Department of Internal Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.
Med Educ. 2012 Feb;46(2):228-33. doi: 10.1111/j.1365-2923.2011.04054.x.
Bedside teaching encounters on hospital wards offer medical students opportunities to learn key medical and interpersonal skills. Although many aspects of bedside teaching have been studied, not much is known about the selection process used by medical teachers to find patients for these encounters. Patient selection could have a substantial impact on medical students' clinical experiences. Therefore, we studied the ways in which medical teachers select patients for bedside teaching and tried to determine the factors that affect patient selection.
Using a qualitative research approach, we interviewed 15 teachers from three departments within the Medical Faculty at Hamburg University on how they choose patients for bedside teaching encounters. We extracted selection criteria from the transcripts of the audio-recorded interviews and identified other factors that influenced selection.
One main category and two minor categories of factors relevant to patient selection were identified: educational; bio-psycho-social, and structural. Medical teachers look primarily for patients who have diseases that fit their conceptions of the learning objectives of the lessons in question. The two minor categories influence their choice of patients in different ways. By finding a balance between these categories, they decide which patients are eligible for participation. As a result of these selection criteria, some patients are more likely to become involved in clinical teaching, whereas others may be omitted.
Patient selection for bedside teaching is based on several criteria. Non-representative patient selection may narrow the learning experiences of medical students. Curriculum planners need to be aware that specific aspects of medical care may be neglected as a result of the exclusion of some patients. Teacher training and additional teaching formats should be provided to ensure that these are covered.
病房中的床边教学为医学生提供了学习关键医学和人际技能的机会。尽管床边教学的许多方面都已经过研究，但对于医学教师用来为这些教学机会选择患者的选择过程却知之甚少。患者选择可能会对医学生的临床经验产生重大影响。因此，我们研究了医学教师选择患者进行床边教学的方式，并试图确定影响患者选择的因素。
采用定性研究方法，我们采访了汉堡大学医学系三个系的 15 位教师，了解他们如何选择患者进行床边教学。我们从录音采访的文字记录中提取了选择标准，并确定了影响选择的其他因素。
确定了与患者选择相关的一个主要类别和两个次要类别：教育；生物心理社会和结构。医学教师主要寻找符合他们对所讨论课程学习目标的疾病的患者。两个次要类别以不同的方式影响他们对患者的选择。通过在这些类别之间找到平衡，他们决定哪些患者有资格参与。由于这些选择标准，一些患者更有可能参与临床教学，而其他患者可能会被排除在外。
床边教学的患者选择基于多个标准。非代表性的患者选择可能会缩小医学生的学习经验。课程规划者需要意识到，由于某些患者被排除在外，可能会忽视特定的医疗护理方面。需要提供教师培训和其他教学形式，以确保涵盖这些方面。
