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Bedside / Wards

The bedside provides a rich opportunity to educate both the patient and the students. The bedside educator can be successful by orienting the learner to teaching at the bedside, using sound principles of teaching, giving students value added roles and giving lots of feedback.
To participate in clinical teaching of FIU HWCOM  students, you must have a clinical faculty appointment and undergo an initial orientation with the clerkship or course director, or their designee.  The following information is designed to supplement and reinforce what you gain from orientation.

  • Orienting the Learner to the Site and Preceptor

    Orienting students and setting expectations are the foundations of a good clinical learning experience. Skilled clinical teaching will be lost on a student who is preoccupied with trying to figure out what they should do, what they are supposed to learn and know, what and how much they are supposed to do with a patient, or even how they will find the bathroom.

    In some sites, ancillary providers or staff may quickly provide this on the student’s first day. If you would like to write any specific and consistent expectations of your site for students to review prior to the first day, the clerkship director or clinical faculty director can provide this before the rotation begins. Some clinical sites may provide an “Orientation PowerPoint” the students can watch prior to arrival at the site. If you would like to do this with narration, FIU has very easy-to-use PowerPoint narration software provide by the IT support staff.

    The One Minute Learner is a tool adapted from Boston University that you can use when you first meet the student to orient them to your teaching and site:

     

    ONE MINUTE LEARNER, adapted from Boston University

    1. GOALS: Learner’s level of experience; Learner’s and Your Goals
    2. GETTING GOING:  When, how and who should the learner see? 
    3. HOW MUCH and HOW LONG  Focused or Full?
    4. PRESENTING:  Where and how?
    5. CHARTING:  When and how?
    6. QUESTIONS: When is a good time to ask questions that come up?
    7. USE OF TECHNOLOGY*  When can learners use phones/ipads to look up the answers to clinical questions? At the moment of care or later?
    8. UNSTABLE PATIENTS*  How would you describe an unstable patient? When should the learner immediately get you to assess a patient?
    9. LOGISTICS* who’s on the team/reporting/residents, the logistics of rounds, lunch, bathroom, entry codes, daily schedule/activities/roles for student (even if faculty not on floor)

    *added by S.Minor at FIU

    For further information about the One Minute Learner, view either resource below: You can also ask your staff to orient the students to:
    • How patients move through the wards and hospital
    • How the student may contribute to patient care
    • How to contact the hospital team in case of personal emergency
    • Where to put personal belongings and any possible independent workspace
    • Rooms equipment, supplies, and organization
    • Patient education materials
    • EMR Access
    • Retrieving test results
    • Ordering tests and consultations
    • Scheduling follow-up appointments
    • Dining options and locations
  • Teaching at the Bedside

    The inpatient physician functions as an educator and as a coach. From the outset, set expectations of the learner using the One Minute Learner. Consider the structure of your rounds.  Let the student know how many patients he/she is responsible for pre-rounding on, what to do during pre-rounds, and the time/location/structure of rounds.

    The inpatient attending can motivate learners by addressing learners by name, using physical touch, tapping into the students’ own motivation for learning (personalize your teaching based on the student’s interests or motivations), using visualization, emphasizing methods rather than content, and striving to ensure the quality and quantity of teaching as appropriate to the level of the learner. You do not have to know everyone’s name to start with. Call on the learner whose name you do know and ask them to call on the next person: "Gregoir, I've called on you enough. Choose someone else on the team by name." Use the names as often as you can to remember them.

    To promote learner memory and retention, the attending should:

    • Consider using organizers (such as illustrations or mnemonics) and teaching in an orderly sequence (building on foundational information). 
    • Use questions appropriately (see the section on using questions) can help students to learn as well. 
    • Teaching in the Presence of the Patient (TIPP) can be helpful to involve the patient, role model patient-centeredness and further your own work satisfaction.  To learn more about TIPP, view either of these resources: stfm.org or meddent.uwa.edu.au

    Another important task for the attending is to establish a supportive environment in which everyone can say “I don’t know”, even the teacher.  This can also be considered a no-blame culture.  Calling on students during rounds with questions regarding patient care and management is appropriate in that your motivation is to further patient care and student learning.  Calling on a learner until they don’t know a question that seems unrelated to patient care may be perceived as pimping and will not further the student’s learning.  The same skills that you use in communicating with patients will help you to communicate with students.  Rounds present an excellent opportunity to ask questions linking the learner’s basic science knowledge to clinical care and treatment.

    In the inpatient setting, learners can hone their time management, data organization, interpersonal, communication, lifelong learning and clinical skills.  Students may not understand how to address the many tasks they will be charged with in the inpatient setting.  You may encourage learners to organize their tasks into important or urgent tasks and prioritize urgent tasks.  Assigning learner reading to be presented at the end of the day or the following day will help the student to incorporate daily reading into her/his daily habits. 

    The University of Western Australia crafted the Teaching on the Run Tips Series.  Each Tip is less than two pages.  
    This is an article from the New England Journal of Medicine geared towards residents who teach and applicable to any medical educator.
    This article discusses "Twelve tips to improve bedside teaching"
    These YouTube videos offer tips on teaching at the bedside:
    This 17 minute voice over powerpoint describes clinical teaching:
  • Ways Students Can Contribute to Patient Care While Learning
    Students can contribute to patient care! Consider these opportunities for students to practice their skills while enhancing patient care:
    • Help the nurse with triaging patients. 
    • Complete initial intake of patients; this helps patients feel they are waiting less.
    • Complete pre-op history and physical examinations.  Then, present these history and physical examinations along with the pre-op labs.
    • Review the EMR on the patient and present to the attending.
    • Track down or follow up on missing lab results/studies.
    • Write patient notes.  This may include daily care notes for the chart which you co-sign or discharge summaries which you use for dictating. 
    • Present information from evidence-based resources such as Uptodate or a review article from Pubmed.
    • Call consults or act as connection with other health providers.
    • Call the patient with their lab results, further patient education (such as titrating insulin up), and for follow up on behavior changes (such as smoking cessation).
    • Document patient calls. 
    • Provide patient education about diet, exercise, family planning and advance directives.
    • Perform injections, blood draws, EKG’s and urine dipsticks.
  • Giving Feedback
    Giving feedback is an integral skill for medical educators.  Characteristics of quality feedback include:
    • Frequent
    • Timely – don’t wait too long!
    • Named – "I'm giving you feedback…."
    • Limited – in bite size chunks, just as we provide patient education
    • Requires a credible source and a culture of respect and support - It’s all about the relationship! Learners need to know you are looking out for their learning and well-being.
    • Based on direct observation
    • Uses questions, thus promoting self-reflection. Some great questions include:
      • "What did you do well?"
      • "What can you improve?" 
      • "What’s your SMART plan for improvement?" SMART=Specific, Measurable, Achievable, Relevant, Time-limited
    • Focuses on the process not the person – giving feedback about the process of learning or development of a skill creates a growth mindset whereas feedback about the person creates a fixed mindset in which growth does not occur.  This is an example of feedback on the process: "You took in the feedback I gave you about avoiding medical jargon and used layperson’s language when explaining the patient’s diagnosis. Well done!"  This is an example of feedback on the person, which is not helpful to the student: "You are such a smart student."
    Giving Feedback: The University of Western Australia crafted the Teaching on the Run Tips Series. Each Tip is less than two pages.

    Giving Feedback for free CME: FIU COM Online Teaching Modules on Giving Feedback for free CME!

  • FIU COM Online Teaching Modules for Free CME!
    Go to the FIU COM Online Teaching Modules on Giving Feedback, Narrative Comments, Orientation to Clerkship Teaching, the EPA’s (Entrustable Professional Activities) and the Patient Role in Teaching: