Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
University of Alabama at Birmingham School of Medicine, Birmingham, AL.
Chest. 2021 Dec;160(6):2187-2195. doi: 10.1016/j.chest.2021.06.055. Epub 2021 Jul 6.
The bedside encounter between a patient and physician remains the cornerstone of the practice of medicine. However, physicians and trainees spend less time in direct contact with patients and families in the modern health care system. The current pandemic has further threatened time spent with patients. This lack of time has led to a decline in clinical skills and a decrease in the number of faculty members who are confident in teaching at the bedside. We offer several strategies to get physicians and trainees back to the bedside to engage in clinical skills teaching and assessment. We recommend that providers pause before bedside encounters to be present with patients and learners and to develop clear goals for a bedside teaching session. We suggest that clinical teachers practice an evidence-based approach, which includes an hypothesis-driven physical examination. We encourage the use of point-of-care technology to assist in diagnosis and to allow learners to calibrate traditional physical examination skills with real-time visualization of disease. Tools like point-of-care ultrasound can be powerful levers to get learners excited about bedside teaching and to engage patients in their clinical care. We value telemedicine visits as unique opportunities to engage with patients in their home environment and to participate in patient-directed physical examination maneuvers. Finally, we recommend that educators provide feedback to learners on specific clinical examination skills, whether in the clinic, the wards, or during dedicated clinical skills assessments.
医患床边交流仍然是医学实践的基石。然而，在现代医疗体系中，医生和住院医师与患者及其家属直接接触的时间减少了。当前的大流行进一步威胁到了与患者相处的时间。这种时间的缺乏导致了临床技能的下降，以及对在床边教学有信心的教师人数减少。我们提供了几种策略，让医生和住院医师回到床边进行临床技能教学和评估。我们建议临床医生在床边交流前暂停，与患者和学习者进行交流，并为床边教学会议设定明确的目标。我们建议临床教师采用基于证据的方法，包括基于假设的体检。我们鼓励使用即时护理技术来协助诊断，并允许学习者使用实时可视化疾病来校准传统的体检技能。即时护理超声等工具可以成为激发学习者对床边教学兴趣以及让患者参与其临床护理的有力杠杆。我们重视远程医疗就诊，将其视为在患者家中环境中与患者接触并参与患者指导的体检操作的独特机会。最后，我们建议教育工作者在具体的临床检查技能方面为学习者提供反馈，无论是在诊所、病房还是在专门的临床技能评估中。
