Patient misunderstanding Climate Limited time Patient privacy Lack of faculty training Uncooperative/angry patient Lack of faculty rewards Lack of role models Miscellaneous Crowded room No blackboard/X-ray view-box Can't refer to textbook Teacher/learner hesitancy in discussing Differential Dx Fear of undermining house staff Learner fatigue Ramani, S., et al (2003). (con’t) Strategies to Increase/Improve BT Pre-rounds Prepare goals for each session Orient learners to goals (PE, communication, professionalism) Orient patients to purpose of rounds During rounds Establish safe environment ("I don't know" is OK) Respect learners (1° caregiver, challenge don't humiliate) Respect patients (humans, not specimens) Engage everyone in the room Involve the patient Match teacher-learner goals Post-rounds Debrief Ramani, S. (2003). Twelve Tips to Improve Bedside Teaching. 25 Medical Teacher, Source for model cited in handout. Williams, K. N., Ramani, S., Fraser, B., & Orlander, J. D. (2008). Improving Bedside Teaching: Findings from a Focus Group Study of Learners. 83 Academic Medicine, Authors from Boston University. Focus groups among residents describe obstacles/solutions. Barrier Strategy Personal Low initiative Institutional incentives Low teacher/learner expectations Set explicit expectations/objectives Low BT teaching skills Set good learning environment Acknowledge learners needs Plan flexibility per workload Selectively/efficiently integrate BT w/work Set teaching time limits Low clinical knowledge/skills Faculty development Reassure: EVERYONE has something to offer Pt uncooperative Ask beforehand Interpersonal Orient pt to format/goals Include/inform pt Lack of learner autonomy Respect learner-pt relationship Negotiate of autonomy
Patient misunderstanding Climate Limited time Patient privacy Lack of faculty training Uncooperative/angry patient Lack of faculty rewards Lack of role models Miscellaneous Crowded room No blackboard/X-ray view-box Can't refer to textbook Teacher/learner hesitancy in discussing Differential Dx Fear of undermining house staff Learner fatigue Ramani, S., et al (2003). (con’t) Strategies to Increase/Improve BT Pre-rounds Prepare goals for each session Orient learners to goals (PE, communication, professionalism) Orient patients to purpose of rounds During rounds Establish safe environment ("I don't know" is OK) Respect learners (1° caregiver, challenge don't humiliate) Respect patients (humans, not specimens) Engage everyone in the room Involve the patient Match teacher-learner goals Post-rounds Debrief Ramani, S. (2003). Twelve Tips to Improve Bedside Teaching. Medical Teacher, 25 Source for model cited in handout. Williams, K. N., Ramani, S., Fraser, B., & Orlander, J. D. (2008). Improving Bedside Teaching: Findings from a Focus Group Study of Learners. Academic Medicine, 83 Authors from Boston University. Focus groups among residents describe obstacles/solutions. Barrier Strategy Personal Low initiative Institutional incentives Low teacher/learner expectations Set explicit expectations/objectives Low BT teaching skills Set good learning environment Acknowledge learners needs Plan flexibility per workload Selectively/efficiently integrate BT w/work Set teaching time limits Low clinical knowledge/skills Faculty development Reassure: EVERYONE has something to offer Interpersonal Pt uncooperative Ask beforehand Orient pt to format/goals Include/inform pt Lack of learner autonomy Respect learner-pt relationship Negotiate of autonomy