Background: There are no objective tools to assess ambulatory teaching, an increasingly important component of medical education. Purpose: To develop and describe an objective ambulatory teaching tool. Methods: Exactly 30 consecutive ambulatory teaching encounters were audio taped. Audio tapes were transcribed and teacher-learner utterances were qualitatively analyzed by 3 coders using a grounded theory approach. Results: A total of 4,560 utterances were coded: 1/3 were devoted to case presentations, and the remainder to case discussion. Most learner utterances conveyed factual patient information; only 7% conveyed learner thoughts on diagnosis or management. Attending utterances were equally divided between questions, statements of fact, and management statements. Most attending questions (75%) asked patient or medical facts; few were of a higher-level asking learners to analyze, synthesize, or apply content. Feedback, although common (10%), consisted of mostly minimal statements such as "right" or "1 agree." At the bedside, 80% of utterances were by the teacher. Conclusions: This is a feasible tool that reliably documents ambulatory teacher and learner behaviors and may be useful for educational research and faculty development.
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