Qualitative evaluation of a formal bedside clinical teaching programme in an emergency department

Background: Bedside clinical teaching in emergency departments is usually opportunist or ad hoc. A structured bedside clinical teaching programme was implemented, where a consultant and registrar were formally allocated to teaching and learning roles separated from the usual departmental management or clinical roles. Themes emphasised included clinical reasoning, practical clinical knowledge, communication, physical examination, procedural and professional skills. Aim: To evaluate the perceived educational value, effects on patient care and areas for ongoing development. Methods: The study setting was an urban, tertiary referral, university-affiliated emergency department with prospectively allocated educational shifts of 4 or 5 h duration over a 6-month period. Evaluation was by session and course evaluation questionnaires, with respondents ranking predetermined themes and giving free-text responses. Qualitative presentation of results allowed exploration of the themes identified. Results: Learners ranked history taking and physical examination technique as the most frequently learnt item, but clinical reasoning as the most important theme learnt. Informal discussion and performance critique or constructive feedback were the most frequent teaching methods. The biggest obstacle to learning was learner apprehension. The most frequent positive effect on patient care was faster management, decision making or disposition. Most often, no negative effect on patient care was identified. Conclusion: Formal bedside teaching is effective if organised with adequate staffing to quarantine the teacher and learner from routine clinical duties, and concentrating on themes best taught in the patient setting. Clinical reasoning and clinical knowledge were perceived to be most important, with positive effects on patient care through more thorough assessment and faster decision making.