Bedside clinical teaching for - PowerPoint Presentation

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Bedside clinical teaching for medical students at UNC

Peadar G Noone, MD FCCP FRCPI UNC Chapel Hill.

AOE UNC

Chapel Hill

Background

For generations, clinical bedside teaching was the basis of medical school education (think of the weighed down white coat – hammers, ophthalmoscopes, tuning forks

etc

)

Started with the

clinico

-pathologic correlation science in the late 19

th

century

(the

Oslerian

school)

UK / Irish medical school teaching (the “colonial”

system)

still heavily bedside focused

Less so in the US: recent publications lament this decline (though not everyone in

agreement).

Outstanding clinical teachers in history:

Cheyne

Graves

Stokes

Corrigan

AdamsWildeOslerVerghese (Stanford)

Noone background:

Traditional medical school, 3 basic science years, 3 years of clinical training, heavily bedside focusedIntern

: small community hospital with very charismatic clinician teacher at the helm

Every ward round was a teaching round, every clinical point, sign and laboratory value squeezed dry

Post graduate examination in British Isles (MRCPI/MRCP) still involves several bedside components with real patients and patient data

2010: Invited back as extern examiner for the “Final Med” exams at RCSI Dublin

Bare below the elbow, no tie,

jewelry

Today:

Abraham

Verghese

–NEJM

article “Culture shock – patient as icon, icon as patient”*Spoke about the “tension” between traditional approaches (the body as a text) versus the care of the “iPatient” (in the “bunker”)http://stanfordmedicine25.stanford.edu/

Whose fault – us as teachers?

Time, expectations, the encroachment of more exciting technologies, computerized records

Do our students want anything different?

*

NEJM 2008; 359: 2748-2751

Lets get back to

basics at UNC:

Inspect

Palpate

Percuss

AuscultateCerebrate

A pilot study of rotating bedside clinical tutorials

for medical students at UNC

Hypothesis

: That med students want bedside clinical teaching, and that data will support that

Aims:

To study the feasibility of rotating clinical tutorials for clinical studentsTo gather data to assess the benefits of focused teaching in the context of modern medical education

Preliminary data

:

Feedback

over

many years of clinical teaching on

rounds, enthusiastic generally, perhaps there is indeed a “hunger” for this type of approach

There

is a literature supporting this from formal studies

e.g. NEJM: Images in clinical medicine

etc

Objectives

: To teach

History taking skills

Clinical exam

Presentation skills

Clinical reasoningProfessionalism

Spin off benefits

: Attending learn more about patients

problems

Patient

benefits of learning about their disease

Methods

:

Advertised via student forums, flyer and direct conversations with students on the wards

E-mail communication usually with first-come-first-served sign up

Once every two to three weeks.

Strictly bedside, appropriate patient selection importantOne to two hours depending.

Questionnaire formulated (based on the literature and my

instincts)

Results

:

Anonymous

n=11 sessions

N=31 students

Stretched over several months

Data analyzed with help of UNC student on work experience (Melissa House).

Data qualitative, showing simple outcomes of various measures the students were asked to score

Conclusions

:

Generally the tutorials were well received

Scored pretty well on most measures

Consistent with what is in the popular press and formal medical literature

Did not ask for feedback from patients

Did not follow up long term

Limitations

:

Time consuming: Students, teacher

time

(afternoon

formal teaching,

MPH

,

research, organization and communication)

Student understanding

of the principles (

bedside?

– you mean in the room all that time

?; how are we supposed to do this? Are we just to turn up?)

Patient

availability and quiet time (its hard to get an

hour+

in a room

undisturbed)

Other

(vasovagal episodes in two students not used to spending that much time on their feet in the

room)

ACKNOWLEDGEMENTS:

The Academy of Educator Grant

Mechanism

Melissa House work study student

UNC Med students

The willing patients