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The clinical context is a busy and often stressful environment and the learner/teacher relationship can often be transient or short term. Both students and clinicians complain that the learning environment is often rushed and opportunistic, given that the main focus is to care for patients and deliver good clinical teaching and that clinical sites are often geographically located away from main educational centers, it is unsurprising that the wider support and guidance roles are often not fulfilled as well as they might be.

In all aspects of medical education, the provision of guidance and support by teachers helps students and trainees to take control of their lives and gives them the skills to:

- reflect on their own objectives;

- set goals;

- adopt appropriate learning strategies;

- cope with crises;

- review and manage their personal and professional development.

But if learners are to do this it means that teachers themselves have to have the skills and knowledge required to provide effective support. Let us summarise some of the key features of an effective learner support system:

The needs of individual learners are recognized. Each student/trainee will differ in their levels of motivation and expectation, knowledge, skills and practical experiences, confidence levels and powers of problem solving

· Individuals are prepared for learning to equip them with the necessary skills and strategies and ownership of learning and to help them build self-confidence.

· Autonomy in learning is encouraged, while developing the skills of enquiry and critical thinking.

· Self-reliance is encouraged – students and trainees should be equipped to access information, advice and guidance as required and guidance systems should support this approach.

· The individual is enabled to integrate learning with practice.

· Active learner involvement is facilitated with close collaboration and partnership of all those who support the learner.

· Difficulties are anticipated and a proactive approach is taken to addressing problems Facilities for feedback are provided.

· A supportive environment is created in which students and trainees can discuss their learning and openly admit to difficulties and problems.

· There is clear identification of roles and responsibilities for information, advice and guidance and clear statements on how each responsibility area will provide the main information, advice and guidance within its remit.

· Aspects of advice and guidance are located within the relevant professional area.

· Transparent flexible systems are developed which enable both students and staff to access information and support when the need arises, thus encouraging choice and individual responsibility.

· Organisational policies and statements are in place which define the rights and responsibilities for learners.

Ideally, different elements of the guidance role should be shared by all those who come into contact with students/trainees, including medical staff and members of other health professions, academic staff administrative and managerial staff and other support staff. Guidance can include all or some of the aspects below:

· Academic: embracing subject specific guidance, advice and information on students’ overall academic programmes, feedback on assessment, academic development, learning skills and development, recognition and reflection upon learning and key skills profiling

· Professional: including advance and information on performance, continuing professional development, appraisal, careers guidance, recognition and reflection upon learning

· Learning support: including library and IT induction, specialist support for students/trainees with special needs

· Personal support: including welfare issues, financial, health and other personal issues

· Administrative support: including information and advice on all aspects of the administrative system to which students/trainees will relate

Many activities facilitate and support the learner and the learning process but they may not be directly related to ‘teaching’ in the more formal sense. Within medical education the boundaries between educational supervisors, personal tutors and mentors are often blurred. There is a lot of confusion among students, teachers and even institutions about what these various roles entail and often one person fulfils more than one role. Sometimes this is entirely logical and workable but sometimes it is not. Many medical schools have a formal personal tutor system running alongside the academic tutor system. There are conflicting views about whether one person can or should fulfil the role of a personal and academic tutor for the same group of students and institutions will differ as to the approach they take.