Who needs beds?

We wish to respond to two recent articles highlighting a decline in the frequency of bedside teaching and advocating a return to this traditional clinical education set piece [1, 2] We agree with the assertion that bedside teaching has, in the past, proved to be an important form of clinical education through which learners gain professional, communication, physical examination and reasoning skills. However, we question the validity of the authors’ claim that a decline in the prevalence of bedside teaching has contributed to a deterioration in the clinical skills of new graduates. The evidence provided for this assertion is largely based on opinion pieces whereas recent surveys of readiness for practice indicate that graduates are increasingly well prepared for clinical practice [3]. We would also like to take issue with the words ‘bedside’ and ‘teaching’. Teaching at patients’ bedsides has a particular cultural and historical resonance for medical educators because it represents what Shulman [4] would call a signature pedagogy of their own apprenticeship learning experience. However, given the rapidly changing nature of hospital clinical environments, it is important to recognize that clinical education, (i.e. education occurring in the presence of patients) can and does occur in a variety of settings without the necessity for the patient to be supine in a bed. Clinical learning now occurs in a range of contexts including investigative settings, ambulatory clinics, therapeutic areas, (e.g. physiotherapy) and in the community [5]. The term ‘bedside’ has become increasingly redundant because that is not where patients spend much of their time, even in hospitals.