What is NEST?
A Practical Framework for Bringing Adaptive Learning and Coaching Behaviors into Everyday Clinical Teaching
NEST (Nurturing Education through Structured Teaching) is a rapid-cycle clinical teaching framework designed to help faculty and learners make everyday clinical encounters more intentional, reflective, and growth-oriented.
Grounded in the Master Adaptive Learner (MAL) framework, coaching principles, and competency-based medical education (CBME), NEST provides a practical structure for translating established educational principles into the realities of clinical teaching.
Rather than introducing a new theory of learning, NEST provides a structured, point-of-care approach for supporting learner agency, critical thinking, reflection, targeted feedback, and collaborative goal setting within routine clinical care.
From the Master Adaptive Learner Cycle to Clinical Teaching
The Master Adaptive Learner cycle describes an iterative process of planning, learning, assessing, and adjusting that supports continued learner development.
The challenge for clinical educators is often not understanding that these processes matter, but incorporating them consistently within busy clinical environments.
NEST was designed to help bridge that gap.
By structuring a brief teacher–learner interaction around MAL-aligned behaviors, NEST provides faculty with a repeatable approach for bringing adaptive learning and coaching principles into everyday clinical teaching.
The NEST Framework
The NEST Teaching Cycle
NEST guides clinical teaching through five connected phases:
1. Name the Need
Learner selects a learning focus.
The learner identifies what they want to focus on during the clinical encounter, such as physical examination, communication, clinical reasoning, or another relevant skill.
Beginning with a learner-selected need promotes learner agency and establishes a shared focus for observation and teaching.
2. Explore the Experience
Faculty observe the learner and prompt critical thinking.
The learner participates in the clinical encounter while the educator deliberately observes performance. Targeted questions can be used to make the learner’s thinking visible and explore clinical reasoning.
This gives the educator direct information about both what the learner does and how the learner thinks, creating a meaningful foundation for subsequent reflection and feedback.
3. Self-Reflect & Receive Feedback
Learner reflects; faculty provide targeted feedback.
After the encounter, the learner first considers their own performance—what went well, what was challenging, and what they might approach differently.
The educator then provides specific, behavior-based feedback informed by direct observation and the learner’s reflection.
Placing reflection alongside feedback encourages learners to actively assess their own performance rather than functioning only as recipients of faculty judgment.
4. Target the Next Step
Collaboratively identify a specific next step.
Faculty and learner identify a focused, achievable next step based on the learner’s experience, reflection, and feedback.
This turns feedback into an intentional plan for continued development and connects the current encounter with the learner’s next opportunity to practice.
5. Repeat the Cycle
Revisit, reflect, and refine.
During subsequent clinical encounters, learners return to the cycle with an opportunity to apply their next step, reassess their performance, and continue refining their skills.
Rather than treating feedback as the end of a teaching interaction, NEST makes it part of an ongoing cycle of learning and improvement.
Why NEST?
Clinical educators already know that observation, reflection, meaningful feedback, and goal setting matter. The challenge is making these behaviors happen consistently when clinical care is busy and teaching time is limited.
NEST provides a shared structure that helps educators move from:
learner-identified need → clinical experience → reflection and feedback → intentional next step → another opportunity to learn
The framework is designed to fit within routine clinical workflow rather than create a separate teaching activity.environment where learners understand how to grow and faculty feel confident in their teaching and coaching.
For Faculty
NEST provides:
- a repeatable structure for brief clinical teaching encounters
- a learner-centered starting point for teaching
- intentional observation of performance and clinical reasoning
- a natural sequence for reflection and targeted feedback
- a practical way to incorporate coaching behaviors into routine teaching
- a structure for translating feedback into a specific next step
For Learners
NEST supports learners in:
- identifying their own learning needs
- making clinical reasoning visible
- practicing reflection as part of clinical work
- receiving feedback connected to observed performance
- collaboratively identifying meaningful next steps
- revisiting goals across subsequent learning opportunities
Teaching & Coaching
NEST is fundamentally a clinical teaching framework.
It deliberately incorporates coaching behaviors—including learner agency, guided reflection, targeted feedback, and collaborative goal setting—within routine teaching encounters.
In this way, NEST can help bridge clinical teaching and coaching without requiring every clinical interaction to become a formal coaching session.
Designed for Real Clinical Environments
NEST was initially developed and piloted in medical student education within the newborn nursery, where clinical teaching occurs alongside the demands of patient care.
Initial implementation supports the feasibility and acceptability of using the framework within brief clinical teaching encounters. Continued evaluation will examine learner perspectives, observed teaching behaviors, learner outcomes, and implementation across additional clinical environments.
Nurture Education Design 