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Bedside Teaching Encounters (BTEs) Evaluation Research Study

April 2011 - January 2014

Research Overview

What is bedside teaching? What teaching methods, styles and techniques do doctors employ when teaching students in the presence of patients? What evidence do we have to support these depictions of teaching in practice?

Often accounts of bedside teaching are rooted in the first-person experience found in essays, review, editorials and how-to pieces (Ramani et al 2003: 388-9).

In response to these perceived shortcomings of bedside teaching research this video-based study (taking place between April 2011 and January 2014) investigates the practices which make up the training of medical students in real-time. The work takes as its precedent audio-based studies of bedside teaching that have explored power, participation, meaning and identity issues within teaching scenarios (Monrouxe et al. 2009; Rees and Monrouxe 2008; 2010).

Patient-centredness

Medical students learning with, not just about or from, patients

A major theme that is explored within the data-set is patient-centredness. By this we mean the various ways that patients are enabled to participate in their consultations and are involved in their own health care. A key element is how patients learn about their own health issues during appointments and also directly aid the students in their learning about the everyday realities of different health issues and problems.

‘[What is] required is more precise descriptions of how exactly patients are involved in particular educational settings’ (Spencer et al 2000: 856)

Methodology

The activities and events of each consultation is captured using multiple video cameras and audio recorders in order to obtain a ‘good enough’ account of what happened. After the consultations all participants undergo a debrief interview, which allows them to convey their impressions and feelings about the bedside teaching encounter.

Within the corpus of data there are instances of professionalism (e.g. patient dignity and consent), history-taking, physical examinations and clinical decision-making, for example, which are being taught, visibly demonstrated and practised under supervision.

Over the course of the project the research team has been supplemented by five medical students on Student Selected Components (SSC) or Cardiff University Research Opportunities Programme (CUROP) placements who have been heavily involved in topic generation and video analysis.

Clinical specialties videoed

The videos cover the following specialist areas:

  • General Surgery & Medicine
  • Paediatrics (Child Health)
  • Geriatric Medicine
  • General Practice

Outputs

We are currently finishing production of an e-learning resource which utilises video clips taken from actual bedside teaching encounters. The project uses the video extracts to instruct clinicians about patient-centred topics in teaching such as patient dignity, involvement and learning within BTEs.

Peer-reviewed outputs in various stages of completion include work on trust, patient-centredness, patient involvement, feedback-in-action, physical examinations and Ideas, Concerns and Expectations (ICE) communication framework in General Practice.

Future plans

We are currently in the process of pursuing avenues to transform our various streams of analysis into faculty development materials.

Publications

  • Christopher Elsey, Lynn V. Monrouxe & Andrew J. Grant (2013) Interactional activities of patient-centredness andtrust with bedside teaching encounters. Health and Social Care Education Vol. 2 No. 1. pp.11-17.
  • Christopher Elsey,Lynn V. Monrouxe & Andrew J. Grant.Forthcoming. The reciprocal nature of trust in bedside teaching encounters. InKatja Pelsmaekers & Tom Van Hout (eds.) Discourse and Trust. Amsterdam: John Benjamins.
  • Chantelle Rizan, ChristopherElsey , Thomas Lemon,Andrew J. Grant & Lynn V. Monrouxe. Submitted. Feedback-in-action within bedside teaching encounters: a video ethnographic study. To appear in Medical Education.

Conference presentations

  • March 2012 – Lynn Monrouxe, Rola Ajjawi, Christopher Elsey, Andrew Grant &Charlotte Rees - ‘Director, actor, audience and prop: theconstruction and co-construction of the patient in bedside teaching encounters’ presented at the Association for the Study of Medical Education (ASME)’ Involving Patients as Teachers’ conference, York.
  • July 2012 – Christopher Elsey, Lynn Monrouxe and Andrew Grant – ‘Role-modelling patient-centredness within bedside teaching encounters: a video ethnographic study’ presented at the Association for the Study of Medical Education (ASME) annual conference(ERG Research Stream), Brighton UK.
  • October 2012 – Chantelle Rizan, Christopher Elsey, Thomas Lemon, Andrew Grant & Lynn Monrouxe. Feedback-in-action within bedsideteaching encounters: a video ethnographic study. Association for the Study of Medical Education (ASME) DevelopingCommunication for Clinical Practice, York.
  • October 2012 - Thomas Lemon, Christopher Elsey, Chantelle Rizan, Andrew Grant &Lynn Monrouxe.‘More ICE, Sir?’ – A study of Ideas, Concernsand Expectations elicitation in General Practice bedside teaching encounters. Association for the Study of Medical Education (ASME) Developing Communication for Clinical Practice, York.
  • March 2013 –Christopher Elsey,Chantelle Rizan,Thomas Lemon, Andrew Grant & Lynn Monrouxe. Correction as feedback-in-action within bedside teaching encounters.All Wales Medical & Dental Education Conference, Swansea, UK.
  • May 2013 - ChristopherElsey, Andrew Grant and Lynn Monrouxe. Trust-in-(inter)action withinbedside teaching encounters: A video-ethnographic study. Fifth International Clinical Skills Conference ‘Clinical Skills Education: Building Bridges between Simulation and Practice’, Prato, Tuscany, Italy.
  • June 2013 – Christopher Elsey , Chantelle Rizan , Thomas Lemon, Andrew Grant & Lynn Monrouxe. Feedback-in-action during bedside teaching encounters: a video ethnography. WISERD 2013 Conference, Pontypridd, UK.
  • June 2013 – Andrew Grant, Christopher Elsey, and Lynn Monrouxe. Bedside teaching: a videoethnographic enquiry. Aneurin Bevan Health Board Research and Developmentconference 2013, Newport, UK.

Workshops

  • March 2012 -Christopher Elsey, Lynn Monrouxe and Andrew J. Grant – ‘Patient Centredness (Researchon Teaching)’ workshop delivered at ‘C21 Second AnnualCurriculum Conference’, School of Medicine, Cardiff University.
  • May 2012 – ChristopherElsey and Andrew J. Grant.Video Data Sharing Workshop: Multimodal perspectives on policy and education. Multimodal Methodologies for Researching Digital Data and Environments (MODE), Institute of Education, London.
  • May 2013 – Lynn V. Monrouxe, Christopher Elsey andCharlotte E. Rees – ‘Teaching andlearning patient-centredness within bedside teaching encounters’ workshop delivered at Fifth International Clinical Skills Conference ‘Clinical Skills Education: Building Bridges between Simulation and Practice’, Prato, Tuscany (19 – 22 May 2013).
  • June 2013 – Christopher Elsey& Chantelle Rizan - Video methods for understanding workplace learning encounters: practical and analytical issues. Innovation in Health & Social Care Learning and Teaching: HEA Health & Social Care 2013 Annual Conference, Leeds, UK (5-6 June 2013).

References

  • Monrouxe, L. V., Rees, C.E. & Bradley, P. 2009. The construction of patients' involvement in hospital bedside teaching encounters. Qualitative Health Research, 19, 918-930.
  • Ramani, S., Orlander, J.D., Strunin, L. & Barber, T. W. 2003. Whither bedside teaching? A focus-group study of clinical teachers. Academic Medicine, 78, 384-390.
  • Rees,C. E. & , Monrouxe, L. V. 2008. 'Is it alright if I-um-we unbutton your pyjama top now?' Pronominal use in bedside teaching encounters. Communication & Medicine, 5, 171-81.
  • Rees,C. E. & , Monrouxe, L. V.2010. "I should be lucky ha ha ha ha": The construction of power, identity and gender through laughter within medical workplace learning encounters. Journal of Pragmatics, 42, 3384-3399.
  • Spencer, J., Blackmore,D., Heard, S., McCrorie, P., McHaffie, D., Scherpbier, A., Gupta, T. S., Singh, K. & Southgate, L. 2000. Patient-oriented learning: a review of the role of the patient in the education of medical students. Medical Education, 34, 851-857.