Imagine you’re a physician with just five minutes to spare, in an otherwise packed day of rounds and patient care. How would you spend it? You could take a break and sidle up to your coworkers to discuss the news of the day. You could use it as an opportunity to catch up on the administrative side of care – updating EHRs and patient notes. Or, as a recent session at the third-annual Stanford Medicine 25 Skills Symposium posited, you could turn this small chunk of time into a digestible teaching moment for a colleague or student.
This idea, known formally as the 5 Minute Bedside Moment, is essentially a short vignette – a kind of building block that breaks teaching into short, digestible units. “What we tried to do,” Poonam Hosamani, MD, explained to a crowd of roughly 100 attendees, “Is really think about reframing the way we teach at the bedside into little units, what we like to describe as the basic teaching unit of medicine.”
If one were to turn the moment into a recipe, here are the key ingredients: First you begin with a physical maneuver (such as a thyroid exam) that you feel comfortable demonstrating. Next you add an anecdote or narrative, and sprinkle in some clinical context. The result Hosamani, explained, is a “fun, engaging” way to teach at the bedside – and one that acknowledges the reality of time constraints that many learners face.
For the past three years, leadership behind the Stanford Medicine 25 Skills Symposium — including Abraham Verghese, MD; John Kugler, MD; and Errol Ozdalga, MD; have built upon techniques like this to create what participants described as a hands-on, collaborative setting for sharing tips to cultivate – and promote – a culture of bedside medicine. On day one, this was achieved through presentations and live demonstrations with titles like “Assessing Clinical Exam Skills,” and “Presence: The Art and Science of Human Connection in Medicine.”
The second day was organized around four separate tracks, including: “Teaching the Stanford 25,” “Creating Your Own Five Minute Bedside Moment,” “Clinical Examination for the Practicing Physician,” and “Bedside Ultrasound for Internal Medicine.”
In the 5 Minute Bedside Medicine training room, round tables were arranged around three white patient beds. Hosamani began the morning with a brief introduction and then split attendees into small working groups. Conversation and ideas flowed easily for the next hour, as physicians huddled around their tables brainstorming their own bedside moments – which ranged from topics as specific as pupillary response to topics as wide-ranging as general back pain.
During a presentation on the various causes of thumb pain, a physician from the Midwest shared a personal anecdote with the crowd. “Thumb pain in Wisconsin is a big deal,” she explained. “When my patients have thumb pain they can’t shovel snow, they can’t knit, and they can’t do their woodworking.” This kind of story or experience can really “cement your teaching,” Andrew Elder, MD, a professor of medicine at Edinburgh University and one of the symposium facilitators, told the room.
Hosamani wrapped up the session with a summary of best practices, and an acknowledgement of the importance of continued practice and conversation. Her words spoke to both the individual session, and the broader goal of the Stanford Medicine 25, which seeks to build a sense of community around bedside medicine teaching.
“I hope you all leave today with an understanding of other people’s moments, and the building blocks of teaching,” she said. “Remember to engage your learner with questions, anecdotes, visuals, and technology. Continue to iterate and focus. These things will help get your learners excited about the physical exam.”
She continued: “Over these past two days, we hope you learned just as much from each other as you have from all of us. We certainly have. Our hope is that you continue to share this knowledge with our community.”
Previously: Abraham Verghese reflects on the importance of listening and the role of technology in medicine, At first-ever Stanford Medicine 25 Symposium, a focus on bedside medicine and a call for community, Abraham Verghese: "There is no panacea for an investment of time at the bedside with students" and A call for extended bedside-manner training
Photo of Abraham Verghese (on bed) and symposium participants by Errol Ozdalga