Bedside teaching: an underutilized tool in medical education.

Abstract

Bedside teaching (BST) is a fundamental component of clinical training and an essential tool in the creation of a competent physician.1-15 Sir William Osler (1849-1919), one of Canada’s most renowned physicians, was the first to introduce BST to medical education in 1892. He described modern medical education as something that needed to be taught at the bedside: “Medicine is learned by the bedside and not in the classroom.”9 BST allows the physician and patient to interact at the bedside; through this physician-patient interaction process, medical students and residents are simultaneously afforded the opportunity to learn clinical skills, clinical reasoning, physician-patient communication, empathy, and professionalism.6,12,15 In real practice, comprehensive history taking can help the physician diagnose up to 56% of patient problems, which may rise to 73% if a physical examination is added.8 Much information can be gained and a proper diagnosis reached by obtaining a good medical history and performing an efficient clinical examination.8 Clinical teaching in which the patient is involved is enriched by these visual, auditory, and tactile experiences. Senior medical students and medical residents believe that BST is a valuable but underutilized tool.15 Time spent on BST has been on the decline since 1978, as highlighted by Ahmed, who reported that the proportion of teaching time taken up by BST had declined from 75% 30 years ago to only 16% today.8 The learning triad The BST learning triad comprises patients, students, and tutors.6 All three must be present for BST to occur and it must occur within a clinical environment. Each individual member brings his or her own value to the learning triad. For example, the student brings medical knowledge and the eagerness to learn; the tutor brings depth of knowledge, mentorship, and willingness to help the student learn and make connections; and finally, the patient brings relevant clinical issues to the forefront that allow the student to learn. An effective learning environment requires all three groups to work together in the learning triad.6 The obstacles that may reduce the effectiveness of BST can be categorized by each group in the learning triad.