How & Why Attending Physicians Should Teach in Patient Rooms

Concerns & Qualifiers

Of course, not all clinical encounters should be precepted in the exam room. Difficult patients may need a singular provider to talk to. But by and large, even difficult patients provide opportunities for learning and teaching in the room. Although uncomfortable, it provides a window to assess professionalism and interpersonal communication skills. The only caveat? Fellows and residents should provide attendings a heads-up prior to entering a difficult patient’s room so the attending can take it into account.

Another concern: putting learners on the spot and taking away their autonomy. When bedside teaching is done poorly, this is a tremendous problem, but some deference and common sense go a long way towards resolving these problems. I recommend using a light touch and allow fellows to engage with their patients as much as possible. This depends on each learner, but I essentially let the second-year fellows have free rein. If there’s a difference in opinion or a necessary course correction, I make it clear I work as a consultant to provide evidence or an opinion to the contrary, and I let the learner dictate the course of action. This provides two added bonuses of 1) incorporating evidence-based medicine into practice, and 2) elevating the status of learners as independent physicians in the patient’s eyes.

Admittedly, teaching in the room requires flexibility, accommodation and dedication. But it’s worthwhile and helps harmonize clinical service and teaching. Moreover, it better approximates what medical education should be—a slow and gradual substitution of the attending’s visible and palpable presence in the room with the learner’s own judgment and reasoning.

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Bharat Kumar, MD, MME, FACP, RhMSUS, is the associate program director of the rheumatology fellowship training program at the University of Iowa in Iowa City. He completed a dual fellowship in rheumatology and allergy/immunology, and a master’s in medical education in 2017. He has special interests in journalism, healthcare policy and ethics. Follow him on Twitter @BharatKumarMD.

References

1. Chapman R, Wynter L, Burgess A, et al. Can we improve the delivery of bedside teaching? Clin Teach. 2014 Oct;11(6):467–471.
2. Petersen K, Rosenbaum ME, Kreiter CD, et al. A randomized controlled study comparing educational outcomes of examination room versus conference room staffing. Teach Learn Med. 2008 Jul–Sep;20(3):218–224.
3. Anderson RJ, Cyran E, Schilling L, et al. Outpatient case presentations in the conference room versus examination room: Results from two randomized controlled trials. Am J Med. 2002 Dec 1;113(8):657–662.
4. Rogers HD, Carline JD, Paauw DS. Examination room presentations in general internal medicine clinic: Patients’ and students’ perceptions. Acad Med. 2003 Sep;78(9):945–949.