practice, simulation, facilitation and feedback. Becoming a better educator means being able to adapt your approach to the learner, the group and the situation.
• Use feedback and reflection to improve rather than simply accumulating experience. Ask whether learners actually learnt what you intended, seek useful feedback on your own teaching and change something when an approach does not work. Twenty years of teaching only helps if you continue learning from it.
• Let your development grow with your educational responsibilities. Practical teacher training can broaden your skills, presentation training can help if confidence or delivery is holding you back, supervisor training becomes more relevant when you take responsibility for trainees, and postgraduate study may make sense if education becomes a substantial professional interest. The aim is not to collect certificates, but to become a better educator.

Medicine has traditionally relied heavily on doctors learning to teach by watching other doctors teach. After years of medical school, postgraduate training, conferences, departmental education and supervision, it is easy to assume that you somehow absorb the ability along the way.

To some extent, you do. Most doctors can probably think of teachers they admired and approaches they have subsequently borrowed. We also learn from the less successful teaching we have experienced. If you have sat through ‘Death By PowerPoint’, with 60 densely-packed slides delivered in 20 minutes, being read aloud, you probably have strong views about what they would prefer not to do yourself.

But knowing your subject and knowing how to help somebody else learn it are two different things. You can understand a subject exceptionally well and still struggle to explain it simply. You can end up giving an accurate presentation that is too difficult for your audience to process. You can be highly experienced at a practical skill but have automated so much of what you do that you find it surprisingly difficult to break the task down for somebody seeing it for the first time.

Teaching involves its own set of decisions. You need to worry about what the learners already know, where are they struggling and what can be achieved realistically in the time available. You need to decide whether you should explain, demonstrate, ask questions, give them a problem to solve or let them practise. You also need to determine how much support they will need and how you can assess whether your teaching has actually made a difference. Those questions matter whether you are teaching in a lecture theatre, small seminar room, simulation suite, clinic, operating theatre or on Zoom.

The reassuring part is that most of this gets better with practice. You teach, notice what works, notice what falls flat, make adjustments and gradually become more skilled. Formal training can help enormously because it gives you a language and structure for thinking about what you are already doing, but becoming a good teacher is usually a process rather than a single event.

Teaching can affect your own thinking. It is quite easy to feel that you understand something because you have been doing it for years. But when it comes to explaining it clearly to somebody else, it is a rather different test. You suddenly have to decide what the important principle actually is, why one thing matters more than another and whether the explanation you have been giving yourself for years genuinely stands up. In some cases, you’re not even that sure of how you’re doing it yourself. You’re just doing it.

Preparing to teach can have the same effect. You go back to a guideline to check that you have remembered something correctly and discover that the recommendation has changed. You revisit a topic you thought you knew well and realise there is a part of it you have never properly understood. A learner asks an apparently simple question and you discover that the honest answer is not immediately obvious.

This is not limited to clinical subjects. If you teach leadership, quality improvement, research, communication or management, you still have to organise your thinking sufficiently well to make it understandable to someone else. In doing so, you often identify assumptions or gaps you had not noticed before.

That is one reason good teachers usually remain learners themselves. Teaching is not simply a process in which the more knowledgeable person transfers information to the less knowledgeable one. A good learner will question you, challenge you and occasionally make you reconsider something you had taken for granted.

A lot of doctors put off teaching because they don’t yet feel senior enough. This is quite common in the early years of training, when you may find yourself teaching somebody only a year or two behind you.

The first thing to recognise is that you do not need to know everything to be useful. A foundation doctor may be very well placed to teach medical students about the practical realities of starting work precisely because that transition is still fresh. A registrar may understand exactly what junior trainees struggle with when approaching a particular clinical problem or examination. Someone who recently learnt a procedure may remember the awkward stages that an expert has long since forgotten. Being close to the learner's level can sometimes make you more sensitive to what they need.

Obviously, you still need to teach within your competence. If you are delivering formal teaching, prepare properly, check anything that may have changed, and make sure you know where the limits of your expertise lie. If somebody asks something you cannot answer, say so rather than improvising something that sounds plausible.

Most teaching confidence comes afterwards rather than beforehand once you’ve had a go and realised that it wasn’t as bad as you feared. The first few sessions can feel awkward because you are spending a lot of mental energy wondering how you sound, whether people think you know enough and whether someone will ask the one question you hope will not come up.

Once you have developed enough experience, your attention shifts. You become less preoccupied with yourself and more interested in the people you are teaching, you notice when an explanation has lost them, you become more comfortable changing tack and you stop regarding a difficult question or an unexpectedly flat session as a personal disaster. That is usually when teaching starts to feel much more enjoyable.

Everyone can remember a few teachers who stood out, people we wish we could emulate. I remember my history teacher from when I was 13 years old for her story telling abilities and her ability to make medieval history remotely palatable. I remember my Latin teacher from the same period for making dry texts come to life and I thank my English teacher from when I was 15 for not insisting on making me love Shakespeare and making me realise there is life outside of the classics. We often describe these teachers as engaging, enthusiastic or inspiring, but those words are not very useful if you are trying to improve your own teaching. They represents emotions and feelings rather than practical tools.

It is better to watch what they actually do. Some teachers are particularly good at working out what a group already knows before deciding where to begin. Others are excellent at making a complicated idea feel manageable. A good presenter may structure forty minutes so clearly that the audience always knows where they are going. A strong facilitator may ask a question and then be comfortable enough to let the room stay quiet for a few seconds while people think.

Pay attention to what they leave out as well. Doctors usually know far more about the subjects they teach than their learners need at that particular moment. And therefore a good teacher should be able to distinguish essential understanding from interesting detail.

Observe how good teachers deal with people too. Do they make learners feel able to admit they do not know? Is the teacher able to challenge an incorrect answer without making the person regret having spoken?

Poor teaching can teach you just as much. If a presentation loses you, try to work out why. Perhaps there was too much content, the structure unclear, every slide looked the same or the speaker didn’t give you any reason to care about the subject. If a workshop felt frustrating, perhaps it was because the group had no clear task, or because the facilitator stepped in every time a discussion became interesting.

Once you start noticing these things, teaching becomes easier to analyse. You stop thinking that some people simply possess a mysterious talent and begin seeing the smaller decisions behind what they do.

One of the easiest habits to fall into is starting with the subject.

You are asked to teach heart failure, safeguarding, leadership, quality improvement or communication skills, so you immediately begin thinking about everything you know and what ought to go onto the slides.

The more useful starting point is the learner.

Who are they? What experience do they already have? Why are they attending? What do they actually need from you?

A session on quality improvement for medical students should not look like a workshop for consultants expected to lead a service redesign. A presentation about communication for new foundation doctors should probably emphasise different things from an advanced workshop for experienced consultants. Even when the title is identical, the educational problem can be completely different.

You do not need an elaborate needs assessment before every teaching session. Sometimes a conversation with the organiser is enough. With a smaller group, simply asking at the beginning what experience people have and where they tend to struggle may tell you a great deal.

There is also a useful distinction between what learners say they want and what they actually need. Someone may ask for more theory because that feels familiar, when what they really lack is an opportunity to practise. A group may request another presentation when the problem is not lack of information but difficulty applying it.

Starting with the learner stops teaching from becoming an exercise in emptying the contents of your head into somebody else's.

Once you know who the learners are, work out what you want to change. It sounds obvious, but it is surprisingly easy to plan a teaching session without being clear about its purpose. Doctors are particularly prone to trying to cover too much. When you know a subject well, everything feels connected and important. A thirty-minute session gradually expands to include background, theory, current evidence, unusual exceptions, controversies, recent papers and several things that are fascinating to you but not especially useful to the audience.

If you want help in leaving things out, make sure you define your learning outcome first. Perhaps by the end of the session you want someone to recognise a deteriorating patient and know what to do first. Perhaps you want a group of consultants to understand how to approach resistance to change. Perhaps you want participants to be able to structure a difficult feedback conversation or present a service-development proposal clearly. Those are much more useful objectives than “understand leadership” or “know about sepsis”.

They also influence how you teach. If learners need to remember information, explanation may be enough. If they need to use the information, give them a problem. If they need to perform something, they need practice. If they need to weigh competing options, discussion is likely to be more useful than another twenty slides.

This changes how you judge the session as well. Finishing the PowerPoint is not the objective. The objective is whether the learners are now better able to do what you hoped they would be able to do.

Many of us start teaching through presentations because, having sat through thousands of them, presentations are what we know. A good presentation can explain a complicated idea efficiently, create structure and teach a large group of people at once, but it is not the best solution to every educational problem.

If you are trying to develop reasoning, a case may work better. If you want learners to practise communication, role-play or a simulated scenario gives them something they cannot get from listening. Practical skills require demonstration and rehearsal. A small group can be ideal for exploring several reasonable approaches to a problem. Simulation is particularly useful when different capabilities need to come together under pressure.

Sometimes the best teaching is a mixture. You might spend ten minutes explaining an idea, then give the group a problem to work through, bring them back together to compare their reasoning and finish by drawing out the principles. As your experience develops, you should become less attached to one preferred method and more comfortable asking what the learning requires.

Our separate guide to Teaching Methods for Doctors: A Practical Guide to Clinical Teaching Techniques looks much more deeply at why different methods work, including constructive alignment, Bloom's taxonomy, Miller's pyramid, experiential learning, cognitive load, scaffolding and simulation.

Doctors give a lot of presentations. You find them being heavily used in departmental teaching, journal clubs, conferences, induction, grand rounds, webinars and generally most courses.

Obviously, it is worth becoming good at presenting, but presentation skill and teaching skill are not identical. A beautifully designed presentation can still be educationally poor if it contains the wrong material, if it is pitched at the wrong level or if it leaves the audience with no clearer understanding than they had at the beginning.

The opposite is also true. You do not need spectacular graphics or theatrical delivery to teach effectively. Sometimes a clear explanation, a well-chosen example and a simple diagram are all that is required.

The most common problem is usually excess. Experts know too much about their subjects, so slides become crowded and presentations become attempts to include everything that might conceivably matter. Unfortunately, every additional detail competes for the learner's attention. Try deciding what you want people to remember before you design the slides. Build the argument first and then decide what visual material genuinely supports it.

Think about the audience's experience of the presentation as well. If they are trying to read six lines of text while listening to you explain something different, one of those things will lose. If a diagram is complicated, guide people through it rather than placing the whole thing on screen and assuming everyone sees what you see. My anger levels always rise significantly when someone presents a graph with 10 lines, a legend in Font Size 3 and spends just 5 seconds telling you that the graph shows clearly that the results have improved when you don’t even know what they are showing you in the first place.

Remember also that interaction does not automatically mean gimmicks. A good question, short case or brief discussion can make people think. That is far more useful than adding an activity simply because you have been told presentations should be interactive.

We will cover this in more detail in our separate guide to How to Give an Effective Presentation.

As you become more confident, teaching often becomes less about how well you speak and more about how well you get other people thinking. And that is where facilitation comes into play. Just because you have a small group of people around a table doesn’t mean that they are going to engage.

Good facilitation gives the learners something useful to work with. It might be a case, dilemma, problem, decision or scenario. Your job is then to keep the discussion productive without feeling that you must provide every answer yourself.

That is actually harder than it sounds. Our brains do not like uncertainty; so when you know the answer, it is tempting to end that uncertainty quickly and give the answer. But often the discussion between learners is where the useful thinking is happening.

You also need to notice the group itself. One enthusiastic person may answer every question. Somebody quieter may understand the issue very well but never get into the conversation. Two people may begin debating something genuinely useful while you are tempted to drag them back to the point

Facilitation therefore involves judgement. Sometimes you explain, sometimes you ask another question, sometimes you bring someone else in and at other times you let the conversation run. The aim is not to make everybody speak equally but to stop the teacher from doing all the thinking.

You don’t approach teaching one person, ten people or a hundred people in the same way, even if it’s the same topic.

On a one-to-one basis, you can adapt constantly. You can ask where they are struggling, you can observe their response and you change direction quickly.

In small groups, you can allow people to learn from each other. They can compare approaches, they can challenge assumptions and they can also contribute their own experience. In that setting, your role becomes partly one of facilitation.

If, however, you are teaching a large group, you have a lot less flexibility, but that doesn’t mean your teaching has to be passive. You can still ask questions, use polls, give people short problems, ask them to predict an answer or let them discuss something briefly with the person beside them.

The mistake is trying to transplant a method unchanged from one setting to another. A workshop designed for eight people will not necessarily work with eighty. Equally, if only six people have turned up, you probably need to ditch the formal lecture you had prepared and take advantage of the small group to make the session much more interactive.

Online teaching is now normal. It allows doctors from different hospitals, regions and countries to learn together and has made educational opportunities far more accessible.

Having said that, it also changes the teaching environment. It is harder to read a room. Some learners will have cameras off because they’re shy. Others may be interrupted by work. Email and messaging are sitting immediately beside the teaching window. Sixty minutes of uninterrupted talking can therefore feel even longer online than it does in person. In some of my own teaching sessions on Zoom, I had people who did the washing up or even went to the toilet with their camera on!

If you want to produce good online teaching, you need a more deliberate structure. Questions, chat, polling, breakout rooms and short activities can help, but only when they serve a useful purpose. A poll is not automatically educational simply because everyone clicked an answer. A breakout room is not good teaching merely because it is interactive.

Hybrid teaching can be particularly difficult because the people in the physical room naturally dominate. If some learners are online, someone needs to pay deliberate attention to them rather than leaving them as spectators. The technology changes the setting, but it does not change the basic principles of good education.

Teachers sometimes use questions mainly to find out what learners do not know. But there is so much more you can achieve with questions. A good question can tell you what people already understand, it can reveal a misconception, it can make someone apply a concept, it can stimulate discussion or it can expose how they reached a conclusion.

You can also vary the intellectual level of the question. You can test recall by asking someone to list causes. Asking which explanation fits a particular situation requires application. And you can explore someone’s judgement by asking what would make them change their view.

This works also outside clinical teaching. In a leadership workshop, you can ask why a change programme might fail. In a governance session, you can ask what information is missing before deciding what action to take. In a presentation course, you show two slides and ask which communicates more clearly and why.

What is important is that you give people time to think. Doctors are terrible for asking a difficult question and answering it themselves two seconds later. If somebody gets something wrong, resist the urge to correct immediately. Ask how they have reached the answer. Their reasoning is often much more useful than the answer itself. The objective is not to keep questioning until the learner fails, but to understand where they are and help them move a little further.

Learning involves a degree of risk. People have to expose what they don’t know. Sometimes they have to try something they can’t yet do well and, occasionally, they have to get things wrong in front of other people.

No one likes public humiliation. If learners get ridiculed for giving a wrong answer, or find themselves on the receiving end of sarcasm, eye rolling or other means of visible irritation, they will adapt quickly. Typically, they stop volunteering, they avoid questions and they generally become more focussed on protecting themselves than on learning.

Don’t take this to mean that good teaching must always feel comfortable. You can be demanding, and challenge poor reasoning. You can tell somebody clearly that something is not good enough. After all it is important that you maintain high standards. The difference lies in whether the challenge is directed at improving performance or at making the person feel foolish.

This matters beyond the teaching session. Medicine needs people who are comfortable admitting uncertainty and asking for help. Educational environments that punish uncertainty can inadvertently teach the opposite behaviour. Psychological safety and high standards are therefore not alternatives. Good teachers create enough safety for learners to expose the things that need work.

If somebody needs to be able to do something, they eventually need to have a go at performing it. Watching a demonstration can be useful, but it is only the beginning. Nothing beats proper practice. Experienced doctors often forget how much they have automated. A procedure, an examination technique or a communication task that now feels natural may originally have involved dozens of separate decisions.

Do you remember the first time you took a patient history? You probably worried about missing a question or asking things in the wrong order, and mentally worked your way through a checklist. Now you probably miss questions out all the time, change the order depending on what the patient tells you and follow completely different lines of enquiry. The difference is that you now know what matters. If you lose your train of thought or the conversation goes somewhere unexpected, you know how to find your way back.

Teaching develops in much the same way. When you first start, you may rely heavily on a lesson plan, your slides or a particular teaching structure because they give you something to hold on to. With experience, you become less dependent on the plan and more responsive to the people in front of you. You can follow an unexpected question, spend longer on something the group is struggling with, abandon an activity that clearly isn't working and still find your way back to what you wanted people to learn.

When teaching a practical skill, slow yourself down. Explain the important stages and, where useful, the thinking behind them. Then give the learner an opportunity to try. Do not correct everything at once. A beginner may already be concentrating intensely on the sequence, equipment, communication and their own movements. Adding seven simultaneous corrections can simply overwhelm them. Choose what matters most, let them try again and build from there.

This principle applies to much more than procedures. If you want someone to improve their presentation skills, they need to present. If they need to give feedback, they need to practise feedback. If they are learning leadership conversations, they need an opportunity to have one. Listening to somebody explain a skill is not the same as performing it.

Cases are useful because they move learning away from recognition and towards application. A learner can nod throughout an explanation and still have no idea how to use the information.

Give them a problem and you discover very quickly. The case does not have to involve a patient. It could be a struggling team, a failed change project, a complaint, a research paper or a difficult teaching scenario.

You can also let the problem evolve. Introduce another piece of information. Change one condition. Ask what would alter their decision. This is much closer to real professional work, where information is incomplete and circumstances change. It also gives the teacher better information. If learners struggle, you can see where the difficulty lies instead of assuming that silence during a presentation meant understanding.

Teaching has an unfortunate tendency to make us feel that we ought to know every answer. Of course, we don’t. If someone asks you a question that you can’t answer, it’s usually best to say that you are not sure, then check it out. Look at the evidence together and if needed, come back to it later.

There is zero point in pretending to know something. Aside from the fact it models precisely the wrong professional behaviour, if you get found out, you will lose your credibility.

I learnt this relatively early in my own teaching career. When I first started coaching doctors for NHS consultant interviews more than twenty years ago, a candidate asked me to help with a presentation on translational research in paediatric nephrology at Great Ormond Street. I knew about presentations and consultant interviews. I knew nothing meaningful about translational research in paediatric nephrology. Unfortunately, I was keen to be helpful and assumed that because the candidate saw me as the expert, I ought somehow to contribute to the content. I tried reading around the subject and ended up straying into something I did not understand well enough to be useful. What I should have said was much simpler: this is your clinical and academic area, not mine. Prepare the content and I can help you make the argument clear, structure the presentation and communicate it effectively.

That is exactly what I would do now. Knowing where your expertise ends does not undermine you as a teacher. It generally makes you more credible.

Good teaching is not simply about delivering a session and moving on. Part of becoming a better educator is noticing what learners are doing, giving them useful feedback, finding out how they experienced your teaching and then using that information to improve what you do next time. That means thinking about feedback in both directions: the feedback you give to learners and the feedback you receive about your own teaching. It also means looking beyond whether people enjoyed a session and asking whether your teaching actually achieved what you intended.

---

Give feedback that helps people improve

Good teaching involves helping people understand their performance, not simply delivering content. Feedback is therefore a central part of the process.

The problem is that a lot of feedback is too vague to be useful. Teachers are probably well intentioned when they say things such as “Excellent”, “Good job” or “You need more confidence”, but the learner is left to guess what behaviour they should repeat or change.

Useful feedback is more specific. If a presentation was hard to follow, explain why. If the introduction was too long before the main argument became clear, say so. If a learner facilitated a group particularly well, identify what they did that allowed quieter people to participate.

The difficulty is that teachers do not always know what the problem actually is. Sometimes you can see that something is not working, but identifying why it is not working, and therefore what the learner should do differently, requires considerably more insight.

I see this quite often on our consultant interview courses. Candidates come to me after doing several mock interviews with colleagues and tell me they have repeatedly been given feedback such as “You need to be more personal” or “You need to give more examples.” Their colleagues have correctly recognised that the answer is not working, but the feedback has not helped the candidate very much because nobody has explained what is actually missing, what they should say instead or how an example could be used to make the answer stronger.

Giving good feedback therefore requires more than being able to spot a weakness. You need to be able to diagnose the reason for it. That often comes with experience. An experienced teacher starts to recognise the different reasons why somebody might make the same apparent mistake. Perhaps they have misunderstood the underlying concept. Perhaps they understand it but cannot apply it. They may be concentrating on so many things at once that they become overloaded, or they may simply have misunderstood what the task requires. And sometimes, they have just not been listening.

Those different causes require different responses. More explanation will not necessarily help somebody who already understands the theory but needs practice, just as repeated practice may not solve a problem caused by a fundamental misunderstanding. The better you understand what may be happening in the learner's mind, the more likely you are to give feedback that actually helps them improve rather than simply describing what went wrong.

It is also worth hearing the learner's view first. They may already know what did not work, or they may see the situation very differently from you. Not every teaching encounter needs a formal feedback model either. Sometimes one clear observation and one useful suggestion are enough.

The more difficult conversations come when performance is poor, the learner disagrees with you or there are wider professional implications. Those require more thought, which is why we cover them separately in Giving Effective Feedback in Medical Education: A Guide for Doctors.

---

Ask for feedback on your own teaching

If you teach regularly, you also need some way of discovering what it feels like from the other side. Learners can highlight not only the things you overlook, but also areas you think you are performing well in that actually need improvement. You may think the pace is fine when half the group is struggling, or discover that the part you considered most important was not what they found most useful.

Rather than simply asking “Did you enjoy the session?”, ask questions that give you something useful to work with. What helped? What remained unclear? Was anything pitched wrongly? What would they change?

Numerical scores can be useful, particularly if you repeat the same course or programme and want to follow trends over time. But a score of 4.9 out of 5 mainly tells you that people liked it. It does not necessarily tell you what they learnt. Personally, I don't find an individual numerical score particularly useful because if somebody scores me 4 out of 5, I still have absolutely no idea what I need to change. Written comments are messier, but often much more revealing.

Peer observation can be valuable too. Another teacher may notice habits that you cannot see yourself: answering your own questions too quickly, overloading slides, using jargon, talking predominantly to one side of the room or allowing two participants to dominate.

Whatever method you use, look for patterns rather than reacting dramatically to every individual comment.

---

Interpret feedback in context

I have always had mixed feelings about anonymous feedback. I understand why it is used, particularly in medicine where differences in seniority can make learners understandably reluctant to criticise somebody who teaches or supervises them. There is some evidence to support that concern. Studies have found that people may give lower ratings or more constructive criticism when their identity is protected, suggesting that anonymity can make it easier to say things that might otherwise remain unsaid.

What the evidence does not show, however, is whether anonymous feedback is better feedback. Studies comparing anonymous and identifiable evaluations have not consistently found anonymous comments to be more informative or higher quality. There is a trade-off: anonymity may increase candour, but it can also remove some of the context and dialogue that help the recipient understand what the feedback actually means.

That context matters. If somebody has been negative about virtually every aspect of a course and then criticises one particular activity, I will still take the comment seriously, but I will interpret it differently from feedback from a learner who has been engaged and positive throughout the course and then identifies one specific thing that they thought did not work. If somebody who has been overwhelmingly positive suddenly says, “I really struggled with this part”, that is likely to make me sit up and take notice.

The learner's background matters too. If someone tells me that a session was too basic, it is useful to know whether that person was considerably more experienced than the intended audience. Conversely, if somebody says it moved too quickly, I want to know whether they were relatively new to the subject. Neither comment is necessarily wrong. They are describing the experiences of two different learners, and that context helps me decide what, if anything, needs to change.

Knowing who gave the feedback can also give you an opportunity to understand it properly. If somebody tells me that a section was confusing, I want to know what confused them. Was I going too quickly? Had I assumed knowledge they did not have? Was my explanation poor? Was there too much information on the slide? Did they understand the concept but not how to apply it? An anonymous comment can tell me there was a problem without necessarily giving me enough information to diagnose it.

None of this means identifiable feedback should always be preferred. In some educational relationships, the power imbalance is substantial enough that learners may simply not feel able to be candid, and anonymity may therefore be important. The sensible conclusion is that anonymity and usefulness are not quite the same thing. Anonymity may make difficult feedback easier to give, while knowing its source and context can make that feedback easier to understand and act upon.

---

Look for evidence that your teaching worked

Learner satisfaction matters, but ultimately you want to know whether the teaching achieved its purpose. If the aim was to help someone understand a concept, can they explain it afterwards? If they needed to apply it, can they use it in a different example? If you designed a programme to change practice, is there any evidence that practice actually changed?

It would be absurd to carry out an elaborate evaluation after every ten-minute teaching interaction. But the larger the educational intervention, the more reasonable it becomes to ask whether it worked. A six-month programme consuming substantial faculty time deserves more than a final questionnaire asking whether people enjoyed it.

Moving from wanting to know whether people enjoyed your teaching towards wanting to know whether it made a useful difference is an important part of becoming a more thoughtful educator.

---

Reflect on what you will do differently next time

Not everything you learn about your teaching comes from feedback forms. Sometimes you just know something did not work. You lost your audience somewhere along the way, they stopped engaging, you ran out of time, or an explanation that usually works made no sense to this particular group. It is always annoying when the joke that had one audience in stitches is met with stone-cold silence by the next. Sometimes you get the much nicer surprise too: something you thought was your weak point actually worked extremely well.

Reflection is really about being curious enough to ask why. You do not need a 500-word reflective essay after every session. Perhaps you assumed knowledge the group did not have. Perhaps the task was poorly explained to the point that you managed to confuse yourself. Perhaps something about that particular group or situation made an approach that normally works much less effective.

Those observations are useful because they give you something to change or test next time. Reflection matters when it changes your teaching. It matters considerably less when it exists mainly because a portfolio requires a paragraph.

At some point, many doctors move from teaching sessions to organising teaching. You may take responsibility for a departmental programme, induction course, simulation series or regional teaching programme. This requires a different level of thinking.

Instead of asking what you personally should teach next Wednesday, you start asking what the learners need across several months. which subjects matter, what should happen first. where is there unnecessary duplication, which topics need explanation and which need practice and who is best placed to teach them. Otherwise, programmes have a habit of becoming a succession of talks based mainly on whichever consultants volunteered to deliver them. This leads to random selections of topics

There are practical issues too: speakers can cancel, participants often rotate, clinical pressures intervene, and if the programme depends entirely on one enthusiastic doctor chasing everyone every week, it may not survive for long.

You also need to think at programme level about evaluation. You might find that every individual session receives good feedback but an important learning need has been completely missed. This is where teaching begins to become educational design and leadership. Instead of trying the best way to teach your favourite subject, you need to determine what learning problem you are trying to solve, and what the best way of solving it is. That is a much more interesting and far more complex challenge.

You can become a good teacher through experience, but experience does not automatically make you better. It can just make you extremely practised at doing the same thing. You may have delivered essentially the same presentation for five years and become very polished at it without ever asking whether it is still the best way to teach the subject. Structured teaching training gives you an opportunity to examine your habits.

A good Teach the Teacher course should make you think about learner needs, objectives, teaching methods, presentation structure, facilitation, questioning, feedback and evaluation. It should also give you opportunities to try things rather than simply listen to someone explain educational theory. This becomes particularly valuable when you already have some experience. Ideas about disengaged groups, difficult feedback or presentation structure suddenly connect with real situations you have encountered yourself.

The certificate is the least interesting part. The useful part is coming away thinking ‘I do that all the time and I'm not sure why’, or ‘I've never tried approaching it that way’. That is what structured development should do.

---

Take the learning back into your own teaching

The real test of any teaching course is what happens afterwards. Do not try to change everything simultaneously. Pick one or two things. Perhaps you recognise that you routinely begin presentations without establishing what the audience needs. Maybe you realise that your feedback is encouraging but rather vague. Perhaps nearly all your teaching involves slides because that is what you feel most comfortable doing. Try something different deliberately and see whether it works.

You may need to adapt the technique. Something that works beautifully on a course may need adjusting for a busy clinical department or a very senior audience. Occasionally, you will try an approach and decide it does not suit the situation at all. That is perfectly normal and you will learn a lot from this too. Formal training should make you more thoughtful, not more rigid.

---

When does a PGCert in medical education make sense?

For many doctors, teaching remains one part of a broader clinical career. They teach regularly, perhaps supervise others, and want to become better at it without making medical education a major professional focus. For them, practical teaching development may be entirely sufficient.

For others, education gradually becomes something more substantial. They become interested in programme design, assessment, curriculum development, supervision, faculty development or educational leadership and want to understand the academic thinking behind these areas in much greater depth. That is when a PGCert in Medical Education can start to make sense.

A PGCert is not simply a longer Teach the Teacher course. It usually involves sustained postgraduate study, engagement with educational literature, academic assignments and a much deeper examination of how learning, teaching and assessment work. It is also a considerably greater commitment of both time and money, and you certainly do not need one to become a good clinical teacher.

One of our trainers, Jaiden, recently completed a PGCert in Medical Education after first developing his teaching through practical training. His experience illustrates the distinction well. Practical teacher training helped him develop skills he could use immediately in the classroom, while the PGCert gave him the opportunity to explore medical education at a much deeper academic level.

If you are considering taking that next step, read Jaiden's experience of completing a PGCert in Medical Education, including why he chose to do it, how he fitted it around clinical work, the workload and cost involved, and whether he felt the qualification was ultimately worthwhile.

There is no point at which you suddenly become a fully developed teacher. As your clinical career progresses, the educational challenges you encounter change too. Early on, you may be concentrating on explaining things clearly, choosing appropriate teaching methods and feeling confident in front of a group. Later, the emphasis may shift towards facilitation, feedback, supervision, programme design and eventually educational leadership.

The important thing is not to accumulate teaching activity for its own sake, but to keep developing in ways that match the educational responsibilities you are taking on.

---

Move from teaching towards supervision and leadership

As doctors become more senior, their educational role often becomes less about individual teaching sessions and more about developing people over time.

You may begin supervising somebody across an entire placement rather than helping them with one task. That means thinking about their progress, strengths, weaknesses and the support they need. Sometimes the challenge is straightforward. At other times, a learner who appears to be struggling educationally may be dealing with something much more complicated: health problems, difficulties outside work, poor team relationships or an environment that is not giving them appropriate opportunities.

You may need to give difficult feedback, document concerns, involve other people and balance support for the learner with your responsibilities to patients and colleagues. These are rather different skills from delivering a good presentation.

Your role may eventually broaden into educational leadership. You might lead simulation, oversee undergraduate teaching, organise a regional programme, design a teaching programme or help develop other teachers. At that point, success becomes less about whether you personally deliver an excellent teaching session and more about whether you create an environment in which other people can teach and learn well.

It is a significant shift, but the foundations are remarkably similar to the skills you developed much earlier: listening, observing, asking good questions, giving useful feedback and adapting your approach.

---

Develop according to what you need next

Each stage of teaching exposes different strengths and weaknesses. Someone who is excellent at presentations may find small-group facilitation unexpectedly difficult. Someone who teaches brilliantly one-to-one may struggle to manage a large audience. An experienced lecturer may discover that giving direct feedback to a struggling colleague is far harder than standing on a stage. Rather than asking whether you have accumulated enough teaching experience, ask what you need to become better at next.

If you rarely teach, do more of it. If every session you give is a PowerPoint presentation, broaden your methods. If you avoid feedback because you find it uncomfortable, work on feedback. If you already teach confidently but have never thought much about educational design, start looking beyond individual sessions.

Formal development should follow the same logic. A Teach the Teacher course may help you challenge established habits and broaden your repertoire. Supervisor training becomes more relevant when you start taking responsibility for trainees. A postgraduate qualification may eventually make sense if medical education becomes a significant professional interest.

There is no single pathway that every doctor needs to follow. Your development should reflect the educator you are becoming and the responsibilities you are taking on.

---

Don't turn teaching into a portfolio exercise

Teaching can contribute to specialty applications, appraisal and future educational roles, so of course it makes sense to keep evidence of what you do. The danger comes when collecting the evidence becomes the purpose of the teaching.

Doctors sometimes create new teaching programmes because organising one attracts more recognition than contributing to an existing programme, even when learners do not particularly need another one. Feedback gets collected because somebody needs a spreadsheet or certificate rather than because anyone intends to learn from it. That is the wrong way round.

Start with the educational need. If something genuinely needs teaching, teach it. If an existing programme could be better, improve it rather than creating another one. Collect feedback because it tells you something useful, and use it to make the teaching better. Keep evidence as you go so that you can demonstrate what you have done and how you have developed afterwards.

Your portfolio should record your development as a teacher. It should not be the reason the teaching existed in the first place.

Ultimately, developing as an educator is a career-long process. You do not need to follow everybody else's path or collect every possible teaching qualification. You simply need to keep asking what would make you a better educator at the next stage of your career, and develop alongside the educational responsibilities you take on.

Developing as a teacher is not really about accumulating techniques, educational theories or certificates. Those things can help, but the bigger change is that you become increasingly deliberate about what you are doing.

You think more carefully about who is learning, what they actually need and why you are choosing a particular approach. You become more comfortable moving between explaining, presenting, questioning, facilitating, demonstrating and stepping back. You get better at recognising when people have understood and when they have simply nodded politely.

Over time, your attention also moves beyond your own teaching performance. You begin thinking about programmes, supervision, other teachers and the wider environment in which learning happens. That is the progression from simply doing some teaching to becoming an educator.

If you want to continue developing independently, explore Teaching Methods for Doctors: A Practical Guide to Clinical Teaching Techniques for a deeper look at different approaches to teaching, or Giving Effective Feedback in Medical Education: A Guide for Doctors for one of the most important, and sometimes most difficult, aspects of clinical education.

If presenting is the part you find more challenging, or you want to become more confident and engaging in front of an audience, our Public Speaking & Advanced Presentation Skills Course for Doctors and Healthcare Professionals focuses specifically on developing those skills. It is particularly relevant if nerves, delivery, audience engagement or handling questions are limiting your confidence when teaching or presenting.

For broader structured development as a clinical teacher, ISC Medical's Teach the Teacher Course for Doctors and Healthcare Professionals is available as a one-day Essentials programme and a two-day Comprehensive programme, both designed around the real teaching situations doctors and other healthcare professionals encounter.

And if your interest in medical education is developing towards more substantial postgraduate study, read Is a PGCert in Medical Education Worth It? My Experience as a Doctor and Clinical Teacher, written by our trainer Jaiden after completing the qualification himself. It provides a first-hand account of what he gained from the PGCert, as well as the workload, cost and practicalities of fitting it around clinical training.