How to make teaching in the office more time efficient

From the July-August ACP Observer, copyright © 2003 by the American College of Physicians.

By Jason van Steenburgh

SAN DIEGO—While some practicing physicians hesitate to include office-based teaching in their time-starved routines, teaching doesn't have to sabotage your schedule.

At an Annual Session workshop, Dawn E. DeWitt, FACP, head of the school of rural health and dean of the rural clinical school at Australia's University of Melbourne, said that the trick to efficient office-based instruction is to develop a teaching culture that doesn't interfere with the practice's business goals. She offered the following tips:

• Give direction. Spend time up front with residents explaining how your office operates. That way, Dr. DeWitt said, they won't waste any of their time—or yours—trying to figure out office procedures on their own.

  Explain the practice patient flow and introduce all staff. Be sure to review basics like where to park and how to turn on office equipment.

  Then ask residents about their previous outpatient experience, getting a quick inventory of their clinical skills-and be sure to ask them where they think they need help. Those answers will focus your instruction and help you avoid going over what they already know.

• Emphasize brevity. Dr. DeWitt advised scheduling residents with patients who provide good histories and have limited but interesting problems or physical findings. Priming residents for each patient with a key fact—"Mrs. Dougherty has diabetes," for example—will narrow their focus.

  Be sure to tell residents what you expect as far as presentations. Residents can save you time taking a patient's history—then waste those savings by taking too long presenting their findings.

  Tell residents, for example, that you want an uninterrupted three-minute presentation of the patient's diagnosis and care plan in the exam room, using lay terminology. Encouraging them to start with a diagnosis will help them discuss evidence more succinctly, Dr. DeWitt said.

  Focus your attention on residents while they present, not the patient. (Patients might interpret eye contact as a signal to ask questions.) After the presentation, encourage patients to share their thoughts and corroborate the history.

• Delegate nonclinical skills. Assign the task of teaching residents nonclinical skills like billing, coding and claim disputes to other staff. Residents will learn from office staff who know those procedures the best, and it will free up your time to be more productive.

  A well-trained resident can also save you time by pitching in with practice management tasks like triaging patient phone calls and following up on lab results.

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