How is modern bedside teaching structured? A video analysis of learning content, social and spatial structures

Abstract

Background Bedside teaching (BST) is an essential and traditional clinical teaching format. It has been subject to various impediments and has transformed over time. Besides a decrease in bedside time, there has also been a didactic diversification. In order to use time at the bedside effectively and understand the current design of BST, we here offer an evidence-based insight into how BST is practiced. This may serve as a basis for a refinement of its didactic design. Methods In the current study, we investigate the interrelationships between learning content and the social as well as spatial structures of BST. To this end, we have empirically analysed almost 80 hours of video material from a total of 36 BST sessions with good interrater reliability. Results BST lasted on average 125 min, most of which was spent in plenary and less than a third of the time at the patient’s bedside. History taking was primarily practiced at the bedside while case presentations, clinical reasoning and theoretical knowledge were largely taught away from the patient. Clinical examination took place to a similar extent in the patient’s room and in the theory room. Conclusions Even though the filmed BSTs are not purely “bedside”, the teaching format investigated here is a typical example of undergraduate medical education. In order to maximize the teaching time available, a suitable learning space should be provided in addition to the bedside. Moreover, the clinical examination should be revised in its general sequence prior to the BST, and conscious decisions should be made regarding the social structure so as to optimize the potential of small groups and plenary sessions.

Good bedside teaching on secondary care placement: The student perspective

“…This is in keeping with recent findings that the majority of time during BST is spent away from the bedside. 11 Participants in this study also valued the opportunity to observe the clinician demonstrating at the bedside and identified the teacher as a role model. Exposure to professional role models has been argued to develop students into more empathetic doctors; such teaching is not usually explicit but is a critical expectation of patients.…”

“…10 Recent research has explored the clinician perspective of excellent BST and analysed video recording of BST. 11 Features of excellent teaching included deliberate learning objectives, facilitation of learnerpatient interaction and immediate feedback. 15 However, the student perspective was not explored.…”

“…Since the first teaching WR in 1660, BST has traditionally taken place on WRs 10 . However, Blaschke et al 11 argue that there has been recent ‘didactic diversification’ of this format, with various models of ‘patient‐based teaching’, including direct observation, case conference, reporting back and videoing 12 . Previous authors have proposed that learning with patients is most valuable when experiences are structured to incorporate practical experience and feedback 4,13 .…”

Student mistakes and teacher reactions in bedside teaching

“…The demographic data of teachers and students (teachers: medical discipline, age and sex; students: age, sex and year of medical studies [cf. Blaschke et al ( 2022 )]), were collected by means of questionnaires handed out at the end of the lessons. The lecturers in the present sample had an average age of 33 years (range 26–46 years).…”

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Fig. 1 Camera setup in the patient room (components of this graphic are provided unrestricted and copyright-free by Microsoft, figure adapted from Blaschke et al ( 2022 )). P = Patient, R = Researcher, S = Student

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