THE STRUCTURE OF BEDSIDE TEACHING

To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all (Osler, 1903)

Weekly activity
Mon
07.00 08.00

Tue
Preround on patients

We
Preround on patients

Thu
Preround on patients

Fri
Preround on patients
Grand rounds

Sat
Preround on patients

Pretest

08.00 09.00
09.00 10.00

BST
Out patients clinic

CRS

BST

CSS

BST

RPS

10.00 11.00

Ward activity
11.00 12.00

Ward activity

Out patients clinic

12.00 13.00

Meeting with chief of department

13.00 14.00

14.00 -

Night shifts
Example 1 Example 2

BST = bedside teaching; CRS = case report session CSS = clinical science session; RPS = resource person session

Bedside Teaching
Ideal setting for
Demonstration of Physical findings Interviewing Developing interpersonal skills Teacher, Trainee & Patient interaction Role-modeling

KEY STRATEGIES IN BEDSIDE TEACHING

PRE-ROUNDS
PREPARATION PLANNING ORIENTATION INTRODUCTION INTERACTION OBSERVATION INSTRUCTION SUMMARIZATION
DEBRIEFING FEEDBACK REFLECTION PREPARATION

ROUNDS (20)

POST-ROUINDS (100)

Case Analysis :
FINAL OBJECTIVES
Problem Hypothesis Mechanism More info Dont Learning know issues Problem solving

Decision Making: Diagnosis treatment

Tingkat Kompetensi
Akuisisi observasi tindakan Membantu sejawat melakukan tindakan Kompetensi Melakukan tindakan di bawah pengawasan langsung supervisor Melakukan tindakan dalam supervisi indirek Profisiensi Melakukan tindakan secara mandiri

Tutorial 1 (PBL)
t Step One t
One or two students clerk the patient on their own and present the findings to their group in absence of a preceptor

Tutorial 1 (PBL)
t Step Two t
Group discuss the problem and do self / group study to find out information related to learning issues

Tutorial 2 (PBL + PBT)

t Step Three t
Students meet their preceptor and make formal presentation and go through learning issues.
Preceptor, who is an expert clinician, will act as a facilitator and teacher, as and when appropriate

Case Report Session

Discussions on patients who have been seen in previous contact (in BST) Discuss specific diseases /conditions according to the modules Preceptor guides the learning process

Clinical Science Session

Discuss scientific issues related to topics chosen or assigned to a student or a group of students Enhances EBM practice in solving clinical problem Things to be discussed within 2 hours of meeting:
Discuss previous learning issues (30 minutes) Presentation of new topic + discussion (1 hours) Generating next learning issues (15 - 30 minutes)

Resource Person Session

Important topics related to the department Given by the experts First RPS can be used by the chief of department to emphasize the importance of knowing certain topics chosen in dealing with patients in the setting of primary health care/family medicine Encourages active participation of students

Activity Bedside teaching Case report Session Clinical Science Session Expert session

Duration/week Duration in 3 weeks 3 x 2 hours 18 hours 1 x 2 hours 1 x 2 hours 6 hours 6 hours

Duration in 9 weeks 54 hours 18 hours 18 hours

1 x 2 hours

6 hours

18 hours

Mini Clinical Examination Exercise (Mini-CEX)

ABIM developed and validated the clinical exercise (CEX) as a method of assessing residents history taking and physical examination skills

Mini-CEX forms

 The attending evaluates the students history and physical examination, clinical judgment, humanism, and overall clinical competence as a student, using the standardized mini-CEX form

The form uses a standardized nine-point scale : - 1-3 (unsatisfactory) - 4 (marginal) - 4-6 (satisfactory) - 7-9 (superior)

Conclusion :

The benefits of the mini-CEX : - skills are evaluated in a short time - the students will receive a feedback - could be used for observing the student at the bedside, hear the students assessment - low cost