School of Medicine Resident Teaching Skills

Teaching Resident Physicians to Be Educators

BEST Module 3: Bedside Teaching

Bringing Education & Service Together (BEST) is an interdisciplinary service learning project for resident physicians

Learning Outcomes

By the end of this session, residents will be able to:

  • Define the elements of the BEDSIDE approach to bedside teaching.
  • Practice teaching at the bedside and personalize the BEDSIDE approach by participating in a simulation exercise.
  • Employ effective bedside teaching techniques.

Benefits of Bedside Teaching

  • Allows resident teacher to provide professional role modeling for junior medical learners.
  • Can benefit the patient and family.
  • Allows resident teacher to observe learner’s clinical skills and give immediate, direct feedback.
  • Facilitates active, case-based learning.
  • Can be used in almost any patient care setting – inpatient or outpatient.

The "BEDSIDE" Approach to Bedside Teaching

Briefing
  • Prepare the learner(s) before meeting with the patient: learners’ prior experience, problems requiring help?
  • Prepare the patient and explain roles.
  • Use 6 simple steps to improve encounter
    1. Introduce all members of the team to patient and vice-versa
    2. Allow interruptions by all parties
    3. Encourage patient to correct and contribute
    4. Challenge learners with open ended questions
    5. Scale questions up the hierarchy - Easy questions for junior team member, harder questions for experienced learners.
    6. Teach to all levels of understanding.
Expectations

What are the learning goals of the individual?

  • Medical history taking
  • Physical examination
  • Communication with patients
  • Breaking bad news
  • Why learn this particular topic today?
Demonstration
  • If your goal is observation and feedback, watch learner interact with the patient, keeping interruptions to a minimum.
  • If your goal is to model clinical skills, let the learner(s) watch you interact with the patient at the bedside.
  • Organize what you demonstrate to facilitate learning.
  • Facilitate active learning through questioning:
  • What "learning questions" will stimulate thinking while you assess knowledge base and technical skills?
Specific Feedback
  • Offer learner-centered feedback, starting with the positive aspects.
  • Clarify criteria for desired performance. Can you explain or show learner how to improve any clinical skills?
  • Encourage reflection and self-appraisal.
  • End with an action plan.
Inclusion of “Microskills”

Will Neher’s "five-step microskills model" work here? If so, include it:

  • Offer learner-centered feedback, starting with the positive aspects.
  • Get a commitment (a plan)
  • Probe for supporting evidence
  • Teach general rules
  • Reinforce what was done right
  • Correct mistakes
Debriefing
  • Start with input from patient and learner.
  • Any questions from learner or patient?
  • You can also talk to learner alone, especially if feedback is extensive
Education

What resources can the learner read or use to promote self-directed learning?

Bedside Psychomotor Teaching

Learners must progress through four levels of understanding.

  • Unconscious incompetence.
  • Conscious incompetence.
  • Conscious competence.
  • Unconscious competence.

Tailoring Teaching to Each Level

To get to Conscious Incompetence:

  • State the goals of the physical exam.
  • Explain how to do it.
  • Have learner explain each step of the exam.

To get to Conscious Competence:

  • Observe learner practicing the exam.
  • Allow self-feedback, then give your feedback.

To get to Unconscious Competence:

  • Observe more practice in “real” situations.
  • Refrain from interrupting while you observe.
  • Tailor feedback to teaching the fine points.