The Basics
These "basics" emphasize, as well, the application of BDA as a framework for clinical teaching. Framing the experience and establishing expectations is the BEFORE aspect of the BDA framework.-
Frame the clinical experience as a learning situation. This means you should IDENTIFY the medical student's role that is pertinent to the objective of a given clinical situation.
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Establish the expectations. Describe the key skills, behaviors and/or attitudes the student should perform in the clinical situation to be effective.
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Identify potential challenges for the students. Ask the student about their knowledge, procedural skills or other abilities. Will this expectation for performance be within their zone of proximal development (reasonable to expect them to perform given their knowledge and abilities)? If so, the student is ready. If not, tailor the expectation so the clinical experience will present enough of a challenge to be a true learning experience for the student.
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Offer guidance, as needed. Find out if the student has any questions and address these, when appropriate, providing guidance as needed for effective performance and to support learning.
Examples
Below is an example for each of the four RIME roles in the context of a patient brought to the Emergency Room reported to have possible sepsis.
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REPORTER – I need for you to gather and report to me the information we need to determine whether the patient has sepsis.
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INTERPRETER – Please review the lab results and results of the physical exam and history to determine whether the evidence allows us to differentiate sepsis from other possible diagnoses. Identify what additional diagnostic testing we need to do, if any.
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MANAGER – The patient is homeless. We will not be able to release him without an assurance of follow-up care. I want you to identify the resources available, get whatever consults we need to determine whether this patient might be admitted to ensure appropriate follow-up care.
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EDUCATOR – Now that we have determined the patient has sepsis. Your role is to explain to the patient what sepsis is and describe the next steps we recommend he take to treat it.
Strengthen your application of this framework by combining it with the strategic use of the B-D-A framework to structure the learning experience.