Join Molly, Era, and Dr Subha Ramani to discuss best practices for bedside teaching. We help you move past Res-Attending and embrace effective bedside teaching! You’ll learn to effectively prepare, lead, and debrief rounds with patients and learners.
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Bedside teaching is where the patient is present, and most importantly engaged as a partner in the process.
Effective teaching is when everyone learns something, including all parts of the triad: the learner, the attending, and the patient.
Teaching Rounds: Primarily for teaching, make sure to orient the patient to the patient to the purpose and goals, for the aid of our future medical providers. Usually involves more preparation ahead of time of teaching goals.
Work/Business rounds: Focused on patient care, let the patient know we are all thinking carefully on the patient’s best care.
Identifying and moving past barriers may allow more effective bedside teaching.
Culture-Driven: Finding the balance of work and teaching is very important and needs modification as a whole.
Faculty Driven: Many faculty are unsure about their own skills (communication, exam, history taking) and believe that they might not have much to offer to the learner. They may be in the mode of “res-attending”.
Learner Driven: Learners are often overwhelmed with tasks to complete that they may not feel they have the time to be taught.
Briefing- set up the case ahead of time
Expectations- what are the learners specific goals?
Demonstration- model exam or communication skills
Specific Feedback
Inclusion of Microskills (Neher 1992). The five microskills that make up the model are (1) get a commitment, (2) probe for supporting evidence, (3) teach general rules, (4) reinforce what was done right, and (5) correct mistakes.
Debrief- questions? reflections?
Education- what next step resources to learn more?
From UC Riverside Bedside Teaching Module
Learn from professional society resources such as SGIM Teach, Stanford Faculty Development Program
Get peer coaching, you can learn the most by having direct observation and feedback
EPAs around teaching may help us be aware of key skills by breaking down specifics that educators should be performing (Dam 2021)
Prepare ahead of time: Focus on your strengths, don’t feel intimidated by what you don’t know. If you have some time, great to brush up on a specific exam and be open about that with the learner. Model that we are all learners. Choose a few specific things that you would like to demonstrate- it does not need to be a complete cardiac exam, choose a few pearls.
Decide if you are going to model, discuss and then have the learner perform the exam, then provide feedback; or will you have the learner demonstrate the exam first and you will observe.
Explain to the patient what you will be doing, have a running commentary of what you are looking for and what you find on exam.
Keep it focused and brief. Plan to choose a limited number of patients, for example in an outpatient clinic half day see 1-2 patients with a resident.
Bring your teaching back to the “why”. Highlight the clinical relevance of bedside exams. Focus on a “reflective or hypothesis driven exam.” (Garibaldi 2021) Tie your teaching back to pathophysiology or likelihood ratios to help learners see the practicality and retain the knowledge. Reinforce cases that have similar findings or serial exams on the same patient to optimize skills (Mazzella, Rose-Jones 2018).
Debrief afterward- discuss any questions, feedback. If there are things you don’t know, have a plan to look those up and discuss afterward.
If you are the learner trying to get more bedside exam oversight, ask your attending to help with specific goals
As a bedside teacher, enthusiasm, curiosity, compassion for the learners, and humility in our own skills as teachers is key
Engage the patient as an educator, as a partner
Best Advice:
Favorite Failure:
Listeners will become familiar with commonly used tools to integrate teaching into clinical care at the bedside.
After listening to this episode, listeners will be able to…
Dr. Ramani reports no relevant financial disclosures. The Curbsiders Teach team report no relevant financial disclosures.
Ramani S, Heublein M, Kryzhanovskaya E. “#11 Bedside Teaching. The Curbsiders Teach Podcast. http://thecurbsiders.com/teach February. 22, 2022.
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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