medigraphic.com
ISSN 2007-5057 (Print)
Investigación en Educación Médica

2020, Number 35

<< Back Next >>

Inv Ed Med 2020; 9 (35)

Models for Medical Education in Clinical Settings

Gutiérrez-Cirlos C, Naveja JJ, Sánchez-Mendiola M

Language: Spanish
References: 33
Page: 96-105
PDF size: 571.12 Kb.


ABSTRACT

Learning and teaching in clinical settings, whether these are more or less formal, are a fundamental task in the healthcare professions. These environments foster the establishment of teaching and learning relationships among healthcare workers and undergraduate and postgraduate students. The opportunities for learning in clinical spaces are much more diverse and realistic than those found in texts, classrooms, or digital tools, and the real experience of clinical learning at the bedside is not comparable to any of these learning sources. Moreover, certain practical maneuvers, even if they seem simple (obtaining a venous blood sample), can only be effectively taught in a clinical environment. In this paper, we review some general principles of education in clinical settings: the identification of student’s needs, teaching with an appropriate model, and providing feedback accordingly. Implementing systematic methodologies with enough validity evidence for teaching in clinical context allows for more complete and uniform guidance and feedback among students rotating in different clinical environments. We discuss some of the most frequently used models for teaching in clinical settings: BEDSIDE, SNAPPS, IDEA, and the one-minute preceptor. We concisely present their methodology, application context, validity evidence, and limitations.


REFERENCES

  1. Ramani S, Leinster S. AMEE Guide no. 34: Teaching in the clinical environment. Med Teach. 2008;30:347-64.

  2. Sánchez-Mendiola M, Lifshitz-Guinzberg A, Vilar-Puig P, Martínez-González A, Varela-Ruiz M, Graue-Wiechers E. Educación médica: teoría y práctica., 1a ed. México: Elsevier- UNAM, 2015.

  3. Aldeen AZ, Gisondi MA. Bedside teaching in the emergency department. Acad Emerg Med. 2006;13:860-6.

  4. LaCombe MA. On bedside teaching. Ann Intern Med. 1997; 126:217-20.

  5. Peters M, Ten Cate O. Bedside teaching in medical education: a literature review. Perspect Med Educ. 2014;3:76-88.

  6. Ramani S, Orlander JD, Strunin L, Barber TW. Whither bedside teaching? A focus-group study of clinical teachers. Acad Med. 2003;78:384-90.

  7. Dotters-Katz S, Hargett CW, Zaas AK, Criscione-Schreiber LG. What motivates residents to teach? The Attitudes in Clinical Teaching study. Med Educ. 2016;50:768-77.

  8. Steinert Y, Basi M, Nugus P. How physicians teach in the clinical setting: The embedded roles of teaching and clinical care. Med Teach. 2017;39:1238-44.

  9. Feimster J, McDow AD, Mellinger JD. Teaching residents to teach: why and how. In: Köhler TS, Schwartz B, eds. Surgeons as Educators. Cham: Springer International Publishing, 2018:119-36.

  10. Irby DM, Wilkerson L. Teaching when time is limited. BMJ. 2008;336:384-7.

  11. Janicik RW, Fletcher KE. Teaching at the bedside: a new model. Med Teach. 2003;25:127-30.

  12. Abdool MA, Bradley D. Twelve tips to improve medical teaching rounds. Med Teach. 2013;35:895-9.

  13. Tavares W, Eppich W, Cheng A, et al. Learning conversations: an analysis of their theoretical roots and their manifestations of feedback and debriefing in medical education. Acad Med. 2019; published online July 30. DOI:10.1097/ ACM.0000000000002932.

  14. Ngo TL, Blankenburg R, Yu CE. Teaching at the bedside: strategies for optimizing education on patient and family centered rounds. Pediatr Clin North Am. 2019;66:881-9.

  15. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract. 1992;5:419-24.

  16. Koen FM, Vivian AS. Learning the Skills of Clinical Pharmacy Teaching. American Journal of Pharmaceutical Education. 1980.

  17. Gallagher P, Tweed M, Hanna S, Winter H, Hoare K. Developing the One-Minute Preceptor. Clin Teach. 2012;9:358-62.

  18. Gatewood E, De Gagne JC. The one-minute preceptor model: A systematic review. J Am Assoc Nurse Pract. 2019; 31:46-57.

  19. Furney SL, Orsini AN, Orsetti KE, Stern DT, Gruppen LD, Irby DM. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med. 2001;16:620-4.

  20. Salerno SM, O’Malley PG, Pangaro LN, Wheeler GA, Moores LK, Jackson JL. Faculty development seminars based on the one-minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med. 2002;17:779-87.

  21. Pierce C, Corral J, Aagaard E, Harnke B, Irby DM, Stickrath C. A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61. Med Teach. 2020;1-12.

  22. Cohen DA, Truglio J. Fitting It All In: An Interactive Workshop for Clinician-Educators to Improve Medical Education in the Ambulatory Setting. MedEdPORTAL. 2017; 13:10611.

  23. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learnercentered model for outpatient education. Acad Med. 2003; 78:893-8.

  24. Wolpaw T, Papp KK, Bordage G. Using SNAPPS to facilitate the expression of clinical reasoning and uncertainties: a randomized comparison group trial. Acad Med. 2009; 84:517-24.

  25. Wolpaw T, Côté L, Papp KK, Bordage G. Student uncertainties drive teaching during case presentations: more so with SNAPPS. Acad Med. 2012;87:1210-7.

  26. Morrison E. BEST Module 3: Bedside Teaching | Resident Teaching Skills. 2020. https://residentteachingskills.ucr. edu/best-module-3-bedside-teaching (accessed May 12, 2020).

  27. Green GM, Chen EH. Top 10 ideas to improve your bedside teaching in a busy emergency department. Emerg Med J. 2015;32:76-7.

  28. Campbell WW. Augenblickdiagnose. Semin Neurol. 1998; 18:169-76.

  29. Westfall JM. Change in medical student implicit bias. J Gen Intern Med. 2016;31:714.

  30. Baker EA, Ledford CH, Fogg L, Way DP, Park YS. The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students’ Hospital Admission Notes. Teach Learn Med. 2015;27:163-73.

  31. Carlos WG, Kritek PA, Clay AS, Luks AM, Thomson CC. Teaching at the bedside. maximal impact in minimal time. Ann Am Thorac Soc. 2016;13:545-8.

  32. Marfil-Garza BA, Ruiz-Ballesteros MM. DIAGNOSTICAME: una mnemotecnia novedosa para ayudar con el diagnóstico diferencial. Educación Médica. 2017;18:298-9.

  33. Sánchez-Mendiola M, Graue-Wiechers EL, Ruiz-Pérez LC, García-Durán R, Durante-Montiel I. The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine. BMC Med Educ. 2010;10:17.




2020     |     www.medigraphic.com