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Twelve Tipps To Improve Bedside Teaching: Medical Teacher April 2003
Twelve Tipps To Improve Bedside Teaching: Medical Teacher April 2003
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Subha Ramani
Harvard Medical School
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SUBHA RAMANI
Boston University School of Medicine, Boston, USA
SUMMARY Bedside teaching has long been considered the most Bedside teaching can be frustrating and boring or
effective method to teach clinical skills and communication skills. absolutely riveting. What factors account for this extreme
Despite this belief, the frequency of bedside rounds is decreasing and difference? One important factor might be keeping the
it is believed that this is a major factor causing a sharp decline in session learner centred and not using the session to demon-
trainees’ clinical skills. Several barriers appear to contribute to this strate teacher eloquence on medicine (Ende, 1997).
lack of teaching at the bedside and have been discussed extensively Since most clinicians agree that teaching at the bedside is
in the literature. Concern about trainees’ clinical skills has led necessary, despite the abundance of obstacles, a few teaching
organizations such as the American Council for Graduate Medical tips may help faculty gain confidence to start moving their
Education (ACGME) and the WHO Advisory Committee on teaching from the corridors and conference rooms to the
Medical training to recommend that training programs should patient’s bedside.
increase the frequency of bedside teaching in their clinical curricula. Many strategies have been recommended in literature by
Although obstacles to bedside teaching are acknowledged, this expert educators (Cox, 1993; Ende, 1997; LaCombe, 1997;
article in the ‘12 tips’ series is a detailed description of teaching Kroenke, 2001) including a three-domain model described
strategies that could facilitate a return to the bedside for clinical more recently by Janicik & Fletcher. This twelve tips article
teaching. attempts to simplify key strategies and to describe them in
greater depth, and has been categorized as those strategies
that can be carried out sequentially before rounds, during
rounds and after rounds (Table 1).
Introduction
In what may be called the natural method of Tip 1
teaching, the student begins with the patient, con- Preparation is a key element to conducting effective rounds and
tinues with the patient and ends his study with the increasing teacher comfort at the bedside.
patient, using books and lectures as tools, as means
to an end. For the junior student in medicine and For those teachers planning bedside rounds, especially if
surgery it is a safe rule to have no teaching without a unfamiliar or uncomfortable with the technique, a prepara-
patient for a text, and the best teaching is that taught tory phase would be of invaluable help in raising their
by the patient himself. (Sir William Osler, Address comfort level. The following activities could be carried out:
to the New York Academy of Medicine, 1903) The teachers need to familiarize themselves with the
clinical curriculum that needs to be taught (Cox, 1993).
Many educators have stated repeatedly that the benefits of It is important to investigate the knowledge and the actual
bedside teaching are numerous and include teaching history clinical skill levels of all the learners to be taught.
and exam skills, clinical ethics, humanism, professionalism, Teachers need to improve their own history taking, exam
communication skills and role-modeling to name a few. and clinical problem-solving skills by reading, learning
Yet, the frequency of this form of teaching is progressively from senior expert clinicians as well as use of multimedia
decreasing (Ende, 1997; LaCombe, 1997). In the United such as CD-ROMs, tapes, videotapes etc. on specific areas
States, less than 25% of clinical teaching occurs at the bedside of clinical examination (LaCombe, 1997).
and less than 5% of time is spent on observing learners’ An ideal adjunct to this stage of preparation would be
clinical skills and correcting faulty exam techniques (Shankel faculty training on clinical skills and teaching methods.
& Mazzaferi, 1986). Along with this decrease, a decline in
overall clinical skills among trainees and junior faculty has
been observed (Mangione et al., 1993). Numerous barriers Tip 2
have been mentioned in the literature as preventing teachers Draw a road map of what you plan to achieve at the bedside for
from venturing to teach at the bedside (Mattern et al., 1983; each encounter.
Wang-Cheng et al., 1989; LaCombe, 1997; Janicik & Fletcher,
2003; Ramani et al., 2003). It is worth investing some time and energy in planning
Clinical teachers usually do not have any briefing on the bedside rounds (Ende, 1997). Even if this plan is not strictly
clinical curriculum to be taught and even less on the clinical followed, as is often the case during bedside encounters, a
teaching method. The wealth of bedside teaching opportu-
nities is diminishing with rapid patient discharges, overabun- Correspondence: Subha Ramani, MD MPH, Boston University School of
Medicine, Section of General Internal Medicine, Department of Medicine,
dance and over-reliance on technology (Cox, 1993; Kroenke, 720 Harrison Avenue, Suite 1108, Boston, MA 02118, USA. Tel: 617-638-
2001). 7985; fax: 617-638-8026; email: sramani@bu.edu
112 ISSN 0142–159X print/ISSN 1466–187X online/03/020112-04 ß 2003 Taylor & Francis Ltd
DOI: 10.1080/0142159031000092463
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