Studying how educational theory can be translated into practical clinical teaching.

The NEST Framework (Nurturing Education through Structured Teaching) is an educational innovation designed to support Master Adaptive Learner (MAL)-aligned behaviors within routine clinical teaching.

NEST provides a structured, point-of-care approach for incorporating learner agency, critical thinking, reflection, targeted feedback, and collaborative goal setting into brief clinical encounters.

An initial 10-week pilot in the newborn nursery evaluated the feasibility, acceptability, and perceived impact of NEST on faculty teaching practices. This work provides early proof of concept while informing larger-scale evaluation across additional clinical learning environments.

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The Educational Problem

The Master Adaptive Learner cycle emphasizes iterative planning, learning, assessment, and adjustment to support continued learner development.

Translating these processes into everyday clinical teaching can be challenging. During baseline assessment, faculty identified practical barriers to structured teaching, including time constraints, workflow demands, and limited opportunities for private feedback.

NEST was developed to help bridge this theory-to-practice gap by providing a repeatable structure that fits within routine clinical care.

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Study Purpose

The initial pilot evaluated:

• feasibility of incorporating NEST into routine clinical teaching
• faculty acceptability of the framework
• faculty perceptions of NEST’s effects on structured teaching
• faculty perceptions of its support for learner reflection and actionable feedback
• faculty perceptions of collaborative goal setting
• intentions for continued use

Because this was a small initial pilot, the study was designed to provide proof of concept and implementation experience, rather than establish effectiveness.

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Study Design

• Setting: Newborn nursery
• Learners: Medical students
• Faculty: Medical student preceptors
• Design: Educational innovation pilot with baseline and post-implementation faculty surveys
• Implementation period: 10 weeks
• IRB status: Exempt

Faculty used topic-specific NEST pocket cards during clinical teaching encounters. Baseline surveys assessed faculty perceptions of their teaching practices and barriers to structured teaching. Post-implementation surveys assessed NEST use, feasibility, perceived effects on teaching behaviors, and intentions for continued use.

Responses were summarized descriptively.

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The NEST Intervention

Faculty and learners will use NEST learning cards during real newborn nursery encounters. Each eFaculty used NEST to structure a brief clinical teaching cycle:

1. Name the Need — learner selects a learning focus
2. Explore the Experience — faculty observe the learner and prompt critical thinking
3. Self-Reflect & Receive Feedback — learner reflects; faculty provide targeted feedback
4. Target the Next Step — collaboratively identify a specific next step
5. Repeat the Cycle — revisit, reflect, and refine

This structure is designed to translate MAL-aligned learning processes and coaching behaviors into a practical approach for everyday clinical teaching.

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Initial Findings

Six of six faculty completed baseline surveys. Baseline responses identified opportunities to strengthen learner reflection, actionable feedback, and particularly collaborative goal setting.

Three faculty completed post-implementation surveys after using NEST approximately 3–5 times during the 10-week pilot.

Among post-implementation respondents:

• all strongly agreed that NEST helped them structure clinical teaching
• all strongly agreed that NEST helped elicit learner reflection
• all strongly agreed that NEST helped them provide actionable feedback
• all strongly agreed that NEST helped them collaboratively establish goals with learners
• reported implementation time was approximately 5–10 minutes
• all intended to continue using the framework

Across the four assessed teaching domains, mean post-implementation ratings were 5.0/5.0.

These findings provide initial support for the feasibility and acceptability of incorporating NEST into routine clinical teaching.

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Interpreting the Findings

These results should be considered preliminary.

The small number of post-implementation respondents and reliance on faculty perceptions do not allow conclusions about NEST’s effectiveness or its effects on learner outcomes.

Instead, the initial pilot provides proof of concept that MAL-aligned teaching behaviors can be incorporated into brief clinical teaching encounters using a structured framework.

NEST does not introduce a new theory of learning; rather, it provides a structured, point-of-care approach for translating established principles of adaptive learning and coaching into routine clinical teaching.

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Future Directions

The next phase of NEST scholarship will focus on moving beyond initial faculty perceptions toward broader implementation and more robust educational outcomes.

Future evaluation will examine:

• learner perspectives and experiences
• implementation across additional clinical settings
• feasibility and acceptability across different clinical workflows
• adaptation of NEST resources for additional clinical learning objectives
• opportunities for multi-site collaboration

The long-term goal is to determine whether a simple, reproducible teaching structure can help clinical educators consistently translate principles of adaptive learning, reflection, feedback, and goal setting into everyday clinical practice.