Clinical teaching and feedback: how do we do it and how can we improve our approaches

In health care, most of our teaching takes place at the bedside during outpatient clinic hours, in the operating and in the wards, regardless of the specialty. This bedside teaching is a daily practice and is augmented by formal lectures and conferences in the classroom type of setting. Both are essential and should complement each other. Teaching and patient care should be balanced and time restrains seem to be identified as the main obstacle in clinical teaching, in addition of course to attitudes and perceptions by both the learner and the teacher. After reading the article by Irby and Wilkerson and reviewing the proposed models for rapid teaching I found it interesting that in my clinical teaching I migrate towards a specific approach based on the level of my learner and the case scenario involved. In my typical clinic there will be residents participating in patient care from all levels of training (I-IV) and we try to assign patients based on the resident level. But of course things do not always work out that way and a junior person may end up in a complex consultation case that he or she has never been involved before. It is usually evident when a resident is a bit lost as they attempt to present the case and make sense of what is going on, so I find myself following the “activated demonstrations” model. On the other hand with my senior level residents, who are usually involved in more complex cases that may present a diagnostic challenge, my approach seems to follow the SNAPP(S) model. I put S in parenthesis as I am not always explicit about “Selecting a case related problem for self-directed learning”. Perhaps because I feel my leaners should be or are doing this anyway…area for improvement on my end as a teacher. In general the one-minute preceptor model that we practiced in class and is discussed in this article is my approach to the otherwise “routine” cases we see in the clinic. I did not know it was called the one-minute pr1eceptor model, but interestingly enough after my resident presents the case I tend to ask “so what do you think is going on?” The rest of the conversation usually unfolds in a similar fashion as the model describes, with some variations, based on the learner and the type of case.