Bedside teaching in medical education a literatur

Authors: Max Peters Olle ten Cate

Publish Date: 2013/09/19

Volume: 3, Issue: 2, Pages: 76-88

PDF Link

Abstract

Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession but its use is declining A literature review was conducted to reveal its strengths the causes of its decline and future perspectives the evidence with regard to learning clinical skills and patient/student/teacher satisfaction PubMed Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching Articles regarding the abovementioned subjects were included Bedside teaching has shown to improve certain clinical diagnostic skills in medical students and residents Patients students/residents and teachers all seem to favour bedside teaching for varying reasons Despite this the practice of bedside teaching is declining Reasons to explain this decline include the increased patient turnover in hospitals the assumed violation of patients’ privacy and an increased reliance on technology in the diagnostic process Solutions vary from increasingly using residents and interns as bedside teachers to actively educating staff members regarding the importance of bedside teaching and providing them with practical essentials Impediments to bedside teaching need to be overcome if this teaching modality is to remain a valuable educational method for durable clinical skills‘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’ and ‘Medicine is learned by the bedside and not in the classroom’ are quotes of the famous Sir William Osler 1 William Osler 1849–1919 was in the century after Herman Boerhaave among the greatest promoters of bedside teaching as a mode of medical education and his words are still valid more than a century later 1 2Traditionally bedside teaching has always been seen as a primary teaching modality in which most aspects of clinical practice can be demonstrated and trained It was widely used across medical schools in the first half of the previous century and was estimated to represent as much as 75  of all clinical training in the 1960s 3 The recent explosion of imaging and laboratory testing has decreased its use 4 Today’s estimates range from 8–19  if at all present in medical training 3 5 Bedside teaching has been described as one of the ideal clinical teaching modalities in which history taking and physical examination skills together with professional attitude can be combined to provide a holistic approach in the diagnostic process and in patient care Students and residents are found to be motivated to engage in clinical reasoning and problemsolving if their preceptor acting as a role model provides adequate demonstration and guidance 3 6 7 8 Furthermore a thorough and correct history and physical examination have been shown to provide the correct diagnosis in 73  of cases on average For certain problems this percentage can be over 90  9Several other skills essential in patient contact can for a great part best be learned at the bedside Most importantly communicating effectively with real patients but also medical ethics for example discretion regarding sensitive subjects and adequately obtaining a structured history without the use of extensive medical terminology 5

Keywords: