Cot/bedside
| Advantages | Disadvantages | |
|---|---|---|
| Patient factors | ▶ Patient centred ▶ Can do real-time, clinical bed/cotside teaching involving the patient and parent involvement | ▶ Similar presentations lead to teaching fatigue (eg, bronchiolitis season) ▶ Cooperation of the patient may be an issue ▶ Patient/carer anxiety by use of jargon at bedside ▶ Some cases not be particularly suitable for face-to-face teaching (eg, safeguarding/bad news) ▶ Intimidating to have lots of people around the bed/cot. |
| Environment | ▶ Interruptions (bleep/phones/other teams/nurses/cleaners) | |
| Confidentiality | ▶ Depends on bay or cubicle – others can hear teaching discussion | |
| Teaching | ▶ Case-specific, clinical | ▶ Clinical pressures on time and service |
| ▶ ‘Real management’/practical signs, especially, for example, if symptoms or signs can be elicited or an acute intervention is required. | ▶ Less focus on history | |
| ▶ Information control – time | ||
| ▶ Difficult to express different opinions in front of patient and carer | ||
| ▶ Modelling of consultation, documentation, communication | ||
| ▶ Immediate feedback | ||
| ▶ Allocate specific roles, for example, allow SHO/registrar to lead | ||
| ▶ WPBA opportunities – mini-CEX | ||
| ▶ Visual stimulus to memory | ||
| Team factors | ▶ Allow contributions from different MDT members | ▶ Big group intimidating for patient/trainee/student/family |
| ▶ Interaction with patient, parents, medical/nursing staff | ||
| ▶ Less involvement from junior staff | ||
| ▶ Team working | ||
| ▶ Communication(s) | ||
| ▶ Delegation/use of team | ||
| Innovations | ||
| ▶ Be sensitive to patient's needs | ||
| ▶ Introduce every member of the team by name and role; this legitimises their presence and allows the parent/carer and patient to feel at ease. | ||
| ▶ Modelling child-doctor interaction skills can be done very effectively here. | ||
| ▶ Introducing ‘snippets’ or ‘gems’ relevant to assessment in this area can be helpful, eg, ‘In membership exams always remember to assess the mediastinum like this …’. | ||
| MDT, multi-disciplinary team; mini-CEX, mini clinical examination assessment; SHO,Senior House Officer, ST1-4 Grade equivalent; WPBA, workplace based assessment. | ||