How physicians teach in the clinical setting: The embedded roles of teaching and clinical care

Abstract

Background: Clinical teaching lies at the heart of medical education. However, few studies have explored the embedded nature of teaching and clinical care. The goal of this study was to examine the process of clinical teaching as it naturally, and spontaneously, unfolds in a broad range of authentic contexts with medical students and residents.

Methods: This focused ethnographic study consisted of 160 hours of participant observation and field interviews with three internal medicine teams. Thematic analysis guided data organization and interpretation.

Findings: Three overlapping themes emerged: the interconnectedness between clinical work and pedagogy; a multiplicity of teachers; and the influence of space and artifacts on teaching and learning. Clinical teaching, which was deeply embedded in clinical care, was influenced by the acuity of patient problems, learner needs, and the context in which teaching unfolded; it also occurred on a spectrum that included planned, opportunistic, formal, and informal teaching (and learning).

Conclusions: Study findings suggest that clinical teaching, which is marked by an intersection between service and teaching, can be viewed as an example of work-based teaching. They also yield suggestions for the enhancement of clinical teaching in inpatient settings, faculty development, and educational policies that recognize clinical teaching and learning.

Acknowledgements

We gratefully acknowledge the Dr. Nathan and Judy Laufer Fund for their support of a postdoctoral fellowship in medical education which facilitated this work. We would also like to thank the three physicians who graciously shared their insights and experiences while allowing us to shadow them and their teams.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Notes on contributors

Yvonne Steinert, PhD, is a professor of Family Medicine and is the director of the Centre for Medical Education and the Richard and Sylvia Cruess Chair in Medical Education, Faculty of Medicine, McGill University.

Mandeep Basi, PhD, is an anthropologist and was a postdoctoral fellow in medical education at the Centre for Medical Education, Faculty of Medicine, McGill University, at the time of this study.

Peter Nugus, PhD, is an assistant professor of Family Medicine and is a research scientist at the Centre for Medical Education, Faculty of Medicine, McGill University.