The construction of patients' involvement in hospital bedside teaching encounters

Active and sensitively managed patient involvement in medical education is vital in the drive toward the development of tomorrow's doctors' patient-centered professionalism. Bedside teaching encounters (BTE) involve clinicians, medical students, and patients, and comprise a formative and focused activity through which students learn both the "whats" and "hows" of physicianship. We present four case studies from our analysis of six BTEs, drawing on Goffman's dramaturgy theory and broader interactional research. We demonstrate the multiple roles participants play within BTEs, including actor, director, audience, nonperson, and prop. Although patients sometimes participated as team members, even taking the role of director, they were commonly positioned in less active roles: as audience, nonperson, and prop. In this article we discuss critically this commonality across the BTEs: the patient role as passive object at the point at which the serious act of teaching physical examination begins, even when patients actively reject this passive role.