About | Search | Report Feedback  

Even Better Together.

The quality and quantity of tools such as workshops, presentations and curriculum support is magnified when we work together.

Bedside Teaching

William T. Branch, Jr., MD

I. The presentation

Establishing a learning climate

Orienting the team
Conveying openness and enthusiasm for learning
Choice of a setting
Conference room or bedside
Special aspects of bedside presentations
The presentation
How to begin
Length and detail
To interrupt or not?

Learning about the patient vs. concentrating on the learner
Use of open questions to asses the learners' level of knowledge and clinical reasoning ability
Clarifying, broadening, justifying, or hypothetical questions
Priming for the examination, setting learning goals

Be a role model
Be a "coach"

II. Teaching in the exam room

Role modeling

First build the relationship with the learner
Point our what you will model
Elicit feedback and practice

Coaching and teaching clinical skills

Show one, do one, teach one
Teaching higher level skills: communications skills, diagnostic reasoning, medical ethics, professionalism
Setting up an exercise: eg advanced communications skills, informed consent, explanatory models, advance
directives

Demonstrating humanism and compassion at the bedside

Some ways of master teachers

III. Holding three-way conversations at the bedside

Setting up a three-way conversation
Advantages and disadvantages

Avoid marginalizing the learner
Involve the patient

IV. Summary and didactics

Give the "general rule"
More detailed teaching, making assignments, mini-lectures, or teaching scripts
Opportunities for higher level teaching: providing feedback; addressing ethics and professionalism, communications skills,
or housestaff stress

Selected References

1. Ferenchick G, Simpson D, Blackman J, DaRosa D , Dunnington G. Strategies for efficient and effective teaching in the ambulatory care setting. Acad Med. 1997;72:277-280.

2. Futcher T. The importance of bed-side study and teaching. Can Med Assoc J. 1935;32:357-364.

3. Irby D. How attending physicians make instructional decisions when conducting teaching rounds. Acad Med. 1992;67:630-638.

4. Kroenke K. Attending rounds: guidelines for teaching on the wards. J Gen Intern Med. 1992;7:68-75.

5. Lazare A. Putnam S, Lipkin MD. Three functions of the medical interview. In: Lipkin MJ, Putnam S, Lazare A (Eds). The Medical Interview Clinical Care Education and Research. New York, Sepinger-Verlag; 1995:3-19.

6. McGee S, Irby D. Teaching in the outpatient clinic: practical tips. J Gen Intern Med. 1997;12:1-7.

7. Osler W. The natural method of teaching the subject of medicine. JAMA. 1991;24:1673-1679.

8. Stead EJ. A way of learning. In Haynes B, ed. A Way of Thinking: A Primer on the Art of Being a Doctor. Durham: Carolina Academic Press:7-11.

9. Wang-Cheng R, Barnas G, Sigmann P, Riendl P, Young M. J Gen Intern Med. 1989;4:284-287.

10. Ende J. Feedback in clinical medical education. JAMA. 1983;250(6):777-781.

11. Schoen DA. Educating the Reflective Practitioner. San Francisco: Jossey-Bass. 1987.

12. Smith CS, Irby DM. The roles of experience and reflection in ambulatory care education. Acad Med. 1997;72:32-35.

13. Hekelman FP, Vanke E, Kelly K, Alemago S. Characteristics of family physicians' clinical teaching behaviors in the ambulatory setting: a descriptive study. TLM. 1993;5:18-23.

14. Miller SZ, Schmidt HJ. The habit of humanism with a framework for making humanistic care a reflexive clinical skill. Acad Med. 1999;74:800-803.

15. Branch WT. Professional and moral development in medical students: the ethics of caring for patients. Trans Amer Clin Clim Assoc. 1998;109:218-230.