The findings support the view that real patient encounters can act as a powerful driving force for learning and enhance integration of theory and practice. Student learning might benefit from: better information to students and teachers regarding educational objectives, teacher training and careful selection of patients. In order to gain more insight into learning from patient encounters, further studies should address students' and teachers' views and behaviours in respect of this type of learning.

To acquire professional competences that entail performance of complex skills, an authentic learning environment is required focused on the integration of all aspects of competences. However, most educational programmes offer separate building blocks, such as separate modules for knowledge and skills. Students accumulate what they have learned in these modules as they progress through the curriculum. In this paper the authors advocate the Four-Component Instructional Design model (4C/ID), which offers a whole-task approach to course design for programmes in which students learn complex skills. The four core components of this approach are: learning tasks, supportive information, just-in-time information and part-task practice. A concrete example from medical education will be presented to clarify both the general ideas behind this approach and the differences between the whole-task approach and conventional educational designs.

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Many medical schools evaluate the performance of their tutors by using questionnaires. One of the aims of these evaluations is to provide tutors with diagnostic feedback on strong and weak aspects of their performance. Although everyone will agree that students are able to distinguish between poor and excellent tutors, one can question whether students are also able to differentiate between tutors with different tutoring deficienciestutors who perform badly on a specific key aspect of their performance. The aim of this study was to investigate to what degree students are able to differentiate between tutors with different tutoring deficiencies, how effective tutors are with different deficiencies and what kind of tips students give for improvement of a tutor's behaviour. Based on students' ratings on a tutor evaluation questionnaire, tutors were ranked in groups with different deficiencies and the average overall tutor performance score was computed for each group with a particular deficiency. In addition, students' tips for improvement given in the openended question at the end of the questionnaire were analysed. The results demonstrated that on average one out of five tutors showed a deficiency on only one key aspect. Tutors who did not stimulate students towards active learning were perceived as least effective. Furthermore, students' tips for improvement could be categorized into four groups: tutors who do not evaluate adequately, tutors who are too directive, tutors who are too passive and tutors who lack content knowledge. The results of this study demonstrate that students are not only able to distinguish between poor and excellent tutors, but are also able to diagnose tutors with different tutoring deficiencies and are able to provide tutors with specific feedback to improve their performance.