Strengthening Bedside Teaching in Medical Colleges

INTRODUCTION

The long tradition of bedside teaching makes evident its importance in medical education. According to Sir William Osler, a renowned Canadian clinician and teacher, “There shall be no teaching without the patient for a text, and the best teaching is that taught by the patient himself.” Prior to this, Franciscus Sylvius, a Dutch physician and founder of the Iatrochemical school of medicine stated, “My method (is to) lead my students by hand to the practice of medicine, taking them every day to see patients in the public hospital, that they may hear the patients’ symptoms and see their physical findings. Then I question the students as to what they have noted in their patients and about their thoughts and perceptions regarding the causes of the illness and the principles of treatment.”^1,2 Bedside teaching, considered as the core teaching strategy during the clinical years of a medical student, is briefly outlined as a distinct mode of small group teaching that takes place in the presence of patients. Contrary to the popular opinion, it is not only taken place in a hospital setting but also in any situation in presence of a patient, including long-term care facility and office setting.³ The key characteristics of bedside teaching are augmentation of the learner’s experience and improvement of patient care. Further, it is important to acknowledge the fact that it is a process through which learners acquire the skills of communication that improve patient’s compliance and overall contentment, which is beneficial to a great degree in medical colleges.⁴

IMPORTANCE OF BEDSIDE TEACHING

While learning the theory of a topic is important, learning a practical situation enables a student to build upon existing skills. As mentioned earlier, many educators have stated repeatedly that the benefits of bedside teaching are numerous which includes history-taking and examination skills, clinical ethics, professionalism, communication skills, and role-modeling. An additional skill that is often neglected is observation. Important clues to the patient’s illness, disease, or response to being hospitalized may often be found in the room or at the bedside such as snacks on the diabetic patient’s bedside table, blood-streaked sputum in the emesis basin of a patient with cough and weight loss. The bedside visit is the time to teach and practice careful observation. These skills require the presence of patient and cannot be credibly taught in classrooms.^5,6 Besides these educational advantages, bedside teaching sessions allow the students to develop empathy toward the patients which is vitally important in practicing medicine effectively. Some writers have suggested that patients who participated in bedside teaching report better understanding of their illness. Similarly, Sir William Osler expressed, as paraphrased by William Thayer, the advantage of the bedside medicine most accurately as “Use your five senses. The art of the practice of medicine is to be learned only by experience; ‘tis not an inheritance; it cannot be revealed. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert. Medicine is learned by the bedside and not in the classroom”.⁷

CONCLUSION

To sum up, bedside teaching in medical colleges should form the foundation of clinical teaching and should be preserved in spite of the plethora of obstacles and decline in bedside teaching. This provides beneficial opportunities to integrate the knowledge and skills of current and future generations of doctors for the direct benefit of the patient. Hence, it is crucial for medical schools to give due importance to start moving teaching from the classrooms and conference halls to the patient’s bedside.

REFERENCES

1. Whitman N. Creative Medical Teaching. Salt Lake City: University of Utah School of Medicine; 1990.

2. Stewart MA. Effective physician–patient communication and health outcomes: a review. Can Med Assoc J 1995;152:1423–1433.

3. Peters M, Ten Cate O. Bedside teaching in medical education: a literature review. Perspect Med Educ 2014;3(2):76–88. DOI: 10.1007/s40037-013-0083-y.

4. Stone MJ. The wisdom of Sir William Osler. Am J Cardiol 1995;75(4):269–276. DOI: 10.1016/0002-9149(95)80034-p.

5. Salam A, Ahmad Faizal MP, Siti Harnida MI, Zainuddin Z, Latiff AA, et al. UKM medical graduates perception of their communication skills during housmanship. Med Health 2008;3:54–58.

6. Crumlish CM, Yialamas MA, McMahon GT. Quantification of bedside teaching by an academic hospitalist group. J Hosp Med 2009;4(5):304–307. DOI: 10.1002/jhm.540.

7. Jenkins C, Page C, Hewamana S, Brigiey S. Techniques for effective bedside teaching. Br J Hosp Med (Lond) 2007;68(9):M150–M153. DOI: 10.12968/hmed.2007.68.Sup9.27182.

8. Ramani S. Twelve tips to improve bedside teaching. Med Teach 2003;25(2):112–115. DOI: 10.1080/0142159031000092463.

9. Bassaw B, Naraynsingh V. Ward-rounds: role in clinical teaching and learning in contemporary medicine. West Indian Med J 2011;60(6):601–603. PMID: 22512214.

10. Ahmed M El-BK. What is happening to bedside clinical teaching? Med Educ 2002;36(12):1185–1188. DOI: 10.1046/j.1365-2923.2002.01372.x.

11. Nair BR, Coughlan JL, Hensley MJ. Student and patient perspectives on bedside teaching. Med Educ 1997;31(5):341–346. DOI: 10.1046/j.1365-2923.1997.00673.x.

12. Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med 2008;83(5):452–466. DOI: 10.1097/ACM.0b013e31816bee61.

13. Williams KN, Ramani S, Fraser B, Orlander JD. Improving bedside teaching: findings from a focus group study of learners. Acad Med 2008;83(3):257–264. DOI: 10.1097/ACM.0b013e3181637f3e.

14. Wang-Cheng RM, Barnas GP, Sigmann P, Riendl PA, Young MJ. Bedside case presentations: why patients like them but learners don’t. J Gen Intern Med 1989;4(4):284–287. DOI: 10.1007/BF02597397.