Prior to developing faculty development programmes to improve reflection-in-action abilities while teaching, we sought to elaborate how T2 (teaching & thinking)-in-action is perceived by teachers using the theoretical framework of metacognition. We interviewed seven highly rated clinical teachers. Qualitative analysis techniques were used to code the transcripts and develop themes. The themes related to T2-in-action included: (1) T2-in-action preparation; (2) self-awareness; (3) flow; (4) observing; (5) T2-in-action modifiers; and (6) interactive guidance. The importance of these actions is discussed in relation to research on metacognition and teacher cognitions and actions. These highly rated teachers came to be prepared for T2-in-action by multiple methods, monitored their teaching with specific skills, and adapted their teaching based on situational awareness and evaluation. These metacognitive components provide a set of cognitive skills, which could be incorporated into faculty development activities and contribute to the development of teaching expertise.