Table 1.

Characteristics of the preclinical ‘Guided Bedside Learning’ approach to clinical-skills training

Oriented to foundational clinical-skills training Basic clinical-skills development driven by competencies and developmental progression Clinical-skills competency domains: Interviewing skills Physical examination Oral case presentation Clinical reasoning Documentation, including complete write-up Progression of skills training from basic skills to introduction to advanced skills, with spiral approach to training and assessment (23, 24). Standardized curriculum Students receive objective, written standards (‘benchmarks’) for clinical skills to be mastered prior to clerkships. These benchmarks, tied to competencies and developed by the college faculty, serve as the basis for students’ clinical preparation in the skills lab and at the bedside (16). Formative and summative evaluation of students by mentors is based on competencies/benchmarks Active learning with real patients Combination of monthly organ-specific ‘advanced exam’ teaching sessions in a skills-lab practice setting and weekly half-day bedside teaching encounters with in-patients Students assume responsibility for interviewing and performing physical examinations on consenting in-patients with partial or full observation by faculty mentor Students present patient at the bedside to faculty mentor and student small group, and submit a write-up to their mentor for review and feedback. Each student is directly responsible for at least six patients across 9 months and observes peers presenting patient at the bedside >/ = 30 times. Guidance from mentors with limited introduction to ‘graded responsibility’ Preliminary mentor-led organ-based skills lab sessions are followed by work with real patients Students are alone at the bedside some of the time, performing a history and physical examination, with mentors rotating between two students and providing guidance as needed Mentors provide verbal feedback at bedside and after oral case presentation, and critique write-ups