Bedside Teaching and Feedback in Psychiatry: Using Open Dialogue Strategies on an Inpatient Psychotic Disorders Unit.

Abstract

Bedside teaching is essential to instilling clinical and communication skills, and its benefits to both learners and patients are particularly notable in psychiatry. Bedside rounding has declined in teaching hospitals, however, a trend that may reflect constraints on teaching and clinical time, perceived inefficiency, and awkwardness for trainees. Creating safe and nonpunitive learning environments, maximizing efficiency, and formatting rounds to support learners are strategies that may reduce these barriers. In this column, the authors describe using dialogic practice, a method of communication derived from Finland's Open Dialogue approach, to integrate bedside teaching into psychiatry inpatient rounds. This is the first description of dialogic practice as a teaching tool rather than a clinical approach. In this model, teaching is integrated directly into the patient interview. The attending psychiatrist may step in to make an intervention or teaching point, then hand the interview back to the trainee. The authors demonstrate this method using example cases. The use of dialogic practice, which incorporates multiple voices in each encounter, allows for integrating feedback and teaching into clinical care. Patients benefit by feeling fully included in discussions about their care, while learners receive valuable real-time feedback that they can immediately integrate into the ongoing interview. Dialogic teaching is highly efficient while modeling valuable skills and respecting both the patient and the learner. It must, however, be implemented in a psychologically safe learning environment.