Clinical Education Series: Teaching at the Bedside - PowerPoint Presentation

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Clinical Education Series: Teaching at the Bedside

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 bedside.

Objectives

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

Bedside 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.

Skills 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

Why 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

What 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

Preparing 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

Preparing 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

Let’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?

The Patient Encounter

Introduction

Doing the teaching

Observation

Demonstration / Role Modeling

Instruction

Summarization

Introduction

Clarify Roles to the patient

Orient Patients to the encounter

Encourage patient / family to interrupt and correct

“Doing the Teaching”

Observation

Demonstration / Role Modeling

Instruction

Observation

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

Demonstration 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.

Instruction

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

Wrapping 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)

Post-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.

Exercise

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?

References

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