LaCombe M A
Ann Intern Med. 1997 Feb 1;126(3):217-20. doi: 10.7326/0003-4819-126-3-199702010-00007.
Actual teaching at the bedside during attending rounds, with emphasis on history taking and physical diagnosis, has declined from an incidence of 75% in the 1960s to an incidence of less than 16% today. Profound advances in technology, in imaging, and in laboratory testing and our fascination for these aspects of patient care, account for part of this decline, but faculty must also assume responsibility for the present lack of bedside teaching. If we are to reverse this trend, we will need to realize the barriers to bedside teaching, both real and imagined, and overcome them. And if we are to become effective bedside teachers, as were our mentors, we will need to sharpen our own physical diagnostic skills. We will need to learn how to be gentle with students and housestaff, how to better communicate with patients, and how to teach ethics and professionalism with the patient at hand.
在主治医生查房期间进行的实际床边教学，重点在于病史采集和体格检查，其发生率已从20世纪60年代的75%下降至如今的不到16%。技术、影像学、实验室检测方面的巨大进步以及我们对患者护理这些方面的痴迷，是导致这种下降的部分原因，但教师也必须为目前床边教学的缺失承担责任。如果我们要扭转这一趋势，就需要认识到床边教学的障碍，包括真实存在的和想象中的，并克服它们。而且，如果我们要像我们的导师那样成为有效的床边教师，我们需要提高自己的体格诊断技能。我们需要学习如何对学生和住院医生温和些，如何更好地与患者沟通，以及如何在面对患者时教授伦理和职业素养。
