July 19, 2021

Teaching with the Triangle Method

Bruce Peyser, MD, FACP
Professor of Medicine, Duke University School of Medicine
Director of Education and Teaching, Duke Primary and Urgent Care
Provider, Duke Primary Care Pickett Road

Emphasizing the roles of the precepting provider, student, and patient, the Triangle Method offers another approach to teaching, as well as an opportunity to engage patients in the teaching process.

Last month I discussed an approach to teaching, drawing a parallel with setting the “stage” for an event with three “scenes.” I recently learned about another teaching technique called the Triangle Method.

The Triangle Method for teaching in the outpatient setting emphasizes interactions between the preceptor, student, and patient. Together they form a triad of participants involved in both the provision of care and medical education. Deborah Erlich wrote a one-page summary of the Triangle Method for the December 2018 issue of Academic Medicine. (Note: The link points to a PubMed page created before the issue became available in print. The page will be updated once the article is published online.)

Erlich emphasized the benefits of the Triangle Method—namely, that it is time-efficient, provides variety to one’s usual routine of seeing and evaluating patients and can serve as a way to show patients your skill as a medical educator. The summary offers 10 helpful hints for preceptors and is quite practical. It also details how patients perceive that we spend more time with them when we have learners who present in front of the patient. Lastly, it’s been reported that patients are more satisfied with their interaction when this Triangle approach is utilized (compared to more traditional precepting that occurred when patient information was presented outside the examination room).

There are other ways to solidify and bolster the role of the patient in the interaction, and this was detailed once again in one of my favorite resources, Teaching Physician. This one-page summary of quick tips (enter username Duke2016 and password dfmTP2016 if prompted to log in) focuses on ways to prep the patient for a student to be involved in the visit. There was an emphasis upon having your rooming staff mention to the patient that a student was going to come in, and it works best if the patient is told the gender and approximate age of the student.
On multiple occasions, I have had patients give feedback to the learner that is quite valuable. To quote the last entry in this summary: “Many patients enjoy being involved in a teaching encounter.” (This quote originated from an article in the Medical Journal of Australia; however, we cannot access the publication through our Duke Library system.)