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.
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ABSTRACT: The use of bedside rounds in teaching hospitals has declined, despite recommendations from educational leaders to promote this effective teaching strategy. The authors sought to identify reasons for the decrease in bedside rounds, actual barriers to bedside rounds, methods to overcome trainee apprehensions, and proposed strategies to educate faculty. A qualitative inductive thematic analysis using transcripts from audio-recorded, semistructured telephone interviews with a purposive sampling of 34 inpatient attending physicians from 10 academic U.S. institutions who met specific inclusion criteria for "bedside rounds" was performed in 2010. Main outcomes were themes pertaining to barriers, methods to overcome trainee apprehensions, and strategies to educate faculty. Quotations highlighting themes are reported. Half of respondents (50%) were associate or full professors, averaging 14 years in academic medicine. Primary reasons for the perceived decline in bedside rounds were physician- and systems related, although actual barriers encountered related to systems, time, and physician-specific issues. To address resident apprehensions, six themes were identified: build partnerships, create safe learning environments, overcome with experience, make bedside rounds educationally worthwhile, respect trainee time, and highlight positive impact on patient care. Potential strategies for educating faculty were identified, most commonly faculty development initiatives, divisional/departmental culture change, and one-on-one shadowing opportunities. Bedside teachers encountered primarily systems- and time-related barriers and overcame resident apprehensions by creating a learner-oriented environment. Strategies used by experienced bedside teachers can be used for faculty development aimed at promoting bedside rounds.Academic medicine: journal of the Association of American Medical Colleges 12/2013; · 2.34 Impact Factor
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ABSTRACT: Background: Teaching in the presence of the patient is an acceptable model in medical settings. Questions have been raised about the appropriateness of this type of teaching (exam room teaching) with patients with mental health issues. Purposes: This prospective randomized controlled study examined outpatient exam room teaching in a psychiatric setting. Methods: In 2011-2012, patients in the adult outpatient psychiatry clinic at the University of Iowa were randomized to have faculty-learner presentations either in the presence of the patient or in the conference room. Teaching encounters were timed and faculty, learners, and patients completed post encounter surveys. Results: Participation included 126 patients, nine faculty, and 16 residents. Comparison of patient encounters randomized to exam room (n = 58) or conference room (n = 64) demonstrated that exam room teaching was roughly twice as time efficient as conference room teaching (p ≤ .0001). Patients expressed a preference for exam room teaching during future visits (p ≤ .003) for those patients who experienced exam room teaching during the study. Faculty were generally comfortable with exam room teaching and felt it had some advantages for patient decision making. Learners felt they had to choose their words more carefully in exam room teaching and expressed some concerns about depth of teaching. Conclusions: Once exposed to exam room teaching, this model is acceptable and feasible to faculty, learners, and patients in a psychiatry clinic setting.Teaching and Learning in Medicine 01/2014; 26(1):40-8. · 0.94 Impact Factor
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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