J. Willis Hurst, MD, MACP

The standard methods of teaching clinical medicine are stated. Lectures are simply sources of information that may not always be understood or used by the listeners. Lecturers are not true teachers, because they have no feedback from the listeners. Certain aspects of self-learning are described. This method of learning, guided by a true teacher, should be mastered during internship and residency. Self-learning places patients at the center of the activity where doctors care for them and simultaneously learn medicine by asking themselves questions about their patients and searching for the answers. A clinician who learns medicine using this approach may know more about a problem than can be found in standard textbooks. Textbooks discuss the general rules about an illness, whereas the expert clinician may know the exceptions to such rules. The self-learner always correlates the data found by one technique with the data found using other techniques. This approach improves all skills, including thinking. The self-learner must teach. This discipline demands that trainees organize the data they collect and improve their skill of communication. Finally, trainees should learn early in their training that good doctors make many types of decisions about their patients, and such decisions must always be made in favor of the comfort and convenience of their patients.

There is considerable anecdotal evidence that teaching ward rounds has deteriorated. This article discusses current impediments to the performance of teaching ward rounds and what the attending physician teacher and trainee can contribute simultaneously to improve patient care and teaching. Patients, who are the center of activity, gladly participate in teaching ward rounds and, when carried out properly, enjoy and profit from it. Because this teaching patient care exercise is extremely important, considerable effort must be expended to create an environment that exudes excellence.