The 4th Annual Stanford 25 Bedside Teaching Symposium
On September 7 and 8, Stanford 25 hosted its 4th Annual Bedside Teaching Symposium. The symposium is an annual event that brings together medical educators from around the world to foster clinical teaching skills. It seeks to “build a sense of community among all those who attend and to increase both individual physical examination skills as well as the ability of those in attendance to teach and evaluate the clinical skills of their learners.”
It’s a place for teaching and learning, where doctors share their expertise and absorb the expertise of others. Approximately 125 people from around the world (from the Philippines to Seattle to Taiwan) attended the two-day event.
Day one was largely about presentations: John Kugler, MD, clinical associate professor of medicine welcomed everyone, and then Abraham Verghese, MD, the Linda Meier and Joan F. Lane Provostial professor of medicine, presented his “10 Lessons from 3 Decades of Teaching at the Bedside.”
He urged his audience to “embrace ritual,” pointing out that the patient allows touch in an exam because of the ritualistic setting, and how important “crossing that threshold” is to both doctor and patient. Verghese also emphasized the importance of the physical exam even in a digital age, saying that Stanford 25 itself came about from this desire: “This is not all witchcraft, this is not magic. There’s a science to it.” He spoke to a rapt audience, even early in the morning, who immediately sat up and started taking notes and snapping pictures of his slides.
Other highlights of the first day included Kugler, who returned to discuss “The Role of Technology in the Bedside Encounter.” He told the origin story of the Luddites, millers whose livelihoods were destroyed by technology, who then rioted to destroy the machines that forced them out of work. He asked, are physicians who emphasize the bedside exam “the new Luddites?” and suggested that technology should be embraced, but thoughtfully.
This was followed by Veronica Santini, MD, MA, clinical assistant professor of neurology, who presented on the importance of the basic neurological exam, where she dazzled the crowd with her motivating speech about the importance of neurology. “The nervous system is what gives us our hopes and our dreams. Neurology is everything that makes us human,” she pointed out, after explaining that medical students need to be motivated to learn more about neurology and avoid their own “neurophobia.”
The afternoon session included (among other things) three sessions on specific patient populations and the challenges of physical exams: Karen Hirsch, MD, assistant professor of neurology spoke about patients with neurological damage, Tracy Rydel, MD, clinical associate professor of primary care and population health spoke about examining patients with obesity, and Marina Martin, MD, MPH, clinical assistant professor of primary care and population health ended with geriatric patients.
Day Two was even more hands-on, including presentations on how to detect Parkinson’s and the “5 Minute Bedside Moment,” spearheaded by Poonam Hosamani, MD, clinical assistant professor of medicine, which set up stations for doctors to practice basic reflex exams, chest exams, and many more. Participants were eager to practice, and deeply engaged in listening to all the tips, even suggesting tips of their own to their fellow attendees.
Later that day there were presentations on ultrasound technology and sports medicine, among others, and the final afternoon sessions included a mock PACES exam. PACES, a UK medical exam that all students must pass to become doctors, was recreated for all participants, with various attendees taking the role of candidate, examiner, or observer while the candidates actually performed exams on actual patients.
The PACES “candidates” were genuinely nervous, eagerly awaiting the exam while the “examiners” sat with the patient beforehand, determining which signs the “candidate” must discover in order to pass. The whole process was fascinating to watch: lt was a fake exam, taken completely voluntarily by people who are already established doctors, and yet everyone was taking it so seriously. These are people—staff, Stanford doctors and attendees alike—who truly want to learn to examine patients and teach others how to examine patients, and to do it well.
It was a symposium brimming with ideas and enthusiasm, but one interaction boils it down to its essence: caring. I attended the symposium as a staff observer, and at one point, I spilled coffee, on a table and on myself. The woman next to me, a doctor as well as an attendee, immediately helped me clean it up, and she took my hand in hers to examine it—a doctor’s reflex. She worried I was hurt (although I wasn’t), and she helped. Bedside medicine is alive and well.
Humility is an underappreciated skill in a time of global budgets, evidenced based approaches, and cost-containment. The bright, well-read, talented medical students who may lack humility are not uncommon.
Patient-centered care is an important aspect of the National Strategy for Quality Improvement on Health Care. As such, healthcare institutions are strongly focusing on the patient-physician relationship and the patient experience.
The editor-in-chief of Medscape, Dr. Eric Topol, visited Stanford to sit down and do an interview with our Dr. Vergese for the Medscape One-on-One online video series.
Peter Conrad, a sociologist at Brandeis University, spoke of the rise and fall of the medical authority in the doctor patient office encounter in his many scholarly articles. With the internet becoming the “elephant in the doctor’s office,” the dynamic of medical authority has certainly changed…