Teaching Rounds

Teaching when time is limited

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39456.727199.AD (Published 14 February 2008)
Cite this as: BMJ 2008;336:384

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  1. David M Irby, vice dean for education and professor of medicine, and senior scholar 12,
  2. LuAnn Wilkerson, senior associate dean for medical education, and professor of medicine3
  1. 1University of California, San Francisco, CA 94143-0410, USA
  2. 2Carnegie Foundation for the Advancement of Teaching, Stanford, CA 94305, USA
  3. 3David Geffen School of Medicine at the University of California, Los Angeles
  1. Correspondence to: D M Irby irbyd{at}ucsf.edu

    Teaching in small increments of time during patient care can provide powerful learning experiences for trainees. This article explores the ways that clinical teachers might do this in a time efficient way

    Clinical teachers face a daunting challenge of simultaneously caring for patients and teaching learners in a time constrained environment. A cohort study of 179 Dutch medical students (79% of the cohort) during an internal medicine clerkship located at 14 different clinical sites found that the quality of supervision has a greater impact on clinical competence and knowledge than does the number of patients seen.1 Even small moments of teaching time can offer important learning opportunities to trainees by providing them with new insights and skills that they would not acquire from simply seeing patients on their own.1

    To achieve this combined caring and teaching goal in a time efficient manner, clinical teachers use various strategies to (a) identify the needs of each individual learner, (b) teach according to these specific needs, and (c) provide feedback on performance.2 This three step teaching process can be adapted to the environment in which the teaching is taking place. Here we describe several time efficient strategies in relation to each step in this process.

    Step 1: Identify the learner’s needs

    The time saving rule of thumb is: target, then teach. If the teacher can quickly determine what an individual learner needs to know, then he or she can focus any teaching on those needs, thus saving time by not teaching what the learner already knows or is not ready for.2 To assess the learner’s level of knowledge quickly, the teacher needs only two tools: good questions and the ability to listen and observe.

    Ask questions

    Questions are the teacher’s primary diagnostic tool, can precede or follow the learner’s encounter with the patient, and can guide the …

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