Christopher Driscoll MD Special thanks to Reid Evans PhD Purpose Bedside teaching is an essential competent medical education though its emphasis seems to be declining The purpose In this lecture we will review skills and strategies that optimize learners and educators experience at the be ID: 935944
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Slide1
Clinical Education Series: Teaching at the Bedside
Christopher Driscoll, MD
Special thanks to Reid Evans, PhD
Slide2Purpose
Bedside teaching is an essential competent medical education, though its emphasis seems to be declining
The purpose In this lecture we will review skills and strategies that optimize learners and educators experience at the bedside.
Slide3Objectives
At the end of this lecture, you will be able to:
Define what encompasses bedside education and
list important skills taught at the bedside
List common barriers to bedside education
Apply skills and methods for effective education at the bedside
Slide4Bedside teaching: what is it?
Any education that occurs in the presence of a patient
Seeing a patient together in ambulatory clinics
Ward rounding as a team
Seeing new patient together in the emergency department
Standardized patient encounters
Even simulation.
Slide5Skills that Can Best Be Taught At the Bedside
History taking
Physical exam techniques
Communication skills, professionalism and psychosocial aspects of medicine
Observation skills
Application of Clinical reasoning
Develop management plans
Slide6Why should we do it?
Intuitively there are skills essential to the practice of medicine that can’t be learned anywhere else.
Not a rigorously studied area though there is some literature about the benefits of bedside teaching.
Improved student scores on OSCE examinations and resident identifications in heart murmurs
Patients seem to prefer bedside teaching sessions.
Attendings
, Residents and Medical Students have high levels of satisfaction after participation in bedside education
Slide7What is stopping us? Barriers to Bedside Education
Time Constraints
Perceived disturbance to patients
Heavier reliance on imaging and diagnostic testing as compared to the physical exam
Physicians becoming less comfortable teaching at the bedside.
Fear of own limitations
–
not knowing something in front of the patient.
Learners don’t want to go to the bedside
Not just about the encounter at the bedside
Preparation
The actual encounter
Post-round
Slide9Preparing for the Bedside Encounter
Select patients who would be good for bedside teaching.
Have a plan for each
e
ncounter
Have a set amount of time pre-planned for each patient
Slide10Preparing for the Bedside Encounter
Review expectations with your team prior to starting rounds
Orient the learner. State objectives and expectations clearly
What is the learner hoping to get out of the encounter
? What skills do they want to practice and receive feedback on.
Assign roles. Everybody should be involved.
Be prepared to be flexible
Slide11Let’s Practice Preparing
You are getting ready to round as a team on your patients. The first patient you will be seeing is a two year old admitted overnight with cough and respiratory distress. What are your considerations as you prepare for rounds?
What are some specific goals you have in mind for this encounter?
What roles could you assign to the team members to keep everyone involved with rounds?
Slide12The Patient Encounter
Introduction
Doing the teaching
Observation
Demonstration / Role Modeling
Instruction
Summarization
Slide13Introduction
Clarify Roles to the patient
Orient Patients to the encounter
Encourage patient / family to interrupt and correct
Slide14“Doing the Teaching”
Observation
Demonstration / Role Modeling
Instruction
Slide15Observation
Important first step. This allows the educator to “diagnose of the patient” and “diagnose of the learner “
History, exam and communication skills best assessed by passive observation rather than demonstration / instruction
Important to keep interruptions to a minimum
Feedback is essential at the end of the encounter
Slide16Demonstration and Role-Modeling
Demonstration of particular exam skills
Being a model of professionalism
Interpersonal and communication skills
Admitting one’s own knowledge limitations.
Eliciting subtle points from history.
Slide17Instruction
Challenge the learner with questioning
Not pimping!
Avoid impossible questions and “Read My Mind” questions
Avoid situations of “one-upping”
Have learners compare and contrast findings
Gentle corrections when needed are appropriate .
Think out loud
Short relevant didactics are helpful. Lengthy teachings jeopardize efficiency and hamper engagement.
Don
’
t be afraid to teach in the presence of patients
Teaching does not have to be limited to just the reasons why you are seeing the patient
Going back to the patient on the team with respiratory distress…
What are some questions we can ask as you go to help promote learning?
For the students
For the intern
For the resident
Slide19Wrapping up the Encounter
Leave patient with an overview of what happened
Be explicit with learners regarding what they were taught immediately following the encounter.
Allow time for asking questions (patient and learner)
Slide20Post-Rounds
Feedback.
Both for the learner and the teacher
For the learner, start by reinforcing positive aspects of the encounter, and then specific critiques about what can be improved
Asked what worked well for them, what you could do better as the teacher
End with an action plan
Reflection
Planning for next session.
Slide21Exercise
Case: you are the senior resident working in the emergency department with a medical student who you haven’t worked with before. You plan to see a 2 month old who is there for a medical evaluation after sustaining injuries rolling off of the bed. The baby is in the ER with Mom and Dad
What are some considerations as you prepare for this encounter?
What strategies would you use at the bedside?
What are some of the didactic points you may want to make?
Slide22References
Bannister S.L. et al. 2018 ‘Just Do It: Incorporating Bedside Teaching Into Every Patient Encounter’
Pediatrics
Vol
142 (1) e20181238
Elder A. et al. 2013 ‘The Road Back to the Bedside’
JAMA
Vol
310 (8)
799
-800
Rahmani
S. 2003 ‘Twelve Tips to Improve Bedside Teaching’
Medical Teach
er
,
V
Vol
25 (2) 112-115
Kroenke
K. et al. 2003 ‘Bedside Teaching’
Southern Medical Journal
Vol
90 (11) 1069-1074
Lacombe M.A. 1997 ‘On Bedside Teaching’
Annals of Internal Medicine
Vol
126 (3) 217-220
Peters M. 2013 ‘Bedside Teaching in Medical Education: A literature Review’
Perspectives in Medical Education
Vol
3 76-88
Ngo T. 2019 ‘Teaching at the Bedside’
Pediatric Clinics of North America
Vol
66 (4) 881-889