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Bedside Teaching. Jennifer L. Peel, Ph.D . Director of Education, Office of Graduate Medical Education Assistant Professor, Anesthesiology Educational Development Specialist, UTHSCSA Division of Educational Research & Development.

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Bedside teaching l.jpg

Bedside Teaching

Jennifer L. Peel, Ph.D.

Director of Education, Office of Graduate Medical Education

Assistant Professor, Anesthesiology

Educational Development Specialist, UTHSCSA Division of Educational Research & Development


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There should be “no teaching without a patient for a text, and the best teaching is that taught by the patient himself.”

Osler, 1903



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Advantages of Teaching with the Patient Present present?

1. The patient can be seen as an individual, with whom medical decisions are made, rather than to whom procedures and tests are applied, thus humanizing and personalizing medical care.

Linfors & Neelon, 1980


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2. The presence of the patient helps the teaching process to be more participative, such that teachers and learners together have the collegial opportunity to understand the patient’s problems and find ways to solve them.

Linfors & Neelon, 1980


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3. Bedside teaching is the ultimate manifestation of the physician as teacher, rather than as lecturer, discussant, or consultant. This role modeling behavior is critical to the student’s professional development.

Linfors & Neelon, 1980


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4. Bedside teaching is essentially the only method in which the teacher has the opportunity to observe patient care skills directly and give immediate feedback.


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What are some of the barriers to bedside teaching? the teacher has the opportunity to observe patient care skills directly and give immediate feedback.


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Barriers to Teaching at the Bedside the teacher has the opportunity to observe patient care skills directly and give immediate feedback.

1. A false concern that teaching which involves the patient may upset or disturb his/her comfort and well-being

Linfors & Neelon, 1980


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Evidence the teacher has the opportunity to observe patient care skills directly and give immediate feedback.

  • Lehmann, et al. (1997)

  • Linfors & Neelon (1980)

  • Nair, et al. (1997)


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2. Concern by some physicians that patients should not be involved at all in medical discussions, even through bedside teaching

Linfors & Neelon, 1980


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3. The belief by some physicians that medical education should always consist of the direct transmission of knowledge from the active teacher to the passive learner

Linfors & Neelon, 1980


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Levels of Cognitive Learning should always consist of the direct transmission of knowledge from the active teacher to the passive learner

  • Evaluation

  • Synthesis

  • Analysis

  • Application

  • Comprehension

  • Knowledge

Bloom, et al., 1956


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4. The desire of some teachers to limit their discussions to the technological and biomedical aspects of medical care, particularly to the area in which they feel expert

Linfors & Neelon, 1980


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5. The concern that house staff are tired and unmotivated the technological and biomedical aspects of medical care, particularly to the area in which they feel expert

Janicik & Fletcher, 2003


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6. The fear that some teachers may lack the necessary complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

Linfors & Neelon, 1980


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How Do We Overcome the Barriers? complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

Physician

Patient

Teacher

Learner

  • Trust

  • Respect

  • Transfer of information and emotion


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How Do We Overcome the Barriers? complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

Educational Golden Rule:

The teacher should treat the student as the teacher would have the student treat the patient.


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Bedside Teaching Model complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

  • Three “Domains”

  • Attending to patient comfort-remain patient centered and respectful

  • Establish rules for conduct

  • Ask the patient ahead of time

  • Introduce all

  • Provide a brief overview

  • Avoid technical language

  • Teach with data about the patient

  • Provide a genuine, encouraging closure

Janicik & Fletcher, 2003


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Bedside Teaching Model complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

  • 2. Focused teaching-conduct an effective teaching session in a focused manner that is relevant to an individual patient’s and learner’s needs

  • Diagnose the patient

  • Diagnose the learner

  • Target the teaching

  • Provide constructive feedback (privately)

Janicik & Fletcher, 2003


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Effective Feedback complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

  • Research on feedback recognizes the importance of credibility

    You will be perceived as credible by medical students and others if they see that you “call ‘em the way you see ‘em.”

Cathcart & Samovar, 1989


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Effective Feedback complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

  • Research on feedback supports the notion that it is important to demonstrate responsiveness

    You will be perceived as responsive by medical students and others if you “begin with the learner.”

Cathcart & Samovar, 1989


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Effective Feedback complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

  • Research on feedback emphasizes the key role of trust

    There is some evidence that trust is enhanced when you “sandwich the negative feedback” between the positive.

Cathcart & Samovar, 1989


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“EGO” Sandwich complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

Positive

Negative

Positive


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Effective Feedback complex interactive skills to lead an elegant, erudite, and compassionate Oslerian-type discussion

Timing is critical


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“Without feedback, mistakes go uncorrected, good performance is not reinforced, and clinical competence is achieved empirically or not at all.”

Ende, 1983


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Bedside Teaching Model performance is not reinforced, and clinical competence is achieved empirically or not at all.”

  • 3. Group dynamics-keep the entire group active during the session

  • Set goals

  • Assign roles

  • Set a time limit

  • Pay attention to the entire group

Janicik & Fletcher, 2003


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Patient’s Room performance is not reinforced, and clinical competence is achieved empirically or not at all.”

Ask patient’s permission

Establish rules & goals

Set a time limit

Assign roles

Diagnose learner

Diagnose patient

Introduce all

Brief overview

Conduct focused teaching

Discussion

Ask patient if they have questions

Closure

Debrief

Feedback (private)

Follow-up with patient

Janicik & Fletcher, 2003


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In Summary… performance is not reinforced, and clinical competence is achieved empirically or not at all.”

  • Provides an opportunity to:

    • Gather additional information

    • Directly observe learners’ skills

    • Role model skills and behaviors

  • Humanizes care by involving patients

  • Engages trainees in an active learning process

  • Includes patients in the learning process

  • Improves patients’ understanding


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“To study the phenomena of disease without books is to sail an uncharted sea. Whilst to study books without patients is not to go to sea at all.”

Sir William Osler (1849-1919)


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