Bedside Teaching: general and discipline-specific teacher characteristics, criteria for patient selection and difficulties

Patient outlook on bedside teaching in a medical school

Objective

Bedside teaching is an important element of training undergraduate and postgraduate medical students to attain clinical skills. The perceptions of patients about bedside teaching vary significantly based on their understanding of the educational climate in hospitals. This study aimed to evaluate the views of diverse groups of patients on bedside teaching and the degree of involvement of medical students in their clinical decision-making processes.

Methods

This was a cross-sectional study conducted among patients admitted to various departments of a tertiary care hospital. A total of 200 patients were surveyed by students using a questionnaire, which covered their knowledge, views, and expectations with respect to medical students in hospital settings and bedside teaching.

Results

The majority (83.5%) of patients surveyed felt that the students made the hospital environment more comfortable and friendly. Male patients chose to permit students' involvement more than female patients. Among the female patients, teens, young adults, and unmarried women were more positive towards students' direct participation in their physical examinations. Health concerns and stress were issues for adults and older patients, whereas privacy and confidentiality concerned the younger age group. Patients admitted to the obstetrics and gynaecology wards were more likely to reject student involvement in hospital procedures than patients in other departments.

Conclusion

Most of the patients had a markedly positive attitude towards bedside teaching. Alternative methods of teaching can be implemented in situations where patients feel uncomfortable with students' involvement during their hospital stay.

Strategies for teaching in clinical rounds: A systematic review of the literature

Background:

Strategies for teaching in clinical rounds are dispersed. There is a need to comprehensively collate bedside strategies to enhance teaching and learning and make clinical rounds more effective.

Materials and Methods:

A systematic review of English articles using Web of Science, PubMed, Embase, Scopus, and Cochrane library was conducted. Relevant keywords for teaching rounds/medical teachers/medical students/strategies and their synonyms were used accordingly. Additional studies were identified by searching reference lists of retrieved articles. All searches were conducted within a 10-day period from May 25, 2017, to June 3, 2017. In this systematic review, studies with any design on the subject of strategies for clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 524 articles. After removing duplicates, 337 articles remained. Based on the title and abstract review, 37 articles were obtained for further review and finally 18 entered the study. Data were extracted from the included studies. Two authors independently screened and scored the studies. We used inductive content analysis, and categories of strategies were derived from the data.

Results:

Content analysis yielded identification of strategies for clinical rounds in nine categories named: system issues, advance planning, a preround huddle, patient issues, teachable moments, teacher issues, student issues, atmosphere issues, and a postround huddle. These were classified as “before rounds,” “during rounds,” and “after rounds” activities. Quality assessment scores for the research studies ranged from 5 to 14 (possible range, 1–16). Fourteen (77.8%) studies received quality scores at or above 10, and 4 (22.2%) studies received quality scores below 10.

Conclusion:

Due to the importance of clinical rounds in students’ learning, medical teachers should divide their teaching session into activities before, during, and after rounds. These strategies on rounding practices can improve teaching and learning.

Psychometric properties of the newly developed Physician Teaching Self-Efficacy Questionnaire (PTSQ)

BACKGROUND

High teaching quality and students' corresponding learning progress are the most important indicators of teachers' work performance. Theory and numerous empirical studies indicate that self-efficacy, a person's belief in her or his ability to accomplish a task, is an important predictor of work performance. Accordingly, it can be assumed that teaching self-efficacy also influences teaching performance and students' learning progress with regard to physicians who teach in undergraduate medical education. Therefore, the aim of this study was to develop and validate an instrument measuring clinical teaching self-efficacy in physicians.

METHODS

We developed 16 items reflecting physicians' beliefs to provide high quality clinical teaching when facing regularly occurring critical teaching situations. These constitute the Physician Teaching Self-Efficacy Questionnaire (PTSQ). For its validation, we used data from a sample of 247 physicians from internal medicine and surgery at six German medical faculties. Regarding factorial validity, we performed exploratory structural equation modelling (ESEM) as well as confirmatory factor analysis (CFA). Regarding criterion validity, correlations with the scales of the Physician Teaching Motivation Questionnaire (PTMQ), teaching experience and perceived teaching involvement were calculated. Additionally, we conducted the same analyses with a short 6-item version.

RESULTS

ESEM delivered evidence for a three-factor structure with a superordinate general factor, which was confirmed by local and global fit indicators in CFA (RMSEA = .055, TLI = .939, SRMR = .048, CFI = .948). We identified the following three subfactors: teaching self-efficacy with respect to self-regulation, dyadic regulation involving students, and triadic regulation involving students and patients. Internal consistencies indicated acceptable to excellent reliability for all scales (Cronbach's alpha = .77-.90). Theory-consistent correlations with the PTMQ scales, teaching experience, and teaching involvement confirmed criterion validity. Besides excellent global fit, the short version of the PTSQ also fulfilled all other validity criteria.

CONCLUSIONS

The PTSQ is a valid instrument to assess physicians' clinical teaching self-efficacy. It could be used in faculty development programmes and for educational research. The short version could be used in situations that are time-critical for physicians in order to ensure high response rates.

Validation of the Physician Teaching Motivation Questionnaire (PTMQ)

BACKGROUND

Physicians play a major role as teachers in undergraduate medical education. Studies indicate that different forms and degrees of motivation can influence work performance in general and that teachers' motivation to teach can influence students' academic achievements in particular. Therefore, the aim of this study was to develop and to validate an instrument measuring teaching motivations in hospital-based physicians.

METHODS

We chose self-determination theory as a theoretical framework for item and scale development. It distinguishes between different dimensions of motivation depending on the amount of self-regulation and autonomy involved and its empirical evidence has been demonstrated in other areas of research. To validate the new instrument (PTMQ = Physician Teaching Motivation Questionnaire), we used data from a sample of 247 physicians from internal medicine and surgery at six German medical faculties. Structural equation modelling was conducted to confirm the factorial structure, correlation analyses and linear regressions were performed to examine concurrent and incremental validity.

RESULTS

Structural equation modelling confirmed a good global fit for the factorial structure of the final instrument (RMSEA = .050, TLI = .957, SRMR = .055, CFI = .966). Cronbach's alphas indicated good internal consistencies for all scales (α = .75 - .89) except for the identified teaching motivation subscale with an acceptable internal consistency (α = .65). Tests of concurrent validity with global work motivation, perceived teaching competence, perceived teaching involvement and voluntariness of lesson allocation delivered theory-consistent results with slight deviations for some scales. Incremental validity over global work motivation in predicting perceived teaching involvement was also confirmed.

CONCLUSIONS

Our results indicate that the PTMQ is a reliable, valid and therefore suitable instrument for assessing physicians' teaching motivation.