Table 4


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
▶ 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.