Learning clinical skills during bedside teaching encounters in general practice: A video-observational study with insights from activity theory

This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills.

An audio and/or video observational study examining seven general practice BTEs was undertaken. Additionally, audio-recorded, semi-structured interviews were conducted with participants. All data were transcribed. Data analysis comprised Framework Analysis informed by Engeström’s Cultural Historical Activity Theory.

BTEs can be seen to offer many learning opportunities for clinical skills. Learning opportunities are negotiated by the participants in each BTE, with patients, doctors and students playing different roles within and across the BTEs. Tensions emerged within and between nodes and across two activity systems.

Negotiation of clinical skills learning opportunities involved shifts in the use of artefacts, roles and rules of participation, which were tacit, dynamic and changing. That learning is constituted in the activity implies that students and teachers cannot be fully prepared for BTEs due to their emergent properties. Engaging doctors, students and patients in reflecting on tensions experienced and the factors that influence judgements in BTEs may be a useful first step in helping them better manage the roles and responsibilities therein.

The paper makes an original contribution to the literature by highlighting the tensions inherent in BTEs and how the negotiation of roles and division of labour whilst juggling two interacting activity systems create or inhibit opportunities for clinical skills learning. This has significant implications for how BTEs are conceptualised.