Teaching at the Bedside

1
Teaching at the Bedside

• ltPresenter/sgt

2
Presentation based on materials from
theProduced by Supported by HRSA
Family Medicine Training Grant 1 D15
PE50119-01
3
Goals

• Review past and recent history of bedside
  teaching.
• Discuss the advantages and challenges to teaching
  at the beside.
• Explore strategies to improve teaching on rounds
  and at the bedside.
• Review techniques for bedside teaching in the
  office setting.

4
Teaching at the Bedside History

• Hippocrates (460-370 BC)
• The Principles of the Hippocratic Method
• 1. Observe all
• 2. Study the patient rather than the disease
• 3. Evaluate honestly
• 4. Assist nature

5
Teaching at the Bedside History

• Sylvius (Jacque du Bois 1614-1672)
• My method (is to) lead my students by hand to
  the practice of medicine, taking them everyday to
  see patients in the public hospital, that they
  may hear the patients symptoms and see their
  physical findings. Then I question the students
  as to what they have noted in their patients and
  about their thoughts and perceptions regarding
  the causes of the illness
• and the principles of treatment.

6
Teaching at the Bedside History

• Sir William Osler (1849-1920)
• There should be no teaching without a patient
  for a text, and the best is that taught by the
  patient himself. (1903)

7
Teaching at the Bedside History

• The Twentieth Century Where are we now?
• 1964 lt 20 teaching time in presence of patient
• 1978 16
• Now ?

8
Teaching at the Bedside Challenges and
Obstacles

• Time
• Patient-related concerns
• Do learners like it?
• Teacher concerns

9
RoundsWhat Needs to Happen?

• Work Rounds
• Determine care plan
• Administrative details/ Charges
• Chart rounds
• Review and sign notes and orders
• Write notes

10
RoundsWhat Needs to Happen?

• (Continued)
• Teaching rounds
• Mini-lectures
• Listening to presentation
• Teaching interviewing and physical exam skills
• Ward rounds
• Seeing the patients
• Talking to families

11
If Not at the Bedside... Where?

• Conference room
• Corridor

12
Teaching on Rounds Conference Room

• Advantages
• Comfortable/Quiet
• Confidential
• Time efficient
• Disadvantages
• No patient contact
• Relies on presentation/chart

13
Teaching on Rounds Conference Room

• Characteristics
• Presentation skills
• Mini-lectures
• Topic related to current patient care issue
• Topics unrelated to current issues
• Team teaching - Other disciplines

14
Teaching on Rounds Conference Room

• Strategies
• Keep to task and time.
• Diagnose the patient and the learner at the same
  time.
• Look for (and capture) teachable moments.
• Focus on clinical problem solving

15
Teaching on Rounds Corridor

• Advantages
• Allows potential access to patient
• Disadvantages
• Uncomfortable
• Noisy/distracting
• Not confidential

16
Teaching on Rounds Bedside

• Advantages
• Patient contact
• Allows clarification of history and physical
• Allows teaching of history and physical
• Allows role modeling

17
Teaching at the Bedside

• Overcoming the Obstacles TIME
• Set aside time to teach at the bedside
• Bring a learner on routine patient visits

18
Teaching at the Bedside

• Overcoming the Obstacles
• Concern for patient comfort
• Provide advance notice of visit
• Limit length of time for patient comfort
• Be cautious with presentations at the bedside

19
Teaching at the Bedside

• Overcoming the Obstacles
• Concern for patient comfort (contd)
• All examinations and procedures should be
  explained
• All discussions and communications should be
  explained and understandable to the patient
• The patient is visited after rounds to answer
  questions and thank the patient

20
Teaching at the Bedside

• Overcoming the Obstacles
• Getting Started
• Start small
• Use the material you have
• Involve learners in beside teaching
• See one or two new admissions at bedside
• Review your own physical exam skills
• Have references on HP skills readily available

21
Teaching at the Bedside

• Other Locations
• The Nursing Home
• The Out-patient Setting

22
Teaching at the Bedside

• Summary
• A valuable form of clinical teaching
• Start small and build comfort and skill
• Be sensitive to patient and learner.
• Everyone -- patient, learner and teacher --
  should feel better after the teaching session.
• Have fun.