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Come along to watch some clinical teachers in action.(1) A nurse practitioner and 2 nursing students working in a community health centre see a 51 year old woman with symptoms of menopause. The woman has had a total hysterectomy and, other than her menopausal symptoms, is healthy, with no family history of breast cancer or cardiovascular disease. She states that the symptoms are severely affecting her quality of life but seems to be reluctant to take hormone replacement therapy (HRT) because she has heard that it may affect her risk of breast cancer or heart disease. The nurse practitioner tells the woman they will do some research on the risks and benefits of HRT for her next consultation. After the consultation, she invites the students to help find and appraise evidence on this topic and “thinks aloud” about how the evidence will be used to discuss options with the woman at her next appointment.(2) A family nurse is running a vaccination clinic with a group of nursing students. After teaching the students how to give a vaccination using a larger bore, longer needle (23 gauge, 25 mm), the nurse emphasises the importance of using this type of needle because it reduces the likelihood of reactions to the vaccination. She provides the students with the reference of a study that provides evidence to support this claim.1(3) After initiating a multilayered, high compression regimen for a patient with a venous ulcer, a specialist nurse discusses the results of quantitative studies of the effectiveness of this intervention with a group of students. The group then explores how they can use this evidence to discuss the treatment with the patient.2
These teaching moments share 4 important features. Firstly, the teaching is actually happening, despite the barriers and disincentives that clinical teachers …
A modified version of this notebook appears in ACP Journal Club and Evidence-Based Medicine.