Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study

BACKGROUND: Clinician educators face numerous obstacles to their joint mission of facilitating high-quality learning while also delivering patient-centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. OBJECTIVE: To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds. DESIGN: An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015. SETTING: Inpatient general medicine wards in 11 US hospitals, including university-affiliated hospitals and Veterans Affairs medical centers. PARTICIPANTS: Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners. MEASUREMENTS: In-depth, semi-structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds. RESULTS: Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient-centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels. CONCLUSION: This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds. (C) 2017 Society of Hospital Medicine