This advice by William Osler, at the beginning of the 20th century, has been continually handed down since then. Osler’s style wouldn’t be acceptable today, with large rounds, and consent rarely obtained from the patient. Now, simulation is being used for teaching, but teaching that involves patients remains invaluable. Teaching with the patient rather than about the patient should be considered vital for students, junior medical officers and registrars to learn the practice of medicine.

Patients like to be included in the teaching process. Case presentations by junior staff at the bedside significantly increase the time doctors spend with patients, and such patients are more likely to be satisfied with their inpatient stay.2 They prefer having students present their history in front of them than outside the door.3

Teaching with patients allows the important domains of learning to be integrated through teaching, observation and role modelling.4,5 These domains include:

• Clinical (knowledge, decisions, skills)

• Professionalism (ethics, teamwork)

• Communication (with patients, families and other staff).5

Teaching with the patient incorporates adult learning principles, as it is meaningful, relevant to work, and allows active involvement (see “Tips 2”6).

Patients may be adversely affected by teaching in their presence if their rights are not respected,4,7 or if the teacher fails to recognise that patients may have conditions not appropriate to be discussed in front of a group.7

The patient’s perception as to the competence of the junior medical officer or registrar may be harmed by negative feedback that senior clinicians give in front of the patient. Remember that the doctors in training are the ones the patient sees on a daily basis.

In some instances, the patient may be upset and confused by the discussion.2,7

Patients want to be asked for consent beforehand and to be introduced to people. They appreciate an approachable tutor, clear explanations, the opportunity to ask questions, and the feeling that their feedback is valuable.2,4

Plan your teaching using the “Set, Dialogue and Closure” framework (see “Tips 3”8). Important factors in teaching with patients include choosing the correct patient, obtaining consent, and explaining the patient’s role.

Structure your dialogue using methods described such as the “One-minute teacher” and SNAPPS (see below). These have been shown to significantly increase learners’ motivation, their involvement in decision-making, evaluation of their knowledge, and provision of feedback.9,10