This review aims to analyse the origin of bedside teaching as part of medical education, its benefits, the impact of covid-19 Pandemic on medical education, and the mitigation plans for bedside teaching during this Pandemic.
COVID-19 has turned everyday life on its head. Numerous challenges and changes have occurred the past year, and given the current circumstances, the option of returning to the ‘normal’ way of life remains bleak. Medical education has been dramatically affected during this Pandemic. Bedside teaching is a primary teaching tool that has been practised in medical education. Due to the current Pandemic, medical students have limited access to patients as this interaction puts the student, patient and all others in close contact at risk. This circumstance raises the concern of producing competent healthcare workforce for the future.
Sir William Osler was probably the most prominent advocate to bring medical education to the bedside. To quote him “Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book.”
Bedside teaching is defined as a form of small group teaching in the presence of the patient. Clinical learning is integral in medical education whereby senior lead teaching during ward rounds lead to relevant, applied and ongoing learning of knowledge, skills and attitudes. (Ray & Ganguli, 2009)
Patient contact plays a significant role in developing students’ empathy and responsibility towards patients and fostered their professional identity. It is also a useful tool to help students build integrated clinical reasoning, communication, history taking, and physical examination skills. Bedside teaching is a more superior teaching tool than didactic or simulated teaching. Students too have expressed bedside teaching as being to develop essential clinical acumen. Repeated patient contact is useful for students in recognising “illness patterns or scrips” which are useful cognitive structure to form prototypes that leads to developing their fast thinking. (Bokken et al. l,2008, Kahneman, 2013)
Each bedside teaching session is unique to the patient, faculty and student, making it non-replicable. Reproducibility is a major scientific principle in ensuring the validity and the lack of reproducibility in bedside teaching may condemn it as a scientific tool. Another limiting factor is the perceived concern of harming patient comfort and safety among students and faculty. However, there is no proven evidence to support this claim. Furthermore, patients have reported that bedside teaching has helped make them understand their illness. (Bokken et al. l,2008)
There is a decreasing trend in utilising bedside teaching in medical training over the past few decades. As much as 75% of all clinical training in the 1960s was bedside teaching. However, the recent explosion of technological advances and specialisation has decreased so much that in 2013 only 8-19% of medical training was done bedside (Ramani,2003). Though outdated, a study done by Tremonti and Briddle in 1982 found that trainee doctors spent a median time only 2.5 minutes at bedside, compared with 69 minutes in the classroom and this finding is significant in highlighting the reality of present medical training compared to the training Sir William Osler envisioned a century ago.
During the COVID-19 Pandemic, in compliance to public health directives to prevent transmission of the virus, the face-to-face didactic lectures, small group tutorials and bedside teaching were stopped. Contrary to the common practice where doctor-patient interaction was given a significant emphasis and priority, healthcare professionals have been advised to minimise contact between patients during this Pandemic(Tomlinson, Khan, & Page, 2020). The Royal College of Physicians mentioned in its statement that though teaching time for consultants is often the first thing to go when service demands are high, the long-term impact on the training of consultants for the future should not be forgotten (Rimmer, 2020).
Medical education poses more harm than benefit to patients. Glannon mentioned that patient altruism exists when patients willingly allow medical students to treat them in teaching hospitals them with the benefit accruing to the students and future patients rather than to the patients themselves. The beneficence principle demands that health care professionals act in the patient's best interests. If steps are taken to stop bedside teaching, this decreases the risk of patient exposure to COVID‐19. It also releases staff and reduces the workload for teams who may be working under tremendous pressure. However, medical education interruption could have a lasting implication on the "supply chain" of various healthcare professions.
Many medical institutions have been integrating patient instructors to play an active teaching role in undergraduate medical education. In addition to providing students with the opportunity to experience positive findings, it was also found that incorporating patients in clinical teaching empowers patients, gives them a sense of fulfilment in contributing to healthcare and patient instructors were also found to be cheaper than hiring healthcare professionals (Plymale et al. l, 1999). A concern with this particular method is the lack of case-mix that students will be exposed to a teaching hospital.
In an attempt to stay close to the bedside, teleconferencing is used to conduct virtual bedside rounds. Students remotely connect to see and hear attending physician‐patient encounter. There have been vital positive feedback from students on this approach; however, this method remains the most significant drawback despite years of progressive technical glitches. A study conducted on virtual bedside rounds with COVID-19 patients in the University of Manchester found that 92.9% of the students responded positively to the experience felt the virtual rounds improved their knowledge on COVID-19. (Hofmann et al. l, 2020) Another study was done in Hong Kong, where telemedicine was applied to provide web-based surgical skills learning for the medical student during the Pandemic. Students in this study also expressed positive feedback to web-based virtual teaching; however, there was no pre-and post-intervention assessment to evaluate this modality's efficacy (Co, M., & Chu, K. M., 2020).
The COVID-19 situation is fast-moving and fluid, and the workforce has been forced to be more flexible than ever. Protecting education and training opportunities as much as possible will be essential if future skill deficits and workforce shortages are to be avoided. Virtual bedside teaching and patient instructors have been alternative methods tried by some medical schools. Though these solutions seem to work at our current circumstance, we cannot negate the significance of proper bedside teaching on medical training. Sir Osler will be rolling in his grave if he hears of the disservice impacting our medical students, the future healthcare providers during this Pandemic. To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.
Reference
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