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
- Faculty Guide - Module 3 - Bedside Teaching
- Handouts - Module 3 - Bedside Teaching
- Lesson Plan - Module 3 - Bedside Teaching
- Slides - Module 3 - Bedside Teaching
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
- Introduce all members of the team to patient and vice-versa
- Allow interruptions by all parties
- Encourage patient to correct and contribute
- Challenge learners with open ended questions
- Scale questions up the hierarchy - Easy questions for junior team member, harder questions for experienced learners.
- 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.