Abstract
Bedside skills have been declining over the last two decades, with multiple studies reporting increasing reliance on investigations and technology in making diagnostic decisions. During the Covid-19 crisis, even less time is spent at the bedside, and physical examinations seem markedly truncated or non-existent. It is possible that cost of health care, doctor-patient relationships, and the clinical reasoning skills could be seriously impacted by ongoing decrease in bedside skills and the teaching of these skills. Careful history taking and hypothesis-driven physical examination still form the backbone of clinical reasoning and lead to parsimonious investigations. Overreliance on investigations could drive up costs of healthcare if every diagnosis depends on a head to toe scan. In this paper, we describe strategies for bedside teaching that are relevant and applicable even during the pandemic and an era of physical distancing. These strategies are categorised as: before, during and after patient interactions at the bedside. These strategies can be adapted to normal clinical teaching situations as well as challenging situations such as the current pandemic when physical distancing is mandated.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Notes on contributors
Marjel van Dam
Marjel van Dam, PhD, LL.M., is an internist and intensive care physician working in the Intensive Care Center at the University Medical Center Utrecht, The Netherlands.
Subha Ramani
Subha Ramani, MBBS, MMEd, PhD, FAMEE, is Director, Program for Research, Innovations and Scholarship, Department of Medicine, Brigham and Women’s Hospital; and Associate Professor of Medicine, Harvard Medical School, Boston, USA.
Olle ten Cate
Olle ten Cate is professor, Medical Education, University Medical Center Utrecht, Utrecht, The Netherlands, and adjunct professor, Department of Medicine University of California, San Francisco, San Francisco, California, USA.