Learning from the Bedside at the 5th Annual Stanford 25 Bedside Teaching Symposium
Abraham Verghese, MD, MACP, Linda R. Meier and Joan F. Lane Provostial Professor of Medicine, started his talk at Stanford 25’s 5th Annual Bedside Teaching Symposium with a disclaimer: there was no original content in his presentation. Instead, he explained, he gleaned most of his knowledge from his time spent as a medical student, both through personal experiences and through mentorship and lessons passed down from his teachers. But when Verghese spoke about the tips and tricks of “Bringing Learners to the Bedside,” the audience took his words to heart.
Verghese’s tips often involve using what you have. As a teacher, your learners might be distracted, he explained—use this! Direct their attention back to the room. The first tip, in fact, is that learning begins in the hallway. Students can be asked various things, like which abnormal gaits they’ve noticed in the hospital halls, or what they noticed about the patient who just passed. Engaged learners are better learners.
And then, once you’re in the room, a greater level of observation should begin. As Verghese explained, “The body is this text that is speaking volumes and we’re not listening.” And before even that, Verghese asked: “what are the two most important buttons in medicine?” The answer? The light switch and the button that raises the bed. Then you have your students read the room. A book, a spouse, a table, a piece of clothing or a religious icon: everything holds the clues to your patient. Verghese counsels respect and gratitude for the patient and their family members.
He then discussed specific medical techniques, at one point asking his audience to stand and demonstrate the thyroid exam on each other. Asking learners to show their techniques is key in Verghese’s book. And he ends with the two final steps: Exit well and Review. A good exit is kind and thoughtful. Help readjust the patient’s bed, Verghese suggests, and put their socks back on. Talk with family members. If you promise to come back, be sure to come back.
And then for the final step: Review. Give feedback, go over everything you saw, and leave your learners with some self-guided objectives. Verghese suggests “remarking on the human being you just saw” as yet another grounding reminder of what the practice of medicine truly is. And, last but not least, leave your students with a riddle. Insist that they promise not to Google the answer. The point is to let them think and ruminate on a medical mystery. The reward is in the process.
Verghese’s talk was one of several topics discussed at the symposium, but they all fit into a larger theme: the importance of working, teaching, and learning at the bedside. If there wasn’t any original content in his tips and tricks, that was by design. Wisdom gleaned at the bedside, as Verghese demonstrated, is often part of a long chain of tips and tricks passed down through the ages from doctor to doctor in the hopes of enriching the practice of medicine.
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…