Outpatient clinics are intense environments: pressures of service provision conflict with effective teaching and learning (Spencer 2003). Teachers in clinic are torn between patients and learners (medical students or junior doctors) trying to serve each without compromising standards. Traditional teaching methods include ad hoc low-validity lengthy discussions often on a variety of themes dictated by the somewhat unpredictable presenting complaint of the patient. Typically this teaching style results in late running clinics and dissatisfied patients. Learners often report confused or random learning objectives as barriers to deep learning (Sobral 2001). Learning Journals are collections of notes observations and reflections which may facilitate deep effective learning (Moon 1999) (McCrindle 1995). In combination with focused objective-led teaching strategies learners can engage in self-directed learning without disruption to service commitments of the clinic.
