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BEDSIDE TEACHING INCLUDES PATIENT IN CIRCLE OF LEARNING

 "" PHOTO — Former heart patient Carmelina Raffetto became the focus of a group of medical residents and students at UC Davis Medical Center when she needed surgery. Although surgery is not something she would like to repeat, she said she enjoyed being a part of the teaching experience.
 
Former heart patient Carmelina Raffetto became the focus of a group of medical residents and students at UC Davis Medical Center when she needed surgery. Although surgery is not something she would like to repeat, she said she enjoyed being a part of the teaching experience.
   

Carmelina Raffetto was only 42 when she found herself the subject of teaching rounds at UC Davis Medical Center. She needed surgery to replace a severely stenotic aortic valve. "You've got to hear this," the attending enthused to the gathered residents, interns and students as he leaned over to listen to her heart. "A classic textbook case!"

Bedside rounds have long been a mainstay of medical education, including at UC Davis Medical Center. However, if the national trend of fewer bedside interactions continues, this practice may become as obsolete as the wooden stethoscope. Surveys in various teaching hospitals throughout the country found that time spent in bedside teaching averages 2.5 to 12 minutes per patient. And while 85 percent of patients reported that they liked the case presentation discussion at the bedside, only one-third of attendings and fewer residents felt the same way. In one study, most residents felt case presentations should take 5 minutes or less and be delivered away from the patient's bedside.

Raffetto is definitely in the camp of satisfied patients. "It was wonderful to see the doctors' excitement in teaching," she remembers. "I felt they always included me and that I was part of the teaching experience. And I learned a lot about my condition."

PHOTO — Bedside teaching has long been a mainstay of medical education here at UC Davis and at other teaching hospitals nationwide. However, if the national trend of fewer interactions at bedside continue, this practice will be as obsolete as the wooden stethoscope.  ""

Bedside teaching has long been a mainstay of medical education here at UC Davis and at other teaching hospitals nationwide. However, if the national trend of fewer interactions at bedside continue, this practice will be as obsolete as the wooden stethoscope.
 
  

One reason residents cite for disliking the practice is the fear of making the patient uncomfortable in such a public setting. While residents may prefer teaching rounds in the hallway, out of patients' earshot, this practice may make patients more uncomfortable, as they wonder what might be said about them that they can't hear. Raffetto said she remembers that everyone was always polite to her and asked permission to question and examine her first.

This expression of respect for the patient is as important for students to observe as learning the specifics of a disease, according to Faith Fitzgerald, assistant dean of medical humanities and bioethics. "Even if the attending physician is less skilled in the area of expertise required for illuminating a particular patient's case, the clinician can demonstrate skills in human interactions with the patient," she says.

Students and interns also tend to dislike teaching rounds in case they are put in the embarrassing situation of their ignorance being exposed to the patient. But Raffetto was never aware of such a dynamic in her presence.

"The focus was always on what my condition could teach," she says. "I never felt that residents were put on the spot around me or put down like you see on TV."

Although Raffetto would just as soon never find herself hospitalized again, she felt that "on the whole, it was a very positive experience. It was neat being a teaching tool for students."

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  "It was wonderful to see the doctors' excitement in teaching. I felt they always included me and that I was part of the teaching experience. And I learned a lot about my condition." — Carmelina Raffetto  
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