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Bedside clinical teaching for medical students at UNC

Bedside clinical teaching for medical students at UNC. Peadar G Noone, MD FCCP FRCPI UNC Chapel Hill. AOE UNC Chapel Hill. Background.

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Bedside clinical teaching for medical students at UNC

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  1. Bedside clinical teaching for medical students at UNC Peadar G Noone, MD FCCP FRCPI UNC Chapel Hill. AOE UNC Chapel Hill

  2. Background • For generations, clinical bedside teaching was the basis of medical school education (think of the weighed down white coat – hammers, ophthalmoscopes, tuning forks etc) • Started with the clinico-pathologic correlation science in the late 19th century (the Oslerianschool) • UK / Irish medical school teaching (the “colonial” system) still heavily bedside focused • Less so in the US: recent publications lament this decline (though not everyone in agreement).

  3. Outstanding clinical teachers in history: • Cheyne • Graves • Stokes • Corrigan • Adams • Wilde • Osler • Verghese (Stanford)

  4. Noone background: • Traditional medical school, 3 basic science years, 3 years of clinical training, heavily bedside focused • Intern: small community hospital with very charismatic clinician teacher at the helm • Every ward round was a teaching round, every clinical point, sign and laboratory value squeezed dry • Post graduate examination in British Isles (MRCPI/MRCP) still involves several bedside components with real patients and patient data • 2010: Invited back as extern examiner for the “Final Med” exams at RCSI Dublin

  5. Bare below the elbow, no tie, jewelry

  6. Today: • Abraham Verghese–NEJM article “Culture shock – patient as icon, icon as patient”* • Spoke about the “tension” between traditional approaches (the body as a text) versus the care of the “iPatient” (in the “bunker”) • http://stanfordmedicine25.stanford.edu/ • Whose fault – us as teachers? • Time, expectations, the encroachment of more exciting technologies, computerized records • Do our students want anything different? *NEJM 2008; 359: 2748-2751

  7. Lets get back to basics at UNC: Inspect Palpate Percuss Auscultate Cerebrate

  8. A pilot study of rotating bedside clinical tutorialsfor medical students at UNC • Hypothesis: That med students want bedside clinical teaching, and that data will support that • Aims: • To study the feasibility of rotating clinical tutorials for clinical students • To gather data to assess the benefits of focused teaching in the context of modern medical education

  9. Preliminary data: • Feedback over many years of clinical teaching on rounds, enthusiastic generally, perhaps there is indeed a “hunger” for this type of approach • There is a literature supporting this from formal studies • e.g. NEJM: Images in clinical medicine etc

  10. Objectives: To teach • History taking skills • Clinical exam • Presentation skills • Clinical reasoning • Professionalism • Spin off benefits: Attending learn more about patients problems • Patient benefits of learning about their disease

  11. Methods: • Advertised via student forums, flyer and direct conversations with students on the wards • E-mail communication usually with first-come-first-served sign up • Once every two to three weeks. • Strictly bedside, appropriate patient selection important • One to two hours depending. • Questionnaire formulated (based on the literature and my instincts)

  12. Results: • Anonymous • n=11 sessions • N=31 students • Stretched over several months • Data analyzed with help of UNC student on work experience (Melissa House). • Data qualitative, showing simple outcomes of various measures the students were asked to score

  13. Conclusions: • Generally the tutorials were well received • Scored pretty well on most measures • Consistent with what is in the popular press and formal medical literature • Did not ask for feedback from patients • Did not follow up long term

  14. Limitations: • Time consuming: Students, teacher time(afternoon formal teaching, MPH, research, organization and communication) • Student understanding of the principles (bedside? – you mean in the room all that time?; how are we supposed to do this? Are we just to turn up?) • Patientavailability and quiet time (its hard to get an hour+ in a room undisturbed) • Other (vasovagal episodes in two students not used to spending that much time on their feet in the room)

  15. ACKNOWLEDGEMENTS: • The Academy of Educator Grant Mechanism • Melissa House work study student • UNC Med students • The willing patients

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