Background:
Despite surveys of learners and attendings revealing the value placed on bedside teaching for learning physical exam skills, the frequency of their use has been declining. Barriers to teaching at the bedside identified by attendings include inadequate clinical and bedside teaching skills. We sought to improve teaching at the bedside by training internal medicine faculty in two educational strategies for teaching physical exam.
Methods:
Internal medicine faculty were recruited from 2 institutions to participate in a three-hour workshop focused on two educational strategies for teaching the physical exam—the traditional three step model of conduct a needs assessment, model physical exam skills, assess learning and the four-step Peyton model of demonstration, deconstruction, comprehension, performance. The workshop paired clinical content (the shoulder exam) with these teaching skills. Participants divided into small groups (3-4) that first reviewed the two educational strategies for teaching the physical exam and then engaged in role play exercises with feedback from medical education expert and peers. Participants’ teaching skills were assessed 7 months apart using a pre and post-intervention Observed Standardized Teaching Exercise (OSTE) where participants were tasked with precepting an intern in clinic on a case of right shoulder pain and teaching the learner a focused shoulder exam. The standardized intern completed a checklist that rated the participants teaching skills as not done, partially done or well done. At the conclusion of the workshop participants completed commitment to change statements regarding both clinical and teaching skills.
Results:
21 internal medicine faculty participated in the workshop. There was significant improvement in all teaching domains from baseline OSTE to post-intervention OSTE except for the step of modeling the physical exam which was high at baseline (78% to 80% well done). Significant improvement was seen in conducting a needs assessment (65% to 90% well done, p=0.04) and assessing learning (33% to 94% well done, p=0.00004) and use of the Peyton model (33% to 69% well done, p=0.0008). Additionally improvement was seen in the general teaching skills of positive and corrective feedback (31% to 93% well done, p=0.0004 and 50% to 100%, p=0.002 respectively). After participating in this workshop, 85% of participants reported implementing change in clinical practice and 42% implemented change in teaching the physical exam. The majority of barriers to implementation included not encountering an appropriate patient and insufficient time (67% and 33% respectively).
Conclusions:
A three-hour workshop with peer and medical education faculty feedback was able to improve internal medicine faculty’s ability to teach the physical exam. Training faculty in educational strategies to teach the physical exam can help increase the frequency and quality of teaching at the bedside.