Bed site teaching

Bed site teaching Observation Demonstration TrainingBed site teachingDefinition : teaching in the presence of the patientSettings : - hospital setting,-long-term care facality and-office setting.

History : Hippocrates (460-370 BC)Guru dan praktisiDua prinsip metode hippocrates :-observe all, and-study the patient rather than the disease.History : Sylvius (1614-1672)Dokter Perancis My method (is to) lead my students by hand to the practice of medicine, taking them everyday to see patients in the public hospital, that they may near the patientss symptoms and see their physical findings. Then I question the stundent as to what they have noted in their patients and about their thoughts and preceptions regarding the causes of the illness and the principles of treatment. ( Whitman, 1990:23)History : Sir William Osler (1849-1920)Guru dan praktisi di Canada, England dan USHow can we make the work of the student.. Practical...? The answer is, take him from the lecture room, take him from the amphitheater put him in the outpatient department put him in the wards. he also expounded that there should be no theaching without a patient for a text, and the best is that taught by the patient him self. ( Whitman, 1990 )Praktek pada 50 tahun terakhirStudi tahun 1964: 20 % pembelajaran di bangsal bersama pasienStudi tahun 1978: penurunan pembelajaran bedside hingga 16%.Penurunan karena :LOS semakin pendek , pasien semakin rumit, dokumentasi semakin banyakInstraksi terbanyak : ruang konferensi, nurses station atau koridor

Penyulit bedside teaching: Nair, Coughlan, & Hensley(1998)Waktu terbatasMempertimbangkan kenyamanan pasienPembimbing merasa tidak menguasai teknik

Diagram of actionsTrainers students

Changed behavior Changed behaviorTraditional behaviorprior knowledge

Learning objectivesClinical reasoning &skill training improved clinical competenceTeachinglearning processTrainers StudentCheck history takingClarificationphysical examOrganizingdiff.diag.IComprehensionlab testTest TreatmentEvaluationPrognosis

evidence-based medicine,Empidemiology & Critical AppraisalPatientsDevelopment of expertiseDoesnt knowHas been toldHas been shownCould doHas doneHas practisedCan do wellCan do well consistentlyCan be trustedBedside teaching baik untukDetermine care planAdministrative details/chargesChart roundsReview and sign notes and ordersWrite nitesTeaching roundsListening to presentationsMini-lecturesTeaching interviewing and physical exam skillsWard roundSeeing the patientsTalking to familiesBedside teaching baik untukTeaching interviewing and physical exam skillsWard raundsSeeing the patientsTalking to families

Clinical conferenceadvantagesComfortable/quietConfidentialTime efficientGood for work rounds, presentation skill and mini-lecturesTeam teaching-pharmacy, Social Work,Etc.Disadvantages: No patient contactRelies on presentation/chartStrategiesKeep to task and tineDiagnose the patient and the learner at the same timeLook for (and capture) teachable momentsFocus on clinical problem solvingKeep topics related to current patient careKeep learning tools handy and use them

Cooridor discussionadvantagesAllows ready access to the patientMay be needed as a bridge to bedside teaching

DISADVANTAGESUncomfortable and tiringMany distractionsConfidentiality very challengingNot a good location for chart rounds or work roundstrategiesLimit corridor roundingBe vigilant of confidentialityBed site teachingkeuntungankelemahanBedside teachingconditionsPatientTeacherStudentsTimefacilitiesBedside teachinggetting startedAlokasikan waktuLihat pasien yang akan dilakukan bedside teaching (normal, unik, kompetensi). Bisa melibatkan mahasiswa untuk menyiapkan pasien sesuai ketentuan yang ditetapkanJangan melibatkan semua mahasiswa, sebaiknya 1-2 orang ( lanjutkan dengan diskusi dengan mahasiswa yang lain)Baca lagi buku tentang teknik anamnesis, pemeriksaan fisikBedside teachingformatBriefing/introductionExpectationsPatient encounterDebriefingDiscussionWrap up(1&2) Briefing & Expectation Prepare the learner(s) before meeting with the patient : learners prior Knowledge and experience, problem requiring help ?Prepare the patient and explain rolesExpectations- What are learners learning goals?- Why learn this particular topic today? MASALAH KENYAMANAN PASIENBeritahu sebelumnyaBatasi waktuJelaskan pemeriksaan dan prosedur yang akan dilakukan Diskusi dan komunikasi harus dipahami pasienHindari presentasi Visit setelah bedside teaching dan ucapkan terimakasih pada pasien (3) Patient EncounterIf your goal is observation and feedback : - Watch learner interact with the pasient ; keeping interruptions to a minimunIf your goal is to model clinical skills : - let the learner (s) watch you interact with the patient at the bedside - Organize what you demonstrate to facilitate learningBedside teaching levelsHistory takingPhysical examinationPresentation- summarizingSingle-composite caseWard round(4) DebriefingStart with input from patient and learner Any questions from learner or pasient?You can also talk to learner alone especially if you feedback is extensive Education - What resources can the learner read or use to promote further learning ?

(5) Discussion Diskusi lebih lanjut dari ContentMelibatkan keluarga- boleh Bisa menggunakn format Micro skillsEmotional aspectsSaran follow upMemfasilitasi belajar aktif melalui bertanya ( teknik bertanya) - what learning questions will stimulate thinking while you assess knowledge base and technical skills?(6) Wrap upGive information in bite size chunksPut things in a broader context when appropriateAsking learners to summarize is a powerful way of checking their understandingAgaint, asking student will give you feedback on what has been learnt ( but be prepared for some surprises)Reiterate the take home messagesBedside teaching tipsProper preparation preents poor presentationOne hour BST : 30 minutes bedside teaching + 25 minutes discussion/ reflectionPresent 3 silver bulletsBedside teaching Observation DemonstrationTraining