Student and patient perspectives on bedside teaching.
ABSTRACT A cross-sectional study was undertaken to elicit patient and learner opinions about bedside teaching (BST). Only 48% of learners reported that they had been given enough BST during their undergraduate training, while 100% thought BST to be the most effective way of learning clinical skills. Seventy seven per cent of patients enjoyed BST and 83% said that it did not make them anxious. The preferred site for case presentations was the conference room. Further quantitative studies are needed to investigate perceived impediments to BST from the teachers' point of view.
- SourceAvailable from: Jed D Gonzalo[Show abstract] [Hide abstract]
ABSTRACT: Background: Interprofessional collaboration improves the quality of medical care, but its integration into workflow is limited. While a shared conceptualization among nurses and physicians regarding bedside interprofessional rounds may enhance implementation, little work has investigated front-line providers’ perceptions of this activity. Objective: To evaluate the perceptions of nursing staff, attending, and house staff physicians regarding the benefits and barriers to bedside interprofessional rounds. Design and Participants: Observational, cross-sectional survey of hospital-based, internal medicine nursing staff, attending, and house staff physicians. Participants completed an electronic survey (June 2013) developed from prior work on physician bedside rounds and literature review. Descriptive, non-parametric Kruskal-Wallis, and non-parametric correlation were used. Main Measures: Bedside interprofessional rounds was defined as “encounters that include the team of providers, at least two physicians plus a nurse, discussing the case at the patient’s bedside.” Eighteen items related to “benefits” and 21 items related to “barriers” associated with bedside interprofessional rounds. Results: Of 171 surveys sent, 149 were completed (87% response). Highest-ranked benefits to bedside interprofessional rounds related to communication/coordination, including “improves communication between nurses-physicians” and “improves awareness of clinical issues;” lowest-ranked benefits related to efficiency, process, and outcomes, including “decreases length-of-stay” and “improves timeliness of consultations.” Nursing staff reported more favorable ratings compared to physicians for all 18 benefit-related items (p-values <0.05). The rank order for three groups showed high correlation (r=≥0.92, p<0.001). Highest-ranked barriers related to time issues, including “nursing staff have limited time” and “time required for encounters;” lowest-ranked barriers related to provider- and patient-related factors, including “patient lack of comfort.” Rank order of barriers amongst all groups showed moderate correlation (r=0.62-0.82). Conclusions: While nurses perceived greater benefit for bedside interprofessional rounds than physicians, all groups lacked perceived benefit in patient outcomes. To the extent perceived benefits and barriers are generalizable, these findings lay the foundation for building systems that facilitate meaningful patient-centered interprofessional collaboration.Journal of Hospital Medicine 07/2014; · 1.40 Impact Factor
- Perspectives on medical education. 02/2014;
- [Show abstract] [Hide abstract]
ABSTRACT: The Accreditation Council for Graduate Medical Education (ACGME) has established the requirement for residency programs to assess trainees' competencies in 6 core domains (patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice). As attending rounds serve as a primary means for educating trainees at academic medical centers, our study aimed to identify current rounding practices and attending physician perceived capacity of different rounding models to promote teaching within the ACGME core competencies. We disseminated a 24-question survey electronically using educational and hospital medicine leadership mailing lists. We assessed attending physician demographics and the frequency with which they used various rounding models, as defined by the location of the discussion of the patient and care plan: bedside rounds (BR), hallway rounds (HR), and card-flipping rounds (CFR). Using the ACGME framework, we assessed the perceived educational value of each model. We received 153 completed surveys from attending physicians representing 34 institutions. HR was used most frequently for both new and established patients (61% and 43%), followed by CFR for established patients (36%) and BR for new patients (22%). Most attending physicians indicated that BR and HR were superior to CFR in promoting the following ACGME competencies: patient care, systems-based practice, professionalism, and interpersonal skills. HR is the most commonly employed rounding model. BR and HR are perceived to be valuable for teaching patient care, systems-based practice, professionalism, and interpersonal skills. CFR remains prevalent despite its perceived inferiority in promoting teaching across most of the ACGME core competencies. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine.Journal of Hospital Medicine 02/2014; · 1.40 Impact Factor