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Teaching in a busy clinic
  1. Elspeth J R Hill1,2,
  2. James A Giles3,
  3. Tim Dornan1
  1. 1School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
  2. 2School of Medicine, The University of Manchester, Manchester, UK
  3. 3The University of Manchester, Manchester, UK
  1. Correspondence to Tim Dornan, School of Health Professions Education, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; timothy.dornan{at}gmail.com

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Introduction

There is a long tradition of medical student teaching taking place on hospital wards. Increasingly, however, neurological inpatients have rare and complex diseases. In contrast, 40% of patients referred to neurology outpatient clinics have headache or loss of consciousness,1 which are typical of the presentations graduates will encounter in their generalist careers. Another advantage of outpatient settings is that students can participate in authentic clinical care rather than be passive recipients of teaching. So, neurology teaching has to take place in outpatient clinics, whether it fits a traditional teaching style or not. But numbers of referrals are on the increase and neurologists faced with waiting list targets might not know how to accommodate students’ learning in their busy clinics. How is time to be found to teach students and how should that time best be used?

The impact of teaching encounters on clinic throughput has been thoroughly researched in the USA, where time is money. The results are clear.2 Skilled outpatient teachers do not strictly ‘teach’, they help students learn from their practice. Moreover, they allow students to give as well as take. A friendly and skilled clinician makes chores like ushering patients in and out, completing blood forms, looking up information in the British National Formulary, making telephone calls and explaining things to patients very positive experiences for medical students. If time permits, they may put a student in the driving seat so the teacher can take notes while the student interviews. Research showed students’ presence slowed consultations down a little but increased doctors’ satisfaction.3 ,4 There is also clear evidence that most patients do not mind students’ presence, even in private medical settings, unless they have something very confidential to discuss.5 Learning in outpatient clinics, then, is a virtue waiting to happen!

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