January 2016

New Interview About Teaching in the Presence of Patients


Can a clinical preceptor schedule daily direct observations with medical students without falling far behind in productivity? Many preceptors may think that observing their students in the presence of patients is too time-intensive and inefficient. However, Kenya Sekoni, MD, FAAFP, an assistant professor at the College of Human Medicine at Michigan State University, believes that teaching in the presence of patients can actually be a time-efficient strategy.

In a new audio interview that appears at TeachingPhysician.org, Dr Sekoni spoke at length about her successful techniques for teaching her students in front of her patients. The following excerpt is just a portion of the tips and strategies that Dr Sekoni recently shared with the editor of Teaching Physician, Dr Dennis Baker, PhD.

Dennis Baker: Can you tell us a couple of reasons that you believe teaching in the presence of patients is a good clinical teaching strategy?

Kenya Sekoni: When I was in private practice, the only way that I was allowed to precept was to ensure that our productivity would not go down. And that’s the primary reason that I began looking for ways to teach in front of the patients. I think it allows me to be an effective clinical teacher for both the student and my patient. The students themselves have said that they feel like I’m not only listening to them to be able to redirect them, but that I can actively correct their clinical approach as they’re doing the exam right on the spot.

Dennis Baker: Before you share a situation with us where you’ve done this, can you tell me about how you have seen patients respond?

Kenya Sekoni: My patients…absolutely adore having the students with them! They’ve told me that it gives them better insight as to how we as clinicians are thinking about their signs and symptoms. Even when we’re using scary terminology, they love hearing us explain it and hearing the student take a stab at explaining it.

Dennis Baker: Can you go ahead and give us an example of using the strategies that you are sharing?

Kenya Sekoni: Let me share how I conduct a physical exam. I use the acronym “PI.” “P” [is] for “priming” the student. First, I have [the student] look back at the last office visit, and have them think of the patient’s chief complaint. The second thing that I’m doing…is where the “I” of the “PI” comes in. With the “introduction,” I introduce or set the stage for both the patient and the student, and will oftentimes do that in the patient’s presence. That way, they’re primed as to how the interview process is going to go.

Dr Sekoni shares many more tips in the full interview, such as:
• Where she sits in the room during the exam
• How she asks the patient for permission to have the student perform the exam
• Why she asks the student to offer the differential in the presence of the patient

Log in to teachingphysician.org to hear the entire interview and find more practical tips on teaching in the presence of patients.