Bedside Teaching 5 Minutes at a Time

Bedside Teaching 5 Minutes at a Time

“Hi Mr. Davis, I’m here with the whole team. May we examine you?” my attending asked the patient as I and three others in white coats followed her into the hospital room.

Bedside teaching is unique to medical education, and not just because it’s unusual to have a bed in other learning environments. Bedside teaching involves the teacher, the learner and a willing and interested patient. A quick session can not only increase the knowledge and skills of the learners but also can give a patient confidence in his care team and a sense of importance and value.

The Stanford 25 group has developed a basic format for high-yield bedside teaching, broken into a Narrative section and the Physical Maneuver, which should take no more than 5 minutes combined. During the narrative, the context and history, interpretation and common errors are explained. The exam itself is taught by modeling what to do and what not to do. The learners then practice on the same patient and try to teach the maneuver.

In my clinical years of medical training, I have had several bedside experiences that were done well and some that were not. Those that were less effective indeed seemed to lack at least one of the recommended steps in the Stanford 25 format.

  • Once, as a medical student, when I didn't get an explanation of the implications of a lump in the neck, I did not commit to memory the techniques that were necessary to differentiate causes.
  • Another time an expert rheumatologist modeled a knee exam but without attention to common mistakes.  The first time I did a knee exam on my own, I misdiagnosed an effusion because I hadn’t learned what not to do.

As a resident this year, I am responsible for teaching medical students and interns, separate from the teaching by our attending physician. A recent study reported that medical students in the UK found junior-doctors more approachable than senior physicians and gained confidence in their clinical examination skills after the session. I plan to adopt the Stanford 25 format even though it may mean extra effort up front.

  • I may need to research some history in order to share a vignette.
  • I must reflect on my own technique in order to teach a correct technique and be able to clearly differentiate it from incorrect methods.
  • I should be able to demonstrate common mistakes.
  • I’ll need to be able to give feedback in real time as the maneuvers are performed by the learners.

At the bedside, there is opportunity for hands-on learning in the most literal sense. When done correctly, bedside teaching can build skills and trust for all members of a team and just as importantly, can recruit a patient to be more engaged in his own care.

Kirsten Brandt, MD is a Resident in Internal Medicine at Stanford Hospital & Clinics. She plans to work as a primary care physician upon finishing her training in 2015.