Bedside Teaching Rounds Reconsidered

Abstract

In his 1905 farewell address to the staff of Johns Hopkins Hospital, Sir William Osler reflected on 16 years of accomplishments in the field of medical education, concluding that his greatest achievement was “[teaching] medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.”1 Photographs of Osler examining patients and teaching others (Figure) reveal his systematic approach and its command on his trainees’ attention.2 Osler has become a model for modern teachers, although few of them currently regard bedside teaching as their greatest achievement. Most surveys today show that teachers spend less than 25% of their teaching time at the bedside, instead preferring conference rooms or the hallway outside patients’ rooms as the place of instruction.3,4 Barriers to bedside teaching—mostly absent during Osler’s time—are insufficient time to teach, dependence of diagnosis on technology, obstacles created by infection control, and distractions from clinical responsibilities at distant computer stations. Also, many teachers find bedside teaching inherently difficult: normal clinical activities frequently interrupt all but the shortest of prepared bedside lessons, and spontaneous questions from patients and learners at the bedside are often unanswerable, at least immediately, and may fall outside the teacher’s expertise.