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Bedside Teaching Pearls

1. Establish rules of conduct for bedside presentation early in the rotation.

For example:

• Residents should not whisper in the patient’s room
• Calls should be made discreetly outside the room
• Laughing at a patient and the patient’s responses is never appropriate
• Describing the patient’s sex and race in front of the patient is awkward.
• Behavior should be proper and respectful - never flippant.

What are your own personal rules of conduct or expectations?

2. Make appropriate introductions between the patient and the learners.

3. Insure that the setting of the room is suitable for learning.

• Pull the patient’s bedside curtain
• Shut the patient’s door for privacy
• Invite family members and friends to wait in the lobby
• Ask the patient for permission to shut off the television

4. Demonstrate appropriate communication techniques and allow the patient the opportunity to clarify the case presentation.

Sometimes residents and students are frustrated to hear different details told to the attending physician than what was told to them only an hour before! This apparent conflict can be an excellent learning opportunity.

5. Teach in the presence of the patient.

This gives the patient the opportunity to learn about his/her disease and the patient receives confirmation that the team is actually considering every aspect of the case. It may also prompt new information from the patient.

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6. Be careful about asking the student or resident who is caring for the patient a question that they are unable to answer.

Although the "Socratic method" is helpful in stimulating thinking, this can lead to undermining the patient’s confidence in the team’s knowledge.

7. Avoid shoptalk.

Using medical jargon without including the patient in the discussion can lead to apprehension in the patient. The team should discuss medical points or parts of the lab and EKG with the patient and explain their significance with language that is "education-level appropriate."

Watch for terms that may be culturally inappropriate or frightening to the patient. Especially when considering all potential differential diagnoses. Patients may react to terms such as "cancer."

8. Find out from the team what portions of the physical exam give them difficulty, then discuss and demonstrate proper techniques.

During the demonstration of the physical exam it is imperative that patients are appropriately draped and that the patient’s dignity is protected.

An additional value of bedside teaching rounds is that the history, the physical, the assessment and the plan can all be reviewed at the bedside in the presence of the patient so that appropriate Medicare documentation may be made later.

9. As the bedside presentation closes . . .

• Leave the patient with an overview of his/her disease process.
• Always give the patient an opportunity to ask remaining questions
• Make and discuss plans in the patient’s presence and with their input

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Community-Based Teaching Benefits - Strategies for Teaching in a Busy Practice
The Precepting Microskills - Observation and Feedback - Bedside Teaching
What is Evidence-Based Medicine? - Teaching Evidence-Based Medicine
The Ten-Minute Talk - Strategies Home Page

Page last updated: February 24, 2003
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