“Medicine is learned by the bedside and not in the classroom.” Sir William Osler What do you think of this quote?? Do you agree w/it? Why or why not?

94% 82% “bedside teaching time is valuable.” “of residents want MORE!” Yep, those are some pretty big numbers! What could those possibly mean?? Well guess what? These are from a resident survey about bedside teaching conducted at Brigham and Women’s Hospital in Boston. Crumlish CM, et al. Quantification of Bedside Teaching by an Academic Hospitalist Group. J Hospital Medicine 2009; 4:304-7.

Bedside Teaching LTC Douglas Maurer, DO, MPH, FAAFP Program Director Faculty Development Fellowship Madigan Army Medical Center

Learning Objectives Listed obstacles to bedside teaching Identified advantages Practiced models of bedside teaching Planned integration into rounds

Dale, E. Audiovisual Methods in Teaching, 1969, NY: Dryden Who Learns on Rounds? Read 10% Hear 20% See 30% See & Hear 50% Say & Write 70% Do 90% This pyramid represents the Cone of Learning described by Edgar Dale in the 1960’s. Others have found the same effect in various settings. One study in medical school found that after sit-down rounds, 25% of Med students recalled ZERO after 1-3 days. With reduced work hours, WE CAN’T AFFORD that inefficient style of teaching!!! Dale, E. Audiovisual Methods in Teaching, 1969, NY: Dryden

So What Is Stopping Us??

Activity #1: Obstacles List the obstacles to performing bedside rounds Small groups White boards We will hear a sampling So we know our residents want it, we know it’s efficient… what’s stopping us?? Let’s take a couple minutes to list the obstacles. Just shout them out, we’ll come back to this list later. (Use a white board, butcher paper on easel or other surface to write the list generated by the class. Keep it posted through the session.) 5 Minutes

Barriers from the Survey Lack of time / not efficient use of time More effort – have to get up and move Difficult to fully prepare Patient discomfort Availability of patients You’ve developed a great list of barriers, here today! This slide summarizes the barriers listed by those who responded to our pre-session survey. It mirrors those seen in studies from Brigham & Women’s, NYU, and other hospitals around the country. In other words, you guys are smart and you’re not alone! Crumlish CM, et al. 2009

Activity #2: Advantages List the advantages of bedside teaching Small groups White boards We will hear a sampling 5 Minutes

Advantages from Survey See/teach PE skills Provide instant feedback Demonstrate professionalism Teach art of medicine Get patients involved Clarify patient issues Pt-centered care Interpersonal skills Communication skills Integrating exam w/ dx & mgmt decisions Again, great work discussing the tremendous value offered by bedside rounds. Here’s a summary of your answers from the survey. As you can see, these also mirror those found at Brigham & Women’s. More evidence of your brilliance! Crumlish CM, et al. 2009

How Can We Do It? Follow a 12 step model (Ramani) Follow a 3 domain model (Janicik) Make up your own model! So we’ve established that our residents are clamoring for more bedside teaching, and that it’s an extremely valuable, target-rich learning environment. We’ve talked about some barriers, too. How can we bridge the gap? A couple models have been described in the literature: one by Ramani (et al) from Boston University, derived from work within their system with both residents and faculty of all levels of experience; the other by Janicik was initially developed at NYU, then further honed through a series of faculty workshops among faculty from throughout the Northeast. There is a lot of overlap, as you’ll see from the handouts.

Activity #3: Practice!! Small groups Use bedside model assigned Pick a case you have seen on wards Work through the steps Role-play the actual teaching event Let’s break into groups of 4-5 (adjust according to overall size of group). Each group will pick one model and apply it to a real case you’ve had recently on the ward. Work through the steps to prepare a bedside teaching session of that case. We’ll come back together to review some of the highlights from each group. 15 Minutes

Activity #4: Commitment Small groups White boards Plan to integrate into routine We will hear a sampling My goal is for you to commit to some bedside teaching starting next week. What’s a realistic start we can agree on now? 5 Minutes

Learning Objectives Listed obstacles to bedside teaching Identified advantages Practiced models of bedside teaching Planned integration into rounds

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