bedside ed teaching

EDUCATIONAL ADVANCES

Bedside Teaching in the EmergencyDepartmentAmer Z. Aldeen, MD, Michael A. Gisondi, MD

AbstractBedside teaching is a valuable instructional method that facilitates the development of history and physicalexamination skills, the modeling of professional behaviors, and the direct observation of learners. Theemergency department (ED) is an ideal environment for the practice of bedside teaching, because itshigh patient volume, increased acuity of illness, and variety of pathology provide plentiful patient-centeredteaching opportunities. Unfortunately, the pressures of ED overcrowding at many institutions now limit theavailable time for formal bedside teaching per patient. This article will discuss the historical decline of bed-side teaching on the wards, address obstacles to its use in the ED, and reestablish its specific benefits as aunique educational tool. The authors propose several practical strategies to increase bedside teaching byacademic emergency physicians (EPs). These techniques emphasize careful preparation and a focusedteaching approach to overcome the inherent challenges of a typically busy ED shift.

ACADEMIC EMERGENCY MEDICINE 2006; 13:860866 2006 by the Society for Academic EmergencyMedicine

Keywords: teaching, emergency medicine, education, internship and residency, student, medical,medicine

The term bedside teaching refers to physician train-ing that occurs in the presence of patients; liter-ally, it is teaching at the bedside. Much of the

existing literature on bedside teaching has been writtenby primary-care educators who identify ward rounds astheir ideal opportunity for clinical teaching.18 These tal-ented generalist professors have developed a definedskills set for teaching on inpatient rounds. In their set-ting, stable and interactive patients are examined at aslower, more predictable pace. The inpatient wards rep-resent the traditional laboratory for the uninterruptedpractice of bedside-teaching skills.In contrast, opportunities for bedside teaching in the

emergency department (ED) are limited by inherent envi-ronmental challenges. The ED often is chaotic and unpre-dictable, with faculty members under constant pressureto care for a continually rising number of critically illpatients. Direct bedside care represents only a fractionof the total time spentmanaginganyonepatient, thus relo-cating much of the educational discourse outside the pa-tient room. Effective bedside teaching can be challenging

in this busy setting, requiring that emergency medicine(EM) educators possess a skills set unique from that oftheir primary-care colleagues. Bedside teaching method-ologies that address the dynamic pace andvariable patientpopulation of the ED have received little attention in theliterature to date.4,5

This article will review the common impediments toeffective bedside teaching in the ED, discuss the edu-cational value of this instructional method, and offerpractical strategies to overcome barriers to its implemen-tation during a demanding shift.

DECLINE OF BEDSIDE TEACHING

Teaching medicine at the bedside has been an integralpart of the education of young physicians since antiquity.Hippocrates, who is often called the father of bedsidemedicine, advocated teaching The Science by placingthe patient, rather than the disease, at its physical andsymbolic center.9 Sir William Osler, one of the eminentclinical teachers of the modern era, promoted bedsiderounds as the preferred alternative to lecture-based edu-cation: Take [the student] from the lecture room, takehim from the amphitheater. put him in the outpatientdepartment, put him in the wards. no teaching [shouldbe done] without a patient for a text, and the best is thattaught by the patient himself.10

The overall culture of modern medical education hasmoved away from Oslers bedside model to a moredidactic, lecture-based format.3,7,1114 Clinical teaching

From the Department of Emergency Medicine, Feinberg School

of Medicine, Northwestern University (AZA, MAG), Chicago, IL.

Received January 25, 2006; revision received March 12, 2006;

accepted March 13, 2006.

Address for correspondence and reprints: Amer Z. Aldeen, MD,

Northwestern University, Department of Emergency Medicine,

259 E. Erie St., Suite 100, Chicago, IL 60611. Fax: 312-926-6274;

e-mail: [email protected].

ISSN 1069-6563 2006 by the Society for Academic Emergency MedicinePII ISSN 1069-6563583 doi: 10.1197/j.aem.2006.03.557860

on the inpatient wards has retreated from the patientsbedside to the hospital corridor, to the nursing station,and finally, to the conference room.35,7,15 Several studieshave quantified this steady migration; they have reportedthat the incidence of bedside teaching on internal medi-cine rounds declined from roughly 75% in the 1960s11

to just 15% a decade later.12 Some investigators haveestimated that less than 25% of all clinical teaching timeis spent at the bedside.16,17

It is important for academic emergency physicians(EPs) to examine the reasons for the decline of bedsideteaching on the wards. Lessons learned by generalist ed-ucators may aid in overcoming some of the impedimentsto the use of this educational tool in the ED. A survey ofinternal medicine faculty, chief residents, and residencydirectors cited several deterrents to bedside teaching:poor bedside-teaching skills, the unrealistic expectationthat the teacher be omniscient, and the underapprecia-tion of clinicianeducators by academic medical centers.7

Other studies have identified complacent residents andfearful faculty as the major obstacles to bedside teach-ing.3,5,8 One investigator found that 80% of experiencedattendings (defined as those more than 10 years out ofresidency) preferred bedside presentations, comparedwith only half of their junior faculty colleagues.8 Physi-cians also use patients as an excuse for conducting hall-way rounds, citing the assumption that patients mayfeel uncomfortable if confidential medical information isdiscussed in front of multiple learners.4

Several additional obstacles to effective bedside teach-ing exist in the busy ED setting. The pressure to evaluateand manage multiple patients in a limited amount of timecan severely restrict bedside teaching opportunities byacademic EPs.5,18 Acutely ill patients require immediatestabilization, precluding the use of the controlled, inpa-tient style of bedside teaching. The ambulatory care envi-ronment provides a closer approximation of ED patientflow as it applies to bedside teaching. According toKroenke et al., The clinic setting demands real time teach-ing. The learner often has a number of patients to see andis thus on a tighter time schedule than on the wards.5 Inthe ED, students and residents tend to learn new clinicalskills by the just-show-up-and-go approach,19 withoutthe benefit of any structured educational technique suchas formal teaching rounds.The development and growth of the specialty of EM

occurred in concert with the decline in bedside teachingby generalists. Whereas history left internal medicinewith a well-developed cultural legacy of clinical teaching,EM still is developing a teaching ethic of its own.18 Pri-mary-care educators have addressed the problem of de-valued bedside teaching by establishing faculty teachingawards, formal training in teaching skills and educationalresearch, and incentive plans.7,15,19 Since 1989, the Amer-ican College of Emergency Physicians Teaching Fellow-ship has trained up to 30 faculty members biannually,focusing on clinical teaching techniques (including bed-side teaching).20 However, to accommodate the recentgrowth of EM residencies (and learners) across the coun-try, many more formal teacher-training programs willhave to be established. It may be difficult to identifyand reward EM faculty members who are particularlyproficient at bedside teaching, because the specialty has

rarely differentiated this teaching method as a uniqueskills set. Last, there is a need for well-designed educa-tional research that evaluates the effectiveness of suchspecific, time-consuming teaching techniques within theconstruct of EM.

BENEFITS OF BEDSIDE TEACHING

Several studies have documented that excellent clinicalteachers can help to improve learning as measured bystandardized test scores of medical students.2124 Al-though most of these studies have not focused exclu-sively on bedside teaching as the primary technique,Roop and Pangaro demonstrated that students cited bed-side teaching and evaluation as characteristic strategiesof superior clinical teachers.21 Although important clin-ical teaching commonly occurs during presentationsoutside the examination room, bedside instruction hasconceptually distinct goals and methods, while simulta-neously providing equivalent transfer of information.25

Bedside teaching allows for the demonstration of effi-cient history-taking and physical findings, the modelingof professional behaviors and communication tech-niques, and a venue to directly observe learners interact-ing with their patients. Examples of bedside-teachingopportunities in the ED include the instruction of teamleadership, procedural skills, and clinical decision mak-ing during medical and trauma resuscitations. Severalimportant benefits of bedside teaching are summarizedin Table 1.

Opportunity to Demonstrate and Assess Historyand Physical Examination SkillsThe development of appropriate interviewing and physi-cal examination skills is best produced by seeing as manypatients as possible.3,5,6,14,15,26,27 Students and residentsearly in clinical training have difficulty distinguishingcritical elements of a patient history from issues less rel-evant to the case at hand. A proficient bedside teachercan exhibit lines of questioning that achieve the mostefficient transfer of clinical information. Similarly, inex-perienced learners often overlook uncommon or subtlephysical examination findings. Such findings can makefor memorable teaching moments when talented clinicaleducators discuss the manifestations of illness in thepresence of an obliging patient.28 One study found thatstructured sessions in bedside teaching by expert facultygreatly improved resident interpretation of cardiac mur-murs.29 Appropriate patients provide a context in whichto reinforce the understanding of disease processes firstlearned in the classroom.26 A survey by Mandel et al.

Table 1Benefits of Bedside Teaching

Provides an opportunity to demonstrate and assess history andphysical examination skills

Establishes a forum to develop and assess professionalismImproves the therapeutic relationshipImproves patient educationProvides a setting for direct observation as a formal evaluativetool

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indicated that internal medicine graduates felt underpre-pared in their clinical practice skills (including historytaking and physical examination)30 and demonstratesthe need for more bedside experience.14 In response toan increasing demand for evidence-based clinical teach-ing, the Journal of the American Medical Association hasdeveloped the Rational Clinical Exam series.31 This setof articles helps medical educators to teach clinical diag-nostic skills, often by using a bedside approach to facili-tate learning. Bedside instruction thus represents theideals of the patient-centered, Hippocratic approach tomedical education.9,14

Forum to Develop and Assess ProfessionalismBedside teaching provides an excellent opportunity tomodel professional behaviors19 and to discuss thehumanistic aspects of medicine.7 Professionalism andhumanism cannot be learned without the participationof actual patients. A survey of 50 medical-school facultymembers concluded that didactic seminars alone hadfailed to foster humanism amongst their students.32

Directed patient interactions facilitate the understandingof a specific disease process, as well as the broadercontext in which a patient experiences illness.3 Bedsideteaching discourages the practice of denigrating patientswith labels like train wrecks, last nights hits, [and] go-mers.3 Even when the medical aspects of a case requireno further explanation to the learner, faculty may demon-strate excellent interpersonal skills during the bedsideencounter.13,14

Improvement of the Therapeutic RelationshipBedside teaching contributes to an increase in the dura-tion of the clinical encounter and positively affects thepatientphysician relationship.35 A randomized con-trolled trial of bedside teaching conductedon the inpatientmedicine wards at Johns Hopkins University concludedthat patients perceived greater physician contact timewhen rounds were held at the bedside (10 minutes vs.6 minutes).33 Another study demonstrated that 85% ofpatients preferred to be present when their cases werediscussed.8 Educators have found that the majority ofpatients enjoy participating in bedside-teaching roundsand would recommend the process to other patients.34

Improvement of Patient EducationThe increase in physician contact attributable to bedsideteaching also contributes to patient education.27 Twothirds of inpatients who were surveyed in one study feltthat bedside rounds increased their understandingof theirrespective illnesses.1 The majority of patient respondentsin another survey study not only felt that bedside teachingimproved their knowledge about their disease but alsobelieved that the teaching process maintained confidenti-ality.34 In an era in which patients receive much of theirmedical information from popular press and the Internet,improved patient education represents an important sec-ondary outcome of bedside teaching.

Setting for Direct Observation as a FormalEvaluative ToolThe direct observation and evaluation of residents byattending staff can be a positive element of any bedside

teaching encounter. Residents who were queried abouttheir experiences with bedside assessments felt thatsuch sessions were valuable to their education, that areasrequiring improvement were appropriately identified,and that the presence of faculty evaluators was not overlyintimidating.35 Unfortunately, misperceptions of learnerdiscomfort during such evaluations have devalued theuse of bedside assessments by some faculty. In a studyof 21 EM residency programs, half of the more than500 resident respondents recalled fewer than threeobserved histories or physical examinations during theirtraining.36 Torre et al. demonstrated that bedside teach-ing with medical students improves their access to feed-back from faculty, which was regarded by learners as animportant aspect of high-quality clinical teaching.24 TheOutcome Project of the Accreditation Council for Gradu-ate Medical Education has encouraged the implementa-tion of bedside assessments as a means of ensuringclinical competency.37 EM educators have responded tothis issue, most recently with the development and vali-dation of the Standardized Direct Observation Tool.38

Advantages Specific to the ED SettingThe ED provides distinct opportunities for bedside teach-ing that are not available elsewhere in the hospital. Thevariety of pathology, both medical and surgical, allowsfaculty to demonstrate and assess a diverse breadth ofacute care knowledge. Untreated and acutely ill patientswill likely exhibit more abnormal physical examinationfindings that are conducive to bedside teaching tech-niques than will those patients who have been stabilizedand admitted to the inpatient wards. The managementof ED patients often requires performance of differentprocedural interventions that can provide a forum forfaculty to interact with learners at the bedside. A studyby Gerson and Van Dam demonstrated that bedsideteaching of sigmoidoscopy to internal medicine residentsresulted in better procedural proficiency than did usinga virtual reality simulator.39 The volume of patients seenin a typical ED shift is larger than in other clinical settings,offering more teaching opportunities.40 Berger et al.demonstrated that medical students perceived no inverserelationship between quality of teaching and clinical pro-ductivity in an academicED.41Although96%of the facultyfelt that timedemands for productivity reduced the oppor-tunity for clinical teaching, a subset of exemplary facultypossessed both excellent teaching skills and meticulousattention to patient flow. With structured-clinical andbedside-teaching training programs, it may be possibleto improve the efficiency of teaching without sacrificingproductivity for the average academic EP. Senior EMresidents benefit from the bedside modeling of efficientexaminations, professionalism, and conflict-resolutionskills that help faculty augment the flow of timely EDcare.28 The advantages and challenges to bedside teachingin the ED are compared in Table 2.

STRATEGIES FOR EFFECTIVE BEDSIDE TEACHINGIN THE ED

Principles of bedside teaching practiced by generalistson the inpatient wards provide a basic framework for

862 Aldeen and Gisondi ED BEDSIDE TEACHING

EM faculty interested in developing similar skills.6,7 Di-rection of pertinent questions on history, demonstrationof physical examination findings, modeling of profes-sionalism, and educating patients may cross disciplineseasily. Several studies have described specific methodsfor internists to increase the frequency and efficiency ofbedside teaching sessions on the wards.57,13,14,19 Theseteaching techniques should be modified with an under-standing of the clinical demands and opportunitiesinherent to high-volume academic EDs. We offer tenstrategies for implementing effective bedside teachingin the ED; these are summarized in Table 3.

Plan the Teaching Session Before the Next ShiftEffective bedside teaching requires adequate planningwell before the teachable moment.3,6,7 Faculty shouldreview key learning points for specific topics that com-monly are seen during a typical ED shift.28 Ideally, oneshould focus on practical management issues surround-ing uncommon but important diseases that present withcommon chief complaints. Such teaching points arerarely reinforced outside the lecture hall. For example,the evaluation of a potential myocardial infarction is rou-tinely reviewed in the daily presentation of patients withchest pain; however, a discussion of cardiac tamponademight include the bedside search for Becks triad (jugularvenous distention, muffled heart sounds, hypotension) orsonographic evidence of disease.

Know Ones Team, Know Ones GoalsBegin each shift with introductions18,19 and ask teammembers to identify interesting patients for teaching.Displaying an enthusiastic, nonthreatening attitude atthe beginning of a shift helps to establish a positive learn-ing environment.3,19 Goals for the rotation for each

learner should be explicitly reviewed ahead of time, be-cause different members of the team will benefit fromdifferent areas of instruction.6,19,27 Senior medical stu-dents might appreciate the demonstration of character-istic physical examination findings that are useful fordeveloping their differential diagnoses and managementplans. Rotating residents will benefit from observing andcoordinating cardiopulmonary resuscitation sequencesthat they are likely to encounter while covering the inpa-tient wards. Junior EM residents will need to refine thosesame skills, improve efficiency, manage multiple patientsat a time, and learn complex emergency procedures.Familiarity with the learners specific goals will allowthe bedside teacher to tailor the educational forum ap-propriately.19,27

Choose the Right Time to TeachIt is axiomatic that the management of acutely ill patientstakes precedence over clinical teaching.18 Nevertheless,such resuscitations provide excellent opportunities forobservational learning. EM faculty should plan for resus-citations ahead of time3,6 by generating a short list of per-tinent teaching points that can be emphasized during anycase, for example, airway assessment or rhythm analysis.Keep in mind that much learning occurs through themodeling of ideal behaviors during such high-stress en-counters. After a patient is stabilized, opportunities formore formal bedside teaching abound. While learnersare seeing new patients, the teacher can identify stablepatients who are waiting during their workup as poten-tial teaching cases for the next bedside session.

Set Realistic Expectations for YourselfThe introduction of bedside teaching at high-volume EDsshould follow the adage, start low and go slow.2 Whenstarting out, restrict the number of patients seen duringeach shift and learners taught during each session.42

Leading multiple learners into every patient room to ob-serve complete histories and physical examinations willresult in both backup of patient flow and inefficiency ofthe educational process.5,18,28 Instead, set reasonablegoals on the basis of your patient volume and individualteaching experience.5,27 The advice of Kroenke et al. forbedside teaching in the ambulatory clinic may be appliedto the ED: Time with the patient. must often be partic-ularly focused and efficient.5 Select two or three topicsto teach at the bedside each day,5 such as the importanceof eliciting cocaine use in a patient with chest pain, dem-onstrating shifting dullness in a patient with ascites,or dealing with a hostile patient. With comfort and

Table 2Advantages and Challenges to Bedside Teaching in the ED

Advantages Challenges

Variety of medical and surgical pathology Overcrowding limits teaching time per patientAcutely ill patients with abnormal examination findings Resuscitations interfere with planned teaching timeAmple opportunity to teach procedural skills Lack of training for EM faculty in bedside teachingGreater volume of patients than on other units Lack of reward for successful clinical teachersAllows for modeling of efficient, timely care Need for research to prove effective techniquesPractice professionalismPractice conflict resolution skills

Table 3Strategies for Effective Bedside Teaching in the ED

1. Plan your teaching session before your next shift2. Know your team, know your goals3. Choose the right time to teach4. Set realistic expectations for yourself5. Limit the amount of time per patient6. Be professional7. Use the Socratic method with caution8. Summarize and evaluate9. The teach-only attending10. Train residents how to teach at the bedside

Modified from Ramani.6


experience, the bedside teacher can steadily increase thenumber of patients and learners who participate eachday.5

Limit the Amount of Time per PatientTwo general guidelines regarding time management canhelp integrate bedside teaching without interrupting pa-tient throughput. First, a 1-minute hallway lecture beforethe patient encounter can provide orientation to the pro-cess and direct learners to focus their evaluations. Tar-geted mini-lectures such as these have been viewed bymedical students as an effective teaching strategy.24 Forexample, for a patient with acute pulmonary edema, firstreview the key points in pathophysiology (fluid overload,the Frank-Starling curve) and history (dyspnea, orthop-nea, paroxysmal nocturnal dyspnea) before entering thepatients room. Then conduct a bedside auscultation ses-sion focusing on the pulmonary examination for cracklesand on the cardiac examination for an S3 gallop.Second, establish a set time limit for the actual bedside

encounter.6 We suggest 5 minutes as a reasonable periodto prevent undue delay for other patients waiting to beseen.28 Such limits allow adequate time to efficientlyteach or observe clinical skills at the bedside, while con-tinuing to provide expedient care to potentially ill pa-tients.2,5

Be ProfessionalBedside teaching requires both the presence and partic-ipation of a willing patient. Faculty should discuss thegoals for the encounter with the patient and specificallyask permission13,19 to conduct the proposed teachingventure before the learners even enter the room.27 Ex-plain that although the history and physical examinationmay be conducted in the presence of a team of learners,efforts will be made to keep medical information confi-dential. Some EDs may have only curtains separatingrooms, and other patients may overhear the initial pa-tient history as well as the bedside teaching exercise.The Health Insurance Portability and Accountability ActPrivacy Rule specifically has allowed health care profes-sionals to discuss a patients condition during trainingrounds in an academic institution. if reasonable precau-tions are taken to minimize the chance of incidental dis-closure to others who may be nearby. However, in aloud emergency room, or where a patient is hearing im-paired, such precautions may not be practicable.43

The need for the bedside teacher to maintain a profes-sional, empathetic attitude cannot be overemphasized.This is crucial for both patient comfort and for the edu-cation of learners, who will emulate their teachers be-havior.3,6,18 Before leaving the bedside, make sure toaddress any patient questions that were generated dur-ing the encounter,3,13,14 and thank the patient for contrib-uting to the education of future physicians.27

Use the Socratic Method with CautionAlthough it is popular as a general clinical teaching tool,the Socratic method can be potentially humiliating forlearners and patients when used at the bedside.3,14,19

Residents would understandably be distressed if theycould not answer questions correctly in front of theirpatients,5 leading to negative consequences for their

patientphysician relationship.14,18 To circumvent thisproblem, faculty should only ask questions of learnersother than the primary caregiver. In this way, the studentor junior resident who has formed a direct therapeuticrelationshipwith the patient can learnwithout embarrass-ment while his or her colleagues field questions.5 Whileanswering questions, junior learners may ask for a con-sultation from a more senior member of the group; thiswill demonstrate a cooperative, team-oriented approachto the patients care.

Summarize and EvaluateExplicitly summarizing key concepts learned at thebedside is integral to the educational process.19,44 Thisis especially important as the ED faculty member gainsexperience and increases the number of bedside sessionsand learning points per shift. Immediate evaluative feed-back by the bedside teacher is ideally performed at theend of each teaching encounter3,6,14,19 and is viewed asessential by students.24 Furthermore, although evalua-tion of the learners performance by the teacher is im-plicit, the reverse is often conspicuously absent. Facultyshould be evaluated by learners on their teaching perfor-mance; this necessitates an open-minded teacher who isunafraid of constructive criticism.6,14 Observation andpeer review by fellow faculty is another excellent methodof giving feedback to the teacher and of increasing thefrequency and quality of bedside teaching.13,45

The Teach-only AttendingA specialized bedside-teaching program deserves men-tion: the teach-only attending. Shayne et al. describedone such successful initiative at Emory University, wherebedside teaching and observation sessions are per-formed by EM attendings who are free from clinicalresponsibilities.46 The program incorporates structured,weekly, clinical teaching that is supplemented by didacticlectures by each clinical faculty member about four timesper year. The utility of a dedicated faculty observationalshift since has been examined.35 Interns in the ED wereobserved by attendings and given immediate feedbackregarding their patient assessments. Both trainees andobservers believed that the sessions provided higherlevels of educational value than traditional methods ofcase presentation. The teach-only attending techniquemay be applied to the busiest ED shifts, because peakpatient volumes provide many opportunities for theresourceful bedside teacher who does not have directpatient-care responsibilities.

Train Residents How to Teach at the BedsideWith uncertainty in their medical knowledge, supervis-ing residents may have difficulty conducting formalbedside rounds.47 Senior residents play a critical role inteaching medical students,21,24 however, and should beencouraged to develop their bedside teaching skills.19

Training residents to become better clinical teachersoffers many advantages. In one study of clinical teachingon an internal medicine clerkship, resident teacherswere found to have a more beneficial effect than attend-ing teachers on standardized test scores of medicalstudents.21 Residents are usually closer in age to medicalstudents and can be less intimidating when compared


with the more formal studentfaculty relationship.47 Pro-cedures are easily taught by those who still rememberwhat it feels like to perform them for the first time.47 Pro-fessional behaviors are reinforced through modeling bysenior residents during actual patient encounters. Themajority of medical students surveyed in a study of pro-fessional development perceived residents to be impor-tant role models.48

Teaching benefits the budding teacher as well. In onestudy, pediatrics residents who gave lectures on oralhydration for gastroenteritis performed far better on aposttest than did those who simply listened to the lec-ture.49 Fostering the development of strong teaching res-idents enhances the scholarly spirit of a program3,15,19

and better prepares graduates for careers in academics.Initiatives such as the Harvard Teaching Program havesucceeded at fulfilling the goal of American Associationof Medical Colleges to establish residents as formal edu-cators of medical students.47 These teach to teach pro-grams have up to now been instituted largely in primarycare residencies.19 Formal training in clinical and bedsideteaching needs to begin in EM residencies to secure thefuture of these important skills.47

CONCLUSIONS

Bedside teaching is a time-tested, unique method of clin-ical instruction that reinforces classroom study withpatient-centered education.3,5,14 Despite a decline in theuse of bedside teaching on the inpatientwards,11,12 effortshave emerged to reestablish the import of this techniqueamong medical educators.13,14,29 Specific advantages tobedside teaching in the ED provide exceptional opportu-nities for learning. By keeping certain strategies in mind,EM faculty can effectively overcome the inherent chal-lenges to bedside teaching in a busy, overcrowded clinicalenvironment.

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Bedside Teaching in the Emergency DepartmentDecline of bedside teachingBenefits of bedside teachingOpportunity to Demonstrate and Assess History and Physical Examination SkillsForum to Develop and Assess ProfessionalismImprovement of the Therapeutic RelationshipImprovement of Patient EducationSetting for Direct Observation as a Formal Evaluative ToolAdvantages Specific to the ED Setting

Strategies for effective bedside teaching in the EDPlan the Teaching Session Before the Next ShiftKnow Ones Team, Know Ones GoalsChoose the Right Time to TeachSet Realistic Expectations for YourselfLimit the Amount of Time per PatientBe ProfessionalUse the Socratic Method with CautionSummarize and EvaluateThe Teach-only AttendingTrain Residents How to Teach at the Bedside

ConclusionsReferences

bedside ed teaching

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