Bedside Teaching (aka Teaching With the Patient Present!)

Originally developed by Glen Drobot, MD Section of General Internal Medicine

Bedside Teaching - Objectives By the end of this session, the learner will be able to: Provide a definition of bedside teaching List advantages and disadvantages of incorporating bedside teaching into work rounds Describe the three key steps required for effective bedside teaching Discuss the integration of bedside teaching into work & attending rounds

Bedside Teaching “In what may be called the natural method of teaching, the student begins with the patient, continues with the patient and ends his study with the patient, using books and lectures as tools, as means to an end. …”

Bedside Teaching “For the junior student in medicine and surgery it is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself.” Sir William Osler, Address to the New York Academy of Medicine, 1903

What is Bedside Teaching (Not)? Not synonymous with work rounds or attending rounds, but can be used as a tool for both Not conference room rounds, hallway rounds, or “door-jamb” rounds

What is Bedside Teaching? An experience at the bedside of a patient where both the patient and student can learn simultaneously The term “bedside” can be broadened to include the outpatient setting, or any other setting where patient-physician interaction occurs

Advantages/Disadvantages of Bedside Teaching Take 5-10 minutes Pair up with your neighbour Come up with 3 advantages and 3 disadvantages of bedside teaching

Advantages?

Disadvantages?

Three Steps for Effective Bedside Teaching Planning the Bedside Teaching Session The Bedside Teaching Session Debriefing after the Bedside Teaching Session

Planning the Bedside Teaching Session Set time limits and plan accordingly Review previous day’s admissions Set clear objectives Decide whether to observe or model Plan for closure with learners and patients Brief the learners and patients beforehand

The Bedside Teaching Session Focus on sensory experiences not discussions about differential diagnoses Review aspects of obtaining medical history or demonstrating physical examination

The Bedside Teaching Session Involve the patients and family Model professionalism and ethical behaviour Ask questions to probe higher-level learner, not just recall Say “thank you” to the patient

Debriefing after the Bedside Teaching Session Faculty Member (superviser) Plan for immediate feedback to learners Create a non-threatening environment so that feedback can be received by learners Review process (what worked and what didn’t?)

Debriefing after the Bedside Teaching Session With the learner review: findings (what did you observe?) insights (what does it mean?) objectives (what did you learn?) questions (what still needs to be learned?) Reflect on what has been learned and how to apply it to the next encounter

Model of Bedside Teaching Janicik and Fletcher, (2003) Teaching at the bedside: a new model, Medical Teacher, Vol. 25, No. 2, 2003, pp. 127–130

Video What was done well? What could be improved?

Bedside Teaching - Summary Definition of bedside teaching There are advantages and disadvantages of incorporating bedside teaching into work rounds Effective bedside teaching requires planning, input from teacher and learners during the encounter, and debriefing

Objectives By the end of this session, the learner will be able to: Provide a definition of bedside teaching List advantages and disadvantages of incorporating bedside teaching into work rounds Describe the three key steps required for effective bedside teaching Discuss the integration of bedside teaching into work & attending rounds

Thanks!

The 5 Micro-Skills Step 1: Get a commitment Step 2: Probe for supporting evidence Step 3: Reinforce what was done well Step 4: Correct errors, suggest improvements Step 5: Teach general rules (take-home points) (Note: steps 3 – 5 can be in any order)