Bedside Teaching  Nerissa A. De Jesus, MDFPOGS  HP223 Clinical Teaching and Evaluation  UP-NTTC-HP, Manila

Objectives  1.Define bedside teaching.  2. Discuss the objectives of bedside teaching.  3.List bedside teaching pearls.

 4.List the advantages and disadvantages of bedside teaching.  5.Describe the strategies of bedside teaching.

Bedside Teaching  Teaching in the presence of a patient.  “ No teaching without a patient for a text, and the best is that taught by the patient himself ” Sir William Osler

 Bedside teaching skills application -hospital -long-term care facility -out patient -office/clinic setting -community

Objectives: Bedside Teaching  1. Base all teaching on data generated by or about the patient.  “My method …is to lead my hand to the practice of medicine, taking them everyday to see patients in hospital, that they may hear the patients’ symptoms and see their physical findings.” Linfors and Neelon, 1980

 Teaching should focus on history, PE findings, or psychomotor skills being taught  “The time physician-students spend with patients should be devoted entirely to the patient. What is unique and what each says and reveals must be listened to and studied carefully” (Hurst, 1971).

 2. Conduct bedside rounds with respect for the patients’ comforts and dignity.  “Ward round teaching when conducted sympathetically…is not a traumatic emotional experience to patients for it educates and reassures them.” Romano, 1941

 “He has this very deep concern for people’s total well-being: physical, emotional, psychological and spirit that you have, and can develop, but it can’t be taught except by example.” Mattern et al., 1983

 3. Critical time for teaching psychomotor skills -diagnostic and therapeutic procedures -physical examination skills -problem solving skills

 4. Provide feedback to learners. - give both positive and negative -both formative and summative purposes

Bedside Teaching Pearls  1.Establish rules of conduct for bedside presentation early in the rotation.  -students should not whisper in the patient’s room  -calls should be made directly outside the room

 -laughing at a patient and the patient ’ s responses is never appropriate  -describing the patient ’ s sex and race in front of the patient is awkward  -behavior should be proper and respectful-never flippant!

 2. Make appropriate introductions between the patient and the learners.

3. Insure that the setting of the room is suitable for learning.  -pull the patient’s bedside curtain  -shut the patient’s door for privacy  -invite family members and friends to wait in the lobby  -ask the patient for permission to shut off the television

 4.Demonstrate appropriate communication techniques and allow the patient the opportunity to clarify the case presentation.

 5.Teach in the presence of the patient.  -gives the patient the opportunity to learn about his/her disease & the patient receives confirmation that the team is actually considering every aspect of the case.  -prompts new information from the patient.

6.Be careful about asking the student or resident who is caring for the patient a question that they are unable to answer. - can lead to undermining the patient’s confidence in the team’s knowledge.

 7.Avoid shoptalk.  Using medical jargon without including the patient in the discussion can lead to apprehension in the patient.  -use “education-level appropriate”language

 8.Find out from the team what portions of the physical exam give them difficulty then discuss and demonstrate proper techniques.  -patient should be appropriately draped and that the patient’s dignity is protected!

 Added value of bedside teaching rounds:  -history, PE, assessment/plan  All can be reviewed in the presence of patient  Give appropriate Medicare documentation

 9.As the bedside presentation closes…  Leave the patient with an overview of his/her disease process.  Always give the patient an opportunity to ask remaining questions.  Make and discuss plans in the patient’s presence

Advantages: Bedside Teaching  1.strengthens learning.  -use of all senses like hearing, vision, smell  Touch-to learn more about the patient/problems  i.e. diabetic ketoacidosis  -Kussmaul respiration  -decreased skin turgor

 2.allows clarification of history and physical in presence of learners  -case presentation is the result of a great deal of processing and interpretation by the learner.  -bedside visit allows the teacher to clarify & confirm key aspects

 3.Allows role modeling.  Helps preceptors model effective ways of asking questions and demonstrating sensitivity to patient’s comfort and concerns.

Disadvantages: Bedside Teaching  1.takes time.- additional time  -start using small group  2.potential patient discomfort  3.requires specific skills and techniques

Patient Comfort Issues  1.Ask for permission from the patient.  2.Limit length of teaching session in front of the patient.  3.Explain all examinations and procedures to the patient.  4.Make sure the patient understands all discussions.

 5.Take time at the end to answer patient questions and thank the patient!

Strategies  1.Go to the bedside with a specific purpose.  -list issues you want to review with patients or physical findings you want to confirm.  2.Teach history & physical exam skills.  -enhance learner’s observational skills  -clues to patient’s illness

 3.Teach observation.  -time to teach & practice careful observation.

 4.Maintain a comfortable & positive environment for the patient, learners and you!  -Not a place for pointed questioning or criticism of learners.  -provide positive learning experience.

Summary

 Bedside teaching is a form of interpersonal communication between two persons: the teacher and a learner. It is an intense personal and interpersonal experience.

 This educational “ drama ” is complex, requiring considerable enthusiasm and commitment on the part of both teacher and learners.

 Principles guide this intense relationship and are equally applicable to inpatient teaching rounds, morning report, preceptorships and ambulatory teaching.

“The teaching-learning process is a human transaction involving the teacher, learner, and learning group in a set of dynamic interrelationships. Teaching is a human relational problem.” Bradford, 1989

Thank You  References:  1.Schwenk,T & Whitman,N. the Physician as a Teacher. Wilkins & Wilkins.  2.Irby DM. What clinical teachers in medicine need to know. Acad Med  3.Ramani S.Whither bedside teaching? A focus- group study of clinical teachers. Acad Med. 2001