Eric Barna MD
Professor of Medicine and Medical Education
Rex Hermansen
Assistant Professor of Medicine and Medical Education
When on the inpatient service, what are the barriers to teaching/getting to the bedside?
1
Review the importance of bedside rounds for teaching and patient care
2 Describe general teaching skills to enhance the rounding experience
3 Identify core elements that strengthen the team experience
4 Construct an effective bedside teaching plan
Do… Set expectations and foster a warm and welcoming
environment.
Feel…While preparation is half the battle, you are always teaching.
❑ Understand the culture
❑ Evaluate the “rhythm” of the teaching service (shadow when possible)
❑ Clarify institutional expectations
❑ Strive for excellence not perfection
❑ Revisit, Reassess, Reset
Journal of Academic Medicine: A multicenter qualitative study sampled 34 inpatient Attending Physicians from 10 U.S academic institutions. The following categories of barriers to bedside rounding/teaching were identified: Time Patient Driven Systems Issues PhysicianRelated Culture shift
Lack of bedside skill
Lack of comfort
Trainee inefficiency
EMR
Shorter LOS
Limited workday
Conferences
Inefficiency
Increased acuity
Patient privacy /HIPPA
Patients understanding
Educational value
Patient centered care is always patient preferred
Methods: Recruited faculty from 10 institutions including clerkship directors + prior research experience in medical education and conducted bedside rounds
Data Collection/Analysis: Digitally recorded one to one interviews identifying themes and categories generating a codebook to facilitate analysis
Results: All 10 institutions participated 34 interviews conducted focus was directed at key thematic areas
❑Participants: 125Faculty/Residents/Students
5IMresidencyprograms
75%wereresidentsorstudents
❑Participantsrated70attributesofSuccessfulattendingrounds Journal of General Internal
❑Create a safe and welcoming environment
❑ Email welcome before you come on service
❑Set clear expectations from day one
❑Identify your learners strengths/interests
❑Use icebreakers
❑Draw a mental image your time together
❑Review the core service expectations on DAY 1 (10 minutes)
❑Set specific goals for each day on rounds (everyday is different)
❑Consider a pre-round huddle with your intern/medical student to map out the morning
❑Specify bedside goals and recognize that these may change
✓ The order of presentations
✓ Presentation style (SOAP)
✓ Mini teaching topics and look ups
✓ Lightning presentations
✓ Safety Checklist
How do you position your team for bedside rounds?
ATTENDING/ RESIDENT
THE PERFECT TIME TO ASSESS MILESTONE METRICS FOR BOTH RESIDENTS AND MEDICAL STUDENTS
“By failing to prepare, you are preparing to fail”
- Ben Franklin
❑ Avoid asking ‘read my mind’ types of questions
❑ Gentle corrections can be made when needed
❑ Actively discourage one-upmanship among the learners
❑ Avoid asking questions of junior learners when a senior learner has missed the question
❑ Keep all learners engaged to avoid boredom
❑ Avoid lengthy didactic discussions
What do you do to prepare before you meet your team/trainee for rounds?
❑ Chart check the night before and get in early on your first day
❑ “Stealth Round” virtually on your new admissions (EMR efficiency)
❑ Pick 1 or 2 topics that you want to tackle that day
❑ Plan and map out your teaching session:
-Organization/Timing
-How will you engage the learner
-Take home points
-Homework assignments
-Is there room for technology
Recall
– What are the 5 criteria for TTP?
Analysis/Synthesis – What led you to that diagnosis?
Application – How will you treat this patient’s pain?
Self Assessment
– What would you do differently?
❑ Let them speak
❑ Break Points should be limited to 1 or 2
❑ Take notes
❑ Watch patient’s interactions with the presenter and the team
❑ Start thinking about feedback
An exam Skill
An interaction with a patient
Self Directed Learning
The
Power of “I don’t know”
❑Show learners your reasoning process
❑Show learners how to think
❑Open brainstorming
❑Lean on your team leads
Quality and technology are integral in engaging learners and enhancing the rounding experience!
There is a valuable and abundant amount of quality and safety education at the bedside:
❑ Catheters, drains and lines
❑ Bed rails
❑ Fall precautions
❑ Diet
❑ Fluids
❑ Oxygen
❑ Smell
Use media to engage
Make it patient centered Teaching arsenal
Perceived barriers to teaching can be overcome.
Set expectations and foster a warm and welcoming environment.
Feel…
While preparation is half the battle, you are always teaching.
“Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.”
-William Osler