Zeshan Qureshi, Simon Maxwell
Students like bedside teaching because it is patient-centred, contextualises knowledge and provides direct contact with experienced practitioners. Fifty years ago, three quarters of clinical teaching was at the bedside, but by 1978 one estimate suggested it had already decreased to less than a fifth, and a glance at many current student timetables indicates that it has declined even further since. This reduced exposure in undergraduate years may be partly responsible for declining clinical skills.
Bedside teaching opens the mind to the reality of clinical medicine that perhaps cannot be mimicked with an actor. The balance of being efficient with time, yet establishing a rapport with patients can be learned. Although some clinical signs and experiences can be simulated, many cannot (e.g. the tactile experience of hepatosplenomegaly or joint effusions). The progressive decline of bedside teaching is the consequence of several factors. In increasingly busy hospitals, the availability of teachers is reduced as well as the availability of patients, who spend less time in hospital and have a generally ‘busier’ in-patient stay. Teachers, despite an interest in bedside teaching, now find themselves with broader roles in the hospital. There may also be a perception that the bedside teaching, as it was formerly practiced, is intruding or demeaning to patients.