Bedside clinical teaching for medical students at unc
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Bedside clinical teaching for medical students at UNC. Peadar G Noone, MD FCCP FRCPI UNC Chapel Hill. AOE UNC Chapel Hill. Background.

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Bedside clinical teaching for medical students at UNC

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Bedside clinical teaching for medical students at UNC

Peadar G Noone, MD FCCP FRCPI

UNC Chapel Hill.

AOE UNC Chapel Hill


Background

  • For generations, clinical bedside teaching was the basis of medical school education (think of the weighed down white coat – hammers, ophthalmoscopes, tuning forks etc)

  • Started with the clinico-pathologic correlation science in the late 19th century (the Oslerianschool)

  • UK / Irish medical school teaching (the “colonial” system) still heavily bedside focused

  • Less so in the US: recent publications lament this decline (though not everyone in agreement).


Outstanding clinical teachers in history:

  • Cheyne

  • Graves

  • Stokes

  • Corrigan

  • Adams

  • Wilde

  • Osler

  • Verghese (Stanford)


  • Noone background:

  • Traditional medical school, 3 basic science years, 3 years of clinical training, heavily bedside focused

  • Intern: small community hospital with very charismatic clinician teacher at the helm

  • Every ward round was a teaching round, every clinical point, sign and laboratory value squeezed dry

  • Post graduate examination in British Isles (MRCPI/MRCP) still involves several bedside components with real patients and patient data

  • 2010: Invited back as extern examiner for the “Final Med” exams at RCSI Dublin


Bare below the elbow, no tie, jewelry


Today:

  • Abraham Verghese–NEJM article “Culture shock – patient as icon, icon as patient”*

  • Spoke about the “tension” between traditional approaches (the body as a text) versus the care of the “iPatient” (in the “bunker”)

  • http://stanfordmedicine25.stanford.edu/

  • Whose fault – us as teachers?

    • Time, expectations, the encroachment of more exciting technologies, computerized records

    • Do our students want anything different?

      *NEJM 2008; 359: 2748-2751


Lets get back to

basics at UNC:

Inspect

Palpate

Percuss

Auscultate

Cerebrate


A pilot study of rotating bedside clinical tutorialsfor medical students at UNC

  • Hypothesis: That med students want bedside clinical teaching, and that data will support that

  • Aims:

    • To study the feasibility of rotating clinical tutorials for clinical students

    • To gather data to assess the benefits of focused teaching in the context of modern medical education


Preliminary data:

  • Feedback over many years of clinical teaching on rounds, enthusiastic generally, perhaps there is indeed a “hunger” for this type of approach

  • There is a literature supporting this from formal studies

  • e.g. NEJM: Images in clinical medicine etc


Objectives: To teach

  • History taking skills

  • Clinical exam

  • Presentation skills

  • Clinical reasoning

  • Professionalism

  • Spin off benefits: Attending learn more about patients problems

  • Patient benefits of learning about their disease


Methods:

  • Advertised via student forums, flyer and direct conversations with students on the wards

  • E-mail communication usually with first-come-first-served sign up

  • Once every two to three weeks.

  • Strictly bedside, appropriate patient selection important

  • One to two hours depending.

  • Questionnaire formulated (based on the literature and my instincts)


Results:

  • Anonymous

  • n=11 sessions

  • N=31 students

  • Stretched over several months

  • Data analyzed with help of UNC student on work experience (Melissa House).

  • Data qualitative, showing simple outcomes of various measures the students were asked to score


Conclusions:

  • Generally the tutorials were well received

  • Scored pretty well on most measures

  • Consistent with what is in the popular press and formal medical literature

  • Did not ask for feedback from patients

  • Did not follow up long term


Limitations:

  • Time consuming: Students, teacher time(afternoon formal teaching, MPH, research, organization and communication)

  • Student understanding of the principles (bedside? – you mean in the room all that time?; how are we supposed to do this? Are we just to turn up?)

  • Patientavailability and quiet time (its hard to get an hour+ in a room undisturbed)

  • Other (vasovagal episodes in two students not used to spending that much time on their feet in the room)


ACKNOWLEDGEMENTS:

  • The Academy of Educator Grant Mechanism

  • Melissa House work study student

  • UNC Med students

  • The willing patients


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