In today’s hospital and clinic environment, the obstacles to bedside teaching for both faculty and trainees are considerable. As electronic health record systems become increasingly prevalent, trainees are spending more time performing patient care tasks from computer workstations, limiting opportunities to learn at the bedside. Physical examination skills rarely are emphasized, and low confidence levels, especially in junior faculty, pose additional barriers to teaching the bedside examination.
To adapt to the challenges of today’s evolving teaching climate, we have adopted the philosophy that a physical examination skill can be demonstrated in 5 minutes or less (the 5-minute moment) but augmented by narrative, elements of history, the use of story to provide clinical significance, and pearls to magnify the effect on the learner. Through this instructional technique, confidence and enthusiasm can be built in even novice instructors, while acknowledging the increasing time demands our millennial trainees are facing. The 5-minute moment is a simple model that can be easily learned, practiced, and taught to promote teaching at the bedside.
Ever since Sir William Osler brought medical students out of the lecture hall and into the wards for clinical training, teaching at the bedside has been an important and time-honored means of clinical education. The Accreditation Council for Graduate Medical Education states that bedside teaching is one requirement of patient-based instruction for the internal medicine program.1 Until recently, this form of teaching took place during attending rounds; throughout this time, the medical team made decisions about the treatment plan after listening to the patient’s story and performing a thorough physical examination. It was also during this time that the senior physician taught the more junior physicians and medical students how to look for and interpret physical findings.
The explosion of imaging tools and laboratory testing has considerably increased the raw data that pertain to every patient, and as a result, physicians are spending many more hours in front of computers, often at the expense of being with the patient. The “iPatient” appears to get far more attention than the living, breathing patient, a sentiment that most patients would agree with. Trainees commonly begin to feel that the electronic health record represents a more reliable and comprehensive source of information than the interaction with the patient.2 Moreover, in the current era of duty hour restrictions and competing demands for time, opportunities for bedside teaching have become increasingly rare.5 The morning hours, traditionally reserved for rounding at the bedside, have been encroached on by teaching lectures, meetings with the multidisciplinary team, discharge planning, and the rush to ensure that patients are discharged before noon. Thus, there are few opportunities for an attending to round at the bedside with the full team.
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-Jeffrey Chi, MD, Maja Artandi, MD, John Kugler, MD, Errol Ozdalga, MD, Poonam Hosamani, MD, Elizabeth Koehler, MD, Lars Osterberg, MD, Junaid Zaman, MA, BMBCh, MRCP, Sonoo Thadaney, MBA, Andrew Elder, MD, Abraham Verghese, MD, MACP
This article originally appeared in the August 2016 issue of The American Journal of Medicine.
