Johns Hopkins University
Master of Education in the Health
Professions
Anne Belcher, PhD, RN, AOCN, ANEF, FAAN
MEHP
What is bedside teaching?
 Direct interaction among the health care provider, the
student, and the patient or the patient’s family
 Purposes include the following:
 Elicit a history
 Perform a physical examination or procedure
 Discuss the diagnosis and best therapeutic approaches
Encourages student to problem solve
Allows provider to model behaviors such as communication
skills, professionalism, and compassion
History of BST
• Dates back to the time of Hippocrates, Sylvius
and Sir William Osler
• Present studies reveal that fewer health care
providers teach at the bedside
• General agreement throughout academic
education that BST is at risk of becoming a lost
art
Advantages of BST
 Helps students transition from classroom to practice
setting, where they can become a member of the
health care team
 Provides opportunities for active learning
 Provides teacher with opportunities for role modeling
 Allows patients and families to become active
participants in their care
Barriers to BST
 Time—related to pressure to see more patients, fewer
patient days, and more documentation
 However, according to Gonzalo et al (2010), total rounding
time (walk rounds and BST together) did not change with
the addition of BST
 Student based barriers include disinterest
 Teacher based barriers include lack of training, fear of
violating HIPAA, lack of dedicated time
 Patient-based barriers include critical status, discomfort,
distress
 Systems-based barriers include overabundance of
technology-driven diagnoses; interruptions
Description of models
 Microskills of BST (Neher et all, 1992)






Get a commitment
Probe for supporting evidence
Teach general rules
Reinforce what was done well
Correct mistakes
Identify future learning steps
Janicik & Fletcher (2003) Domains
Domain 1 attends to patient’s comfort
Domain 2 focuses on five Microskills
Domain 3 addresses group dynamics
Application of adult learning theory to
BST
• Kolb’s model of experiential learning
– Concrete experience
– Reflective observation
– Abstract conceptualization
– Active experimentation
Knowles’ six core principles of
andragogy
•
•
•
•
•
•
Learner’s need to know
Learner’s self-concept
Prior experience of the learner
Readiness of the learner
Orientation to learning
Motivation to learn
Student and patient perspectives on
BST*
• Only 48% of students reported they had been
given enough
• 100% found it to be the most effective way of
learning clinical skills
• 77% of patients enjoyed BST
• 83% said it did not make them anxious
*Nair, BR, Coughlan, JL, & Hensley, MJ (1997).
Student and patient perspectives on bedside
teaching. Medical Education, 31, 341-346.
Assessing the quality of BST*
• Use of structured, 15-item objective structured
clinical examination checklist
• While useful as a tool for assessing quality, the
authors noted that BST may be a more inherently
subjective process, based on different teaching
(and learning) styles
*Conigliaro, RL & Stratton, TD (2010). Assessing the
quality of clinical teaching: a preliminary study.
Medical Education, 44 (4), 379-386