Some argue that bedside clinical skills have waned due to excessive reliance on technology.
However, a new report published in The New England Journal of Medicine by Northwestern University and the University of Alabama at Birmingham offers six practical strategies to revive the declining culture of bedside medicine in contemporary healthcare.
The suggestions provide clinicians and medical educators with guidance on how to better teach and practice essential bedside clinical skills, such as the physical exam.
Corresponding author, Brian Garibaldi, an expert in bedside teaching and the inaugural director of Northwestern University’s Centre for Bedside Medicine, said: ‘An appropriate physical exam can help avoid the need for additional diagnostic testing, yet research has shown the most commonly reported error in the physical exam is simply that the exam was never performed. Every day, there’s more information coming out about technology and AI, and the more that people use these tools, the more they realise the primary information we get from patients during the history and physical exam is increasingly critical to the decisions we make. There’s only so much tech can do without the correct inputs from humans – both physicians and patients.’
The report was published in NEJM’s final issue in a six-part series on medical education.
Garibaldi, who is also the Charles Horace Mayo Professor of Medicine in the Division of Pulmonary and Critical Care, said: ‘Dedicating part of an education series to these issues underscores the recognition of the value of these skills. If we don’t intentionally cultivate them, they’re at risk of being lost.’
Published on the Northwest Medicine website, the report’s six tips to enhance bedside encounters include:
1. Observing the patient from the foot of the bed or hallway to gather vital clues about diagnosis, prognosis and personal circumstances.
2. Practising and teaching an evidence-based physical exam approach, leveraging the patient’s history and knowledge of common illnesses to estimate diagnosis likelihood.
3. Creating opportunities for patient-centred medical education during rounds, involving learners and teachers at the bedside to improve efficiency and physician satisfaction.
4. Using technology, such as AI-enabled bedside tools like point-of-care ultrasound (POCUS), to supplement traditional exams, emphasising the importance of clinician presence and communication.
5. Seeking and providing feedback on clinical skills in a thoughtful, context-specific manner to reinforce learning while maintaining the patient-physician relationship.
6. Recognising the broader role of the bedside encounter in addressing healthcare disparities and managing clinical uncertainty through curiosity and investigation.
By employing these six strategies, clinical educators can help trainees appreciate the value of the bedside encounter in diagnostic reasoning, strengthen the patient-physician relationship, combat healthcare inequities, and improve professional fulfilment and burnout, the report said.
