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Challenges of ward round teaching
- Sunku H Guptha (30 March 2009)
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Ward teaching; the patient's contribution should not be an afterthought
- Andrew F West (20 May 2009)
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Sunku H Guptha, Consultant Physician Medicine for Older People, Edith Cavell Hospital, Peterborough PE3 9GZ
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Dear Editor I find the article by Ker and colleagues very helpful[1]. I have tried teaching on ward round and have found it extremely challenging because of the working environment. After a ward round of 30 patients, the juniors are often exhausted and do not have any appetite to engage in learning activities. Attempts at setting learning tasks are extremely difficult given the rapid turnover of junior doctors. I conducted a survey of all juniors in our department on their views on ward round teaching. The foundation trainees wished to be shown clinical examination focused to the patient’s complaint and an example given was “ What is the clinical examination in a patient admitted with fall?”. Senior House officers wished to be taught reading radiology images and interpretation of complex pathological investigations either at the time of the ward round or at its end. Registrars wished to be engaged in discussions of complex management problems and an example given was “How to manage a patient who has been admitted with hemorrhagic stroke and subsequently developed a deep venous thrombosis?” It is clear that the learning needs of juniors varied with their experience. I found planning ahead of the ward round as suggested by the authors extremely useful. Clinical examination of a patient chosen before the ward round and getting juniors to read radiology images during the ward round is not time consuming as they are routine ward round activities. Discussions can be done at the end of ward round if there is time or set as a learning task for a departmental educational meeting. Reference: 1] Jean Ker, Peter Cantillon, and Lucy Ambrose Teaching on a ward round BMJ 2008; 337 Competing interests: I have attended the RCP physician as educators courses |
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Andrew F West, consultant Child and Adolescent Psychiatrist, Berkshire Healthcare NHS Foundation Trust, 3 Craven Rd, Reading, Berkshire. RG1 5LF
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Ker, Cantillon and Ambrose have set out very nicely much of what has been learned about effective teaching methods since I was a clinical medical student. I expect that I would have got more out of the teaching rounds I attended, had my teachers used their approach. There is one glaring omission which in this age - enlightened by the patient's voice - is all the more surprising. The informed consent and positive engagement of the patient must be properly obtained and demonstrated, particularly in the case of bedside teaching. Some of us were shocked by what we saw at the time as systematic and repeated ignoring of the predicament of the patient. We saw no evidence of the patient's permission being sought before teaching or any debriefing afterwards, and little evidence of the sensitivities of the patient being taken into account at the time. Most of our teachers set a bad example in this respect. When some of us complained, we very nearly failed the attachment. I know that some of the patients were distressed by the experience. For our part, we missed out on some positive role-modeling (and latched with embarrassing eagerness onto the occasional teacher who clearly did think of the patient as the most important person in the room). Furthermore, our own discomfort caused some of us to participate less actively in the teaching round itself. We would have learned more had this not been the case. I know that the authors were focussing on the needs of the students, but I would have liked them to have identified this aspect of teaching and brought it out. The student should see how the patient has been engaged in the process, and the patient's contribution should be understood by the student to be the most important one, including feeding back to the teachers and students on the conduct of the teaching round. I am grateful to my teachers, and I am lucky to be a member of a profession of which I am proud, but there are times when my profession causes me shame. I am sure that the authors of this paper are respectful in their practice, but if they are teachers they should probably get better at making that respect overt. When it comes to "Learning Respect"(1) it seems there is still a long way to go. 1. West, A., Bulstrode, C. & Hunt, V. Learning Respect. BMJ 2001;322(7288):343 Competing interests: None declared |
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