Whither Bedside Teaching? A Focus-group Study of Clinical Teachers Subha Ramani, Jay D. Orlander, Lee Strunin, and Thomas W. Barber Acad Med 2003 78: 384-390. Reviewed by Randy Rockney, Brown Medical School
Whither Bedside Teaching? A Focus-group Study of Clinical Teachers
Subha Ramani, Jay D. Orlander, Lee Strunin, and Thomas W. Barber Acad Med 2003 78: 384-390.
Reviewed by Randy Rockney, Brown Medical School
The authors study an all too familiar development in clinical teaching: diminishing time spent at the bedside with a shift instead towards conference rooms and corridors. The authors assembled four focus groups, all from a single department of internal medicine: 1) chief residents; 2) residency program directors; 3) skilled bedside teachers; and 4) other faculty. Audiotaped 60-90 minute group discussions were transcribed and analyzed using qualitative research methods.
The perceived barriers preventing bedside teaching centered around clinician lack of confidence with bedside teaching skills. Similarly, clinician educators shy away from bedside teaching because of the performance pressure they felt in the context of bedside teaching, almost as if the shadow of William Osler hung over every such encounter to the detriment of most of us. Other barriers to decreased bed or patient side teaching included the perception of the lack of value given to teaching in academic medical centers and an erosion of the teaching ethic.
Strategies suggested to reverse the trend of diminishing bedside teaching address the perceived barriers. Improving bedside teaching skills of faculty by allowing and encouraging faculty to accompany skilled bedside teachers on rounds is a novel and interesting proposition. Diminishing the aura of bedside teaching builds on the idea that all teachers had something to offer more junior learners at the bedside. As one focus group participant stated, "You can't get everything, but you can get more than you did as a third-year student." To enhance the value of teaching, focus group participants felt that senior faculty ought to be front and center teaching clinical skills. As one participant put it, "Teaching is the pinnacle of academic life…being a great diagnostician, to elicit a history no one else has elicited…great skills...equal to getting an NIH grant…that's the ethic one needs to create so that residents and students view that as a worthwhile goal."
Overall the authors strongly support bedside or, in the case of outpatient medicine, patient-side teaching and observing the development of clinical skills. Let's get away from the card-flipping, conference room seclusion that clinical medicine has too often become and back to the patients themselves.
(It is amazing that insecurity - and not time - seemed to be the biggest barrier. That is great news - it puts the onus on us to be sure to tailor faculty development to these issues. The article includes a table that could serve as a great tool for suggesting how to organize excellent bedside teaching.
Do you run a session for residents or faculty on bedside teaching? Do you have students present patients in front of the family or patient? SM)