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Shaik T, Aggarwal K, Singh B, Sawhney A, Naguluri R, Jain R, Jain R. A comprehensive analysis of different types of clinical rounds in hospital medicine. Proc AMIA Symp 2023; 37:135-141. [PMID: 38173995 PMCID: PMC10761014 DOI: 10.1080/08998280.2023.2261086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/15/2023] [Indexed: 01/05/2024] Open
Abstract
Table rounds and bedside rounds are two methods healthcare professionals employ during clinical rounds for patient care and medical education. Bedside rounds involve direct patient engagement and physical examination, thus significantly impacting patient outcomes, such as improving communication and patient satisfaction. Table rounds occur in a conference room without the patient present and involve discussing patient data, which is more effective in fostering structured medical education. Both bedside and table rounds have pros and cons, and healthcare professionals should consider the specific requirements of their patients and medical trainees when deciding which approach to use. This research utilized a comprehensive search to identify relevant resources, such as university website links, as well as a PubMed search using relevant keywords such as 'bedside rounding,' 'table rounding,' and 'patient satisfaction.' Relevance, publication date, and study design were the basis for inclusion criteria. This study compared the effectiveness of these two methods based on physician communication, medical education, patient care, and patient satisfaction.
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Affiliation(s)
- Tanveer Shaik
- Avalon University School of Medicine, Willemstad, Curacao
| | | | | | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Upland, Pennsylvania, USA
| | - Riya Naguluri
- Great Valley High School, Malvern, Pennsylvania, USA
| | - Rohit Jain
- Avalon University School of Medicine, Willemstad, Curacao
| | - Rahul Jain
- Avalon University School of Medicine, Willemstad, Curacao
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2
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Rosen MA, Bertram AK, Tung M, Desai SV, Garibaldi BT. Use of a Real-Time Locating System to Assess Internal Medicine Resident Location and Movement in the Hospital. JAMA Netw Open 2022; 5:e2215885. [PMID: 35675075 PMCID: PMC9178434 DOI: 10.1001/jamanetworkopen.2022.15885] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE The patient-physician clinical encounter is the cornerstone of medical training, yet residents spend as little as 12% of their time in direct patient contact. OBJECTIVES To use a real-time locating system (RTLS) to characterize intern work experiences in the hospital, understand factors associated with time spent at patients' bedsides, and inform future interventions to increase time spent with patients. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from July 1, 2018, to June 30, 2019 (ie, the academic year 2018-2019). Internal medicine residents from postgraduate year 1 (interns) at an academic medical center wore an infrared badge that recorded location and duration (eg, patient room, ward hall, physician workroom). Data were analyzed from September 1, 2020, to August 30, 2021. MAIN OUTCOMES AND MEASURES Main outcome was time (in minutes) at the bedside; the unit of analysis was a 24-hour intern day or interval of time within the day (eg, rounding period). Descriptive statistics are reported overall, by intern, and for 5 clinical service categories. Multilevel modeling assessed the association of intern, service, and calendar time with time spent at the bedside. RESULTS Data from 43 of 52 interns (82.7%) encompassing 95 275 hours of observations were included for analyses. Twenty-six interns (60.5%) were women. Interns were detected for a mean (SD) of 722.8 (194.4) minutes per 24-hour period; 13.4% of this time was spent in patient rooms (mean [SD] time, 96.8 [57.2] minutes) and 33.3% in physician workrooms (mean [SD] time, 240.9 [228.8] minutes). Mean percentage of time at the bedside during a 24-hour period varied among interns from 8.8% to 18.3%. Mean (SD) percentage of time at the bedside varied by service for the 24-hour period from 11.7% (6.6%) for nononcology subspecialties to 15.4% (6.0%) for oncology, and during rounds from 8.0% (12.4%) for nononcology subspecialties to 26.5% (12.1%) for oncology. In multilevel modeling, the individual intern accounted for 8.1% of overall variance in time spent at the bedside during a 24-hour period, and service accounted for 18.0% of variance during rounds. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study support previous evidence suggesting that interns spend only a small proportion of time with hospitalized patients. The differences in time spent in patients' rooms among interns and during rounds constitute an opportunity to design interventions that bring trainees back to the bedside.
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Affiliation(s)
- Michael A. Rosen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda K. Bertram
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Monica Tung
- medical student at Johns Hopkins University School of Medicine, Baltimore, Maryland
- currently with Department of Medicine, University of California at San Francisco
| | - Sanjay V. Desai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Chief Academic Officer, American Medical Association
| | - Brian T. Garibaldi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cheema B, Li M, Ho D, Amari E, Buckley H, Canfield C, Cuncic C, Nimmon L, Van Enk A, Veerapen K, Wisener KM, Holmes CL. Patient-present teaching in the clinic: Effect on agency and professional behaviour. MEDICAL EDUCATION 2022; 56:270-279. [PMID: 34433224 PMCID: PMC9292717 DOI: 10.1111/medu.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND/PURPOSE Although much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient-centred and respectful behaviours in a patient-present learning environment. METHODS We conducted this study in an ambulatory internal medicine clinic using 'patient-present' clinic visits. All case presentations occurred in examination rooms with the patient. We invited participants (attending physicians, undergraduate and postgraduate learners, patients and family members) to participate in semistructured interviews after each clinic visit to explore the impact of the patient-present learning environment. We recruited 34 participants in the study; 10 attending physicians, 12 learners, 10 patients and 2 family members. We analysed the data deductively using a conceptual framework of agency. SUMMARY/RESULTS We identified three major insights: (1) Patients felt engaged and valued opportunities to be heard; (2) Attending physicians and learners reported a more respectful learning environment and a positive though challenging teaching and learning experience; and (3) A hidden curriculum emerged in a performance-based view of professional behaviour. CONCLUSIONS Patient-present teaching engaged patients and enhanced their agency by recasting the patient as the central focus within the healthcare encounter. We identified a tension between performing and learning. This study adds new insights to the concept of patient centredness and professionalism from the perspectives of all participants in the medical teaching and learning environment.
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Affiliation(s)
- Bavenjit Cheema
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Meredith Li
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Daniel Ho
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Erica Amari
- Office of Faculty Development, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Heather Buckley
- Department of Family Practice, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Carolyn Canfield
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cary Cuncic
- Division of General Internal Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Nimmon
- Centre for Health Education Scholarship and Department of Occupational Science and Occupational TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Anneke Van Enk
- Department for Innovation in Medical EducationUniversity of OttawaOttawaOntarioCanada
| | - Kiran Veerapen
- Office of Faculty Development and Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Katherine M. Wisener
- Office of Faculty Development, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cheryl Lynn Holmes
- Undergraduate Medical Education and the Division of Critical Care, Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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4
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Sweigart JR, Lippert WC, Atkinson HH, Hall AM, Nichani S, Ragsdale JW, Russell GB, Lichstein PR. Impact of Bedside Rounding on Attending Teaching Evaluations. South Med J 2022; 115:139-143. [PMID: 35118504 DOI: 10.14423/smj.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine associations between bedside rounding (BSR) and other rounding strategies (ORS) with resident evaluations of teaching attendings and self-reported attending characteristics. METHODS Faculty from three academic medical centers who attended resident teaching services for ≥4 weeks during the 2018-2019 academic year were invited to complete a survey about personal and rounding characteristics. The survey instrument was iteratively developed to assess rounding strategy as well as factors that could affect choosing one rounding strategy over another. Survey results and teaching evaluation scores were linked, then deidentified and analyzed in aggregate. Included evaluation items assessed resident perceptions of autonomy, time management, professionalism, and teaching effectiveness, as well as a composite score (the numeric average of each attending's scores for all of the items at his or her institution). BSR was defined as spending >50% of rounding time in patients' rooms with the team. Hallway rounding and conference room rounding were combined into the ORS category and defined as >50% of rounding time in these settings. All of the scores were normalized to a 10-point scale to allow aggregation across sites. RESULTS A total of 105 attendings were invited to participate, and 65 (62%) completed the survey. None of the resident evaluation scores significantly differed based on rounding strategy. Composite scores were similar for BSR and ORS (difference of <0.1 on a 10-point scale). Spearman correlation coefficients identified no statistically significant correlation between rounding strategy and evaluation scores. An exploratory analysis of variance model identified no single factor that was significantly associated with composite teaching scores (P > 0.45 for all) or the domains of teaching efficacy, professionalism, or autonomy (P > 0.13 for all). Having a formal educational role was significantly associated with better evaluation scores for time management, and the number of lectures delivered per year approached statistical significance for the same domain. CONCLUSIONS Conducting BSR did not significantly affect resident evaluations of teaching attendings. Resident perception of teaching effectiveness based on rounding strategy should be neither a motivator nor a barrier to widespread institution of BSR.
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Affiliation(s)
- Joseph R Sweigart
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - William C Lippert
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - Hal H Atkinson
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - Alan M Hall
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - Satyen Nichani
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - John W Ragsdale
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - Gregory B Russell
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
| | - Peter R Lichstein
- From the Lexington VA Health Care System, Lexington, Kentucky, the Wake Forest School of Medicine, Winston-Salem, North Carolina, the University of Kentucky College of Medicine, Lexington, and the University of Michigan Medical School, Ann Arbor
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Garibaldi BT, Russell SW. Strategies to Improve Bedside Clinical Skills Teaching. Chest 2021; 160:2187-2195. [PMID: 34242633 DOI: 10.1016/j.chest.2021.06.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
The bedside encounter between a patient and physician remains the cornerstone of the practice of medicine. However, physicians and trainees spend less time in direct contact with patients and families in the modern healthcare system. The current pandemic has further threatened time spent with patients. This lack of time has led to a decline in clinical skills, and a decrease in the number of faculty who are confident in teaching at the bedside. In this review we offer several strategies to get physicians and trainees back to the bedside to engage in clinical skills teaching and assessment. We recommend that providers pause before bedside encounters to be present with patients and learners and develop clear goals for a bedside teaching session. We suggest that clinical teachers practice an evidence-based approach, including a hypothesis-driven physical examination. We encourage the use of point-of-care technology to assist in diagnosis and allow learners to calibrate traditional physical exam skills with real-time visualization of pathology. Tools like point-of-care ultrasound can be powerful levers to get learners excited about bedside teaching, and to engage patients in their clinical care. We value telemedicine visits as unique opportunities to engage with patients in their home environment and to participate in patient-directed physical exam maneuvers. Finally, we recommend that educators provide feedback to learners on specific clinical exam skills, whether in the clinic, the wards, or during dedicated clinical skills assessments.
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Affiliation(s)
- Brian T Garibaldi
- Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Stephen W Russell
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Picón-Jaimes Y, Lozada-Martínez I, Moscote-Salazar LR, Janjua T. The end of the bedside clinical round? J R Coll Physicians Edinb 2021; 51:199-207. [PMID: 34131690 DOI: 10.4997/jrcpe.2021.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | - Tariq Janjua
- Intensive Care, Regions Hospital, 640 Jackson St, Saint Paul, Minnesota, USA
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Cooper CM, Gheihman G. The Kind Care Bundle: A Curriculum to Teach Medical Students the Behaviors of Kind, Compassionate Care. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11141. [PMID: 33889721 PMCID: PMC8056774 DOI: 10.15766/mep_2374-8265.11141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Patients' hospital experiences can be adversely affected by clinicians' negative behaviors. Simple positive behaviors, however, can have a dramatic impact on patient-clinician relationships. Medical students starting clinical training are ideal educational targets for learning good behavioral habits that promote kind, compassionate care. METHODS We developed the Kind Care Bundle, a collection of concrete verbal and nonverbal behaviors for showing compassion in patient interactions. The curriculum was taught in 3-hour small-group interactive sessions to first-year students. Students reflected on personal experiences of compassionate care and role-played the use of the Kind Care Bundle. In pairs, students interviewed patients about their experiences of kind, compassionate care while practicing the Kind Care Bundle. Students completed a postsession evaluation with Likert scales and free-text responses. RESULTS Thirty-seven of 40 students (92%) completed postsession evaluation forms. Session organization was considered excellent (27 of 37 students, 73%) or very good (nine of 37, 27%). Session relevance was rated as excellent by 30 of 37 students (81%) and very good by six of 37 students (16%). Students believed the bundle filled an educational gap. Qualitative themes included appreciation of concrete behaviors in the bundle, importance of empathy, and opportunity to reflect on one's own experience of compassion. DISCUSSION Students appreciated learning about specific behaviors for improving patient interactions. Targeting preclinical medical students has the potential to promote kinder and more compassionate patient interactions during subsequent clinical training. The long-term impact on students' behavior and on their personal and professional development requires further study.
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Affiliation(s)
- Cynthia M. Cooper
- Assistant Professor of Medicine, Harvard Medical School; Associate Physician, Department of Medicine, Massachusetts General Hospital
| | - Galina Gheihman
- Resident, Departments of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital
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8
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Ibrahim SM, Shuster S, Aina D, Wijeratne DT. Seven ways to get a grip on facilitating bedside team rounding. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:e85-e88. [PMID: 33680235 PMCID: PMC7931478 DOI: 10.36834/cmej.70481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Although classically considered a cornerstone of inpatient care, rounding at patients' bedsides is increasingly being replaced by rounding in workrooms. Workroom rounds may provide a sense of efficiency and comfort, however bedside rounds have multiple benefits for patients, trainees, and staff physicians. Alongside its benefits, there are human and institutional challenges when incorporating bedside rounding. This article aims to draw on our own experience of implementing bedside rounding at Kingston Health Sciences Centre, to guide staff physicians and institutions on how to implement bedside rounding effectively while overcoming its challenges. The following seven tips provide a framework to avoid pitfalls when implementing bedside team rounding on inpatient services.
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Affiliation(s)
| | - Shirley Shuster
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
- Department of Medicine, Queen’s University, Ontario, Canada
| | - Deborah Aina
- School of Medicine, Saba University, Saba, Dutch Caribbean
| | - Don Thiwanka Wijeratne
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
- Department of Medicine, Queen’s University, Ontario, Canada
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9
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Vanderberg R, Nikiforova T, Hamm M, Spagnoletti C, McNeil M. Outpatient Exam Room Presentations in Resident Continuity Clinics: a Qualitative Report. MEDICAL SCIENCE EDUCATOR 2020; 30:1445-1457. [PMID: 34457812 PMCID: PMC8368740 DOI: 10.1007/s40670-020-01092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Outpatient exam room presentations (OERPs) in resident continuity clinics could address several current challenges in graduate medical education including increasing patient satisfaction, enhancing patient-centered care, and operationalizing competency-based education through direct observation. The authors' aim of this study was to explore the positive and negative aspects of OERPs as a precepting model in resident continuity clinics and to develop a list of best practices for medical educators to utilize when conducting OERPs. MATERIALS AND METHODS The authors defined an OERP as a case presentation and subsequent discussion taking place inside the exam room with the attending physician, resident physician, and patient present. Following a 1-month pilot period of conducting OERPs in internal medicine resident continuity clinics, the authors conducted individual phone interviews and focus groups with internal medicine attendings and residents, respectively. The authors analyzed transcripts using thematic analysis and the constant comparative method. Sixteen attendings participated in individual phone interviews and four resident focus groups averaged five participants per group. RESULTS Four main topics emerged: (1) effect of OERPs on patient care, (2) effect of OERPs on medical education, (3) barriers to OERPs, and (4) OERP best practices. CONCLUSION Participants noted both positive and negative effects of OERPs on patient care and medical education. Best practices suggested to maximize these benefits and minimize drawbacks included targeting OERPs to certain types of clinical encounters and employing strategies to preserve the resident physician-patient relationship and resident autonomy.
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Affiliation(s)
- Rachel Vanderberg
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Megan Hamm
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
- Qualitative, Evaluation and Stakeholder Engagement (Qual EASE) Research Core, University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, PA USA
| | - Carla Spagnoletti
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Melissa McNeil
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213 USA
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Natesan S, Bailitz J, King A, Krzyzaniak SM, Kennedy SK, Kim AJ, Byyny R, Gottlieb M. Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors. West J Emerg Med 2020; 21:985-998. [PMID: 32726274 PMCID: PMC7390547 DOI: 10.5811/westjem.2020.4.46060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 01/28/2023] Open
Abstract
Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.
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Affiliation(s)
- Sreeja Natesan
- Duke University, Division of Emergency Medicine, Durham, North Carolina
| | - John Bailitz
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Andrew King
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Sara M. Krzyzaniak
- University of Illinois College of Medicine at Peoria/OSF Healthcare, Department of Emergency Medicine, Peoria, Illinois
| | - Sarah K. Kennedy
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Albert J. Kim
- Washington University in Saint Louis School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
| | - Richard Byyny
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado
| | - Michael Gottlieb
- Rush Medical Center, Department of Emergency medicine, Chicago, Illinois
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11
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Russell SW, Desai SV, O'Rourke P, Ahuja N, Patel A, Myers CG, Zulman D, Sateia HF, Berkenblit GV, Johnson EN, Garibaldi BT. The genealogy of teaching clinical reasoning and diagnostic skill: the GEL Study. ACTA ACUST UNITED AC 2020; 7:197-203. [PMID: 32146439 DOI: 10.1515/dx-2019-0107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/15/2020] [Indexed: 11/15/2022]
Abstract
The genealogy of graduate medical education in America begins at the bedside. However, today's graduate medical trainees work in a training environment that is vastly different from medical training a century ago. The goal of the Graduate Medical Education Laboratory (GEL) Study, supported by the American Medical Association's (AMA) "Reimagining Residency" initiative, is to determine the factors in the training environment that most contribute to resident well-being and developing diagnostic skills. We believe that increasing time at the bedside will improve clinical skill, increase professional fulfillment, and reduce workplace burnout. Our graduate medical education laboratory will test these ideas to understand which interventions can be shared among all training programs. Through the GEL Study, we aim to ensure resident readiness for practice as we understand, then optimize, the learning environment for trainees and staff.
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Affiliation(s)
- Stephen W Russell
- Associate Professor of Internal Medicine and Pediatrics, The University of Alabama at Birmingham, c/o UAB Medicine Leeds, 1141 Payton Way, Leeds, AL 35094, USA
| | - Sanjay V Desai
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Paul O'Rourke
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Neera Ahuja
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Patel
- University of Chicago Hospital, Chicago, IL, USA
| | - Christopher G Myers
- Department of Internal Medicine, Johns Hopkins University Carey Business School - Baltimore Campus, Baltimore, MD, USA
| | - Donna Zulman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Heather F Sateia
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Gail V Berkenblit
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Erica N Johnson
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Brian T Garibaldi
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
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12
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Vanderberg R, Rothenberger SD, Spagnoletti C, McNeil M. Internal Medicine Attendings' Perception of Barriers to Outpatient Exam Room Presentations in Resident Continuity Clinic. MEDICAL SCIENCE EDUCATOR 2019; 29:929-934. [PMID: 34457568 PMCID: PMC8368682 DOI: 10.1007/s40670-019-00773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Outpatient exam room presentations (OERPs) in resident continuity clinic (RCC) can operationalize competency-based medical education and enhance patient satisfaction. We aimed to assess current OERP use and OERP barriers by surveying internal medicine attendings prior to and following a 4-week pilot of OERPs in RCC. Twenty-six out of an eligible 35 attendings completed the pre-pilot survey. Twenty attendings participated in the pilot and completed the post-pilot surveys. On the pre-pilot survey, 65% (17/26) of participants reported never using OERPs. Attendings' perception of learner discomfort with OERPs as somewhat of or a significant barrier significantly decreased from pre-pilot to post-pilot (96% (25/26) v. 65% (13/20), p = 0.03). Time, feedback, and sensitive topics were frequently rated as barriers on both the pre-pilot and post-pilot surveys. On the post-pilot survey, most participants reported patient discomfort with OERPs, attending physician discomfort with OERPs, difficulty writing attestations during OERPs, and difficulty teaching during OERPs were not barriers. Additionally, 45% (9/20) reported planning to use OERPs in the future. Despite benefits of OERPs, there are several barriers to OERPs that need to be addressed prior to more routine implementation in resident continuity clinic. Further research should focus on strategies for overcoming barriers and maximizing benefits of OERPs as well as developing a set of OERP best practices to support routine implementation in RCC.
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Affiliation(s)
- Rachel Vanderberg
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
| | - Scott D. Rothenberger
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
- Center for Research on Health Care Data Center, University of Pittsburgh, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Carla Spagnoletti
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
| | - Melissa McNeil
- Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA
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Abstract
Bedside rounds have evolved concurrently with hospitalist medicine and patient-centered care. Family-centered rounds are the foundation of effective communication in the in-patient pediatric setting. Participant perspectives (family members, patients, nurses, faculty, and trainees) on family-centered rounds differ and goals may not always align. Further, the practical components of how rounds are conducted varies and have continued opportunities for improvement. This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward.
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Affiliation(s)
- Lauren A Destino
- Stanford University, Lucile Packard Children's Hospital, 300 Pasteur MC 5776, Palo Alto, CA 94034, USA.
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue ML 9016, Cincinnati, OH 45229, USA
| | - Brian Good
- University of Utah, Primary Children's Hospital, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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