Bedside clinical teaching in ambulatory clinics

I have now had the opportunity spend a few half-days in ambulatory internal medicine clinics. As a medical student training at academic centres and teaching hospitals, often surrounded by other residents, I have been reflecting on hands-on bedside teaching for junior medical students and ways in which we can allow them to be more engaged in the teaching and learning process.

In the article “What makes a tutor effective? A structural-equations modeling approach to learning in problem-based curricula,” Schmidt and Moust highlight two perspectives on the theory of the effective tutor. One perspective emphasized the tutor’s ability to communicate with the students informally and with an empathic attitude that fosters an open and encouraging learning atmosphere. The other perspective emphasized the tutor’s expertise in the subject matter. I am very fortunate to be taught by world-renowned medical experts. However, I wonder how we can continue to foster positive and supportive learning environments. As a student, I have always felt welcomed and engaged when a staff (and resident) introduced the clinic to me and established an agenda and objectives for the day. It allowed me to focus on concrete objectives that I aim to achieve by the end of the day.

I am cognizant that clinics are frequently busy with high volumes and it is difficult to dedicate a large amount of time to teaching. However, one effective and engaging method of teaching that I have encountered is when the staff asks questions around a clinical case, either before, during or after a clinical encounter, to consolidate the knowledge further. If we are given the opportunity to establish and work towards one or two concrete objectives for the day, that would allow me to feel more engaged in the learning process. Similarly, I can understand that it is not realistic to go in depth about each patient encounter. However, spending 1-2 minutes at the end of each case to highlight a couple of take-home points would enrich the ambulatory clinical experience significantly. Moreover, rather than expecting to focus in detail on each patient encounter, it may be valuable for medical students to learn about at least one patient case in greater depth, and use that scenario as an index case to highlight various teaching points.

I have listed a few strategies above that may allow us to engage medical students further in ambulatory clinics, thereby enriching our learning experience.

- Usman T.