Kimberly Royston Hoffman
Published: 2000
Total Pages: 736
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The influence of context on clinical teaching was explored using the qualitative methods of participant observation, individual and group interviews, and document collection. Data were collected from attending physician, resident physician, and medical student participants on three internal medicine hospital based ward teams during 1999-2000. The ward teams practiced in a tertiary care academic medical center in the mid-west. The context of clinical teaching and learning was complex and as the clinical context changed, teaching and learning within the inpatient ward teams changed. The boundaries between teaching and learning, and learning and providing care to one's patient, was blurred within the clinical setting and members of the inpatient ward team moved frequently and fluidly among these roles. Context changed clinical teaching through: (a) the time sensitivity of teaching, learning, and patient care; (b) the distribution of total time among the team's professional roles; (c) available examples and non examples provided as a function of patient census; (d) the multiple and conflicting commitments of the team; (e) information access and (f) the limitations of the physical space. The patient's condition was the catalyst for: the topics to be taught, accessing multiple sources of information, operational learning, and enhancing one's technical/procedural skills. Within the clinical setting, learning was entered into based on unresolved patient problems, and the views of multiple people and multiple disciplines added depth to the discussions of the learners. The patient provided a common reference point in a fluid context and anchored learning and teaching in a setting of continuous change.