Educator’s guide to St Emlyn’s Lesson Plans

Teaching tomorrow

Choose a lesson for your group’s experience and the time available. Read the outcomes, cases and facilitator notes, then check the relevant clinical guidance and local pathway. Choose the case you most want to discuss and decide what you can leave out if time is short.

If you are planning a series, the curated teaching programmes provide a starting order. Reorder, omit or repeat sessions for your learners.

Choose the task, prepare the group, facilitate discussion, observe practice and give feedback. These are practical steps to adapt, not a script to follow.

• Allow about 20–30 minutes to prepare a familiar topic, plus time for any longer resource. For an unfamiliar topic or practical skill, allow more time and arrange an appropriate co-facilitator.
• Send the learner preparation link and the question shown on the lesson page.
• Check the equipment, local contacts and follow-up arrangements needed for the cases.
• Keep the final minutes for learners to explain the main decisions and choose something to practise on placement.

Using the lesson page

Choose Learner preparation at the top of the lesson page for the short preparation tasks, a question to think about and an outline of the group discussion. Choose Facilitator guide for the cases, discussion notes, timings and the no-pre-reading option.

Use Copy learner preparation link to send learners straight to their preparation. Keep the same page open for teaching and use the section links to move between learner material and facilitator notes.

Use Print facilitator guide to open your browser’s print dialogue, then choose the printer or PDF destination your browser provides.

Where a lesson offers paired practice, one learner performs while the other checks the key steps and gives feedback. Then swap. Read the setup first and allow time for both turns; you can run this after the discussion or at a follow-on session.

Learn, discuss, practise and apply

Learners do a small amount of reading, listening or watching before the group meets. The session then gives them time to apply it, explain their decisions and hear other approaches. If preparation has not happened, use the shared preparation task at the start and continue with the case.

• Prepare: establish enough shared knowledge to begin.
• Explore: introduce the clinical problem, clarify unfamiliar terms and invite initial questions.
• Discuss: make decisions, explain the reasons and reconsider them as the case develops.
• Practise when it fits the task: observe a performance, give specific feedback and repeat the part that needs work.
• Consolidate: draw together the important decisions and safety points.
• Follow up in practice: identify how to use the learning and what further help or feedback is needed.

Choose a lesson and make it local

Think about the work your learners are doing. A student may need to recognise deterioration and ask for help. A more experienced clinician may need to justify a threshold, supervise a colleague or coordinate care across teams. Use the audience label as a starting point and adjust the questions to the group.

Check the clinical review status and current guidance before teaching. Compare the decisions in the cases with your department’s pathway and confirm escalation contacts, investigation access and follow-up. If local and national guidance differ, explain the difference and clarify it with the relevant clinical lead.

• Choose two or three outcomes you can discuss properly in the available time.
• Keep preparation short and additional reading optional.
• Use the shorter run sheet when you have 30 minutes.
• For practical skills, arrange suitable equipment, supervision and observation.

Send a short preparation invitation

Send the learner preparation link a few days ahead through your usual teaching channel. Include the topic and the preparation time shown on the page, which allows for the selected reading or core listening and the brief preparation task or question.

For example: “On Thursday we will discuss chest pain. Please use the learner preparation link below and allow the time shown on the page. Think about what a normal ECG would leave unresolved in someone with abrupt pain radiating to the back. We will work through two cases together.”

Use the task and question already on the lesson page; there is no need to add another assignment or track who opened the link. If a resource is inaccessible, offer the written alternative or use the shared preparation task in the session.

Using podcasts

The lesson page distinguishes core listening from optional further listening. Core listening is included in the preparation time; optional listening can be completed afterwards. Where a written alternative is offered, learners choose one route and complete the same brief preparation task. Use the public episode link and check which part is relevant.

Check whether an episode has a transcript and provide a written alternative when listening is inaccessible. Before recommending an older episode, check the clinical points you want learners to use.

To record your listening in MedPod Learn, search for the episode title shown on the lesson page. You can listen through the public episode link.

Set up and open the discussion

Arrange the group so people can see one another. A board or sheet of paper is usually enough. Check sound and captions if you plan to play media. Online, share the case as text and accept spoken or typed contributions; leave camera use optional.

Explain how you want the discussion to work: ‘We are going to compare our reasoning. You can change your mind, ask for clarification or pass. Please challenge ideas respectfully and leave out identifying patient details.’ Be clear that a safety concern may need follow-up outside the session.

Read the opening scenario and ask, ‘What concerns you, and what would you do next?’ Give everyone time to form an answer, then invite pairs to compare. Find out what the group understands before adding an explanation.

A 45-minute session

Use the timings on the lesson page. This general example shows where each part fits. Protect the closing minutes even when a case generates a lively discussion.

• 0–5 minutes: introduce the purpose and clinical scenario; invite an initial decision from each pair.
• 5–10 minutes: discuss the preparation and resolve the knowledge gaps needed for the case.
• 10–32 minutes: work through the case, add information and compare decisions.
• 32–40 minutes: ask learners to explain three important decisions, including escalation and return advice where relevant.
• 40–45 minutes: identify an action for practice, any unanswered question and who will follow it up.
• For 30 minutes, use the lesson’s shorter plan. A typical allocation is opening 3, essentials 5, case discussion 15, consolidation 5 and reflection 2 minutes; leave out the additional case or extension named in that lesson.

If learners have not prepared

Ask without putting anyone on the spot: ‘Would a few minutes with the material help before we start?’ Use the lesson’s no-pre-reading task. It gives the group a bounded activity, such as reading an algorithm, interpreting observations or preparing a handover.

Use the time slot specified in the lesson’s fallback; it replaces part of the opening rather than adding time. Let pairs compare their answers, then continue with the case. If the group needs more help, reduce the case discussion or leave out an extension while keeping the closing minutes.

Keep the task focused on what learners need for the discussion. Use a short, identified podcast segment or written material if playing the whole episode would leave too little time. Missing preparation should not become a surprise test or a reason to abandon the case discussion.

Ask about the decision

Ask one question at a time and let the learner finish. Explore what shaped the decision. When a knowledge gap blocks progress, give a short explanation, then ask the group to apply it to the patient.

• ‘Which finding most changed your view?’
• ‘What else could explain this, and what must we consider urgently?’
• ‘What would this test change?’
• ‘What would make you change your plan?’
• ‘How would you explain that choice to the patient?’
• ‘What help would you ask for, and how urgently?’

Allow time and share the discussion

Silence may mean people are thinking, are unsure what you want or are reluctant to speak in front of senior colleagues. Wait for several seconds. If needed, narrow the question, allow a minute to write or ask pairs to talk first. Invite a contribution and allow a pass.

If one person dominates, acknowledge their point and invite another pair: ‘Let us hear an approach we have not discussed yet.’ Ask experienced clinicians to give others time to answer before adding their view.

Correct an unsafe suggestion clearly and without ridicule: ‘That could cause harm because… What led you to that plan, and what could we do instead?’ Explain the concern, explore the reasoning and give the learner a chance to try again.

Use experience carefully

Invite relevant cases without requiring anyone to disclose a mistake or distressing experience. Ask for the clinical dilemma and the details needed to understand it. Remove identifiers and unnecessary combinations of details that could identify a patient. Use the supplied case if nobody wishes to contribute.

Pause where the decision was made and ask what information was available at the time. Consider workload, team communication and access to help as well as clinical knowledge. Knowing the eventual outcome can otherwise make the earlier decision seem easier than it was.

If the discussion becomes distressing or raises an active patient-safety concern, pause, offer support and follow the local escalation route. Teaching and reflection do not replace incident reporting or clinical follow-up.

Teach groups with different experience

Use the same case and vary the questions. Ask less experienced learners to recognise the problem, describe an initial assessment and say when they would seek help. Ask experienced learners to justify a threshold, manage competing risks or explain how they would supervise that assessment. Avoid a running critique of the junior learner’s performance.

Distinguish a gap in recall from uncertainty in the evidence or a local policy question. Look up forgotten information together. For contested decisions, compare benefits, harms, evidence and patient preferences. For a local question, identify someone who can resolve it. Say when you do not know and agree who will follow up.

If the discussion drifts, return to the patient: ‘In our department tonight, what would you do next and why?’ Record useful side questions for later discussion.

Close the session

Ask learners to summarise the decisions before adding your own explanation. Compare their answers with the lesson’s key messages and correct any remaining safety-critical misunderstanding. A short variation on the case can show whether they can apply the reasoning.

Allow a minute to choose an action for practice: ‘When I next see…, I will…’ Ask what support or supervision is needed. Learners can reflect privately, with a supervisor or in an anonymised note; they do not have to share a personal reflection with the group.

At a later teaching or supervision meeting, ask whether the action was tried and what happened. Use the answer to decide what practice or feedback is needed next. A confident discussion does not establish independent competence.

Educational rationale

This approach gives learners time to explain clinical decisions and receive feedback. Emergency medicine studies of flipped teaching have reported mixed results on knowledge tests. Changing when material is presented does not by itself guarantee better learning, and those studies do not establish that this lesson library improves patient outcomes.

Miller’s assessment framework distinguishes knowing, applying knowledge, demonstrating a skill and performing in practice. Case discussion can reveal applied understanding; a practical or simulation activity can allow an observed demonstration. Judgements about workplace performance require appropriate workplace observation.

Use the discussion to identify what learners need next. Further supervised practice, feedback or assessment may be as useful as resolving the case itself.

About the lesson plans

Iain Beardsell published the original guide on 6 June 2020, during the disruption to teaching caused by COVID-19. It brought together accessible resources, clinician-led case discussion and reflection, allowing preparation either before or within the session.

Evidence and further reading

1. Beardsell I. Guide to the St Emlyn’s Lesson Plans (2020) — Original educational approach, authorship and publication date.https://www.stemlynsblog.org/lesson-plan-guide/
2. Miller GE. The assessment of clinical skills/competence/performance (1990) — Original assessment framework; a teaching session is not evidence of independent workplace performance.https://doi.org/10.1097/00001888-199009000-00045
3. Riddell J et al. Does the Flipped Classroom Improve Learning in Graduate Medical Education? (2017) — Randomised crossover study in emergency medicine; differences in knowledge-test outcomes were small and mixed.https://pmc.ncbi.nlm.nih.gov/articles/PMC5559246/
4. Dubey E et al. Flipped classroom versus traditional lecture for atraumatic back pain (2023) — Small study in emergency medicine; it did not establish noninferiority for knowledge acquisition. Absence of a significant difference is not proof of equivalence.https://journals.sagepub.com/doi/10.1177/23821205231193283
5. GMC and partners. The reflective practitioner — Reflection should identify learning and future plans; it does not replace other required clinical or safety processes.https://www.gmc-uk.org/-/media/documents/dc11703-pol-w-the-reflective-practioner-guidance-20210112_pdf-78479611.pdf
6. GMC. Anonymising reflective notes — Removing a name alone may not prevent identification; retain only the detail needed for learning.https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/the-reflective-practitioner—supplementary-guidance-for-medical-students/anonymising-reflective-notes