What Stands in the Way of Bedside Teaching?

An opinion piece from The BMJ made the rounds a while ago on Twitter. The column, provocatively titled “The death of bedside teaching,” originally appeared in December 2016, but the points made by physician Mark Mikhail continue to reverberate. Is bedside teaching really dying?

It’s a strange idea for us to consider here at Stanford Medicine 25 since our focus is bedside medicine. However, even though we see momentum building around a global physician/mentor community that’s passionate about the physical exam and bedside teaching, its broad resurgence is still in its infancy.

As Mikhail notes, bedside teaching made up 75% of physician training in the 1960s compared to 8-19% in more recent decades. He writes, “Less than half of doctors feel they received enough [bedside teaching],” citing another dire statistic: each day, median time spent at the bedside was 2.5 minutes versus 69 minutes in the classroom. (His sources are footnoted here.)

Both Mikhail’s piece – and the lengthy Twitter conversation around it – offered explanations for why time allocated to bedside teaching had been shrinking:

·      There’s a perception that it’s labor intensive.

·      It has suffered in the past from a bad reputation (insensitive to the patient).

·      It’s difficult to coordinate timing between patients, attendings and students.

·      Doctors don’t want to disrupt or burden patients with multiple exams.

·      Students can feel as though they’re in the way.

·      Today’s hospital systems see faster patient turnover and use ambulatory care more.

·      EHR data entry consumes a lot of time for physicians.

The obstacles are very real, but we know that bedside medicine and bedside teaching don’t have to burden anyone. In fact, we understand that even five minutes is enough time to teach a technique at the bedside, and like Mikhail, we’ve found that students are “desperate to learn in a non-threatening but real-life environment.” There’s not only room for these teaching methods and approaches, there’s a desire for them: both physicians and patients are craving a deeper connection. And in that connection, as we’ve seen over and over, time spent at the bedside energizes practitioners and helps patients feel more well.

Of particular note on this list is the EHR and what it demands of the physician. Embedded in the conversation about EHRs is a big picture question: “How should we spend our time as doctors and as teachers?” As we consider the answers, we also have to ask, “What’s standing in the way?” A return to the model of the apprentice at the bedside will only be possible if we identify and address those barriers. What are they for you? Do you see a path toward removing them? 

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