Practical tips to improve bedside teaching using learning theories and clinical reasoning

Bedside teaching strengthens the link between theory and practice. The tips given here, which were derived from various learning theories and models, aim to provide structure to bedside teaching and to make this format effective, even though empirical evidence is still missing for this specific setting. These 10 tips may not always be fully implemented in each bedside teaching, but they should be applied selectively for targeted students. In essence, they are more to be understood as a repertoire of effective methods and are intended to expand the literature and framework concepts already available.

Role Modeling Kindness at the Bedside

Compassion and kindness are interchangeable attitudes and behaviors in society. As evidence shows the importance of compassion and kindness in healthcare, there has been a push to nurture and teach compassion through experiential learning in medical schools. However, there is not much evidence of educating learners on the importance of kindness as the complement or foundation of compassion and empathy. Kindness is the ability to act positively and appropriately and can be provided without emotion, judgment, or expecting anything in return. Kindness does not require the receiver to be in severe distress or suffering. Acts of kindness can be random acts done to anyone, anytime, with or without illness or suffering. Research shows that kindness elevates the healthcare profession for both clinicians and patients. Compassion and kindness must be taught through the integrated approach of role modeling, observation, practice, experience, and reflection in the classroom and in the clinical environment. It is vital that medical schools and healthcare institutions' faculty and staff make kindness to patients, families, and staff a key behavior, along with compassion and empathy. There is more that can be done to encourage acts of kindness through everyday actions; educators can display kindness toward colleagues and medical students in their learning. Kindness can improve conversations with patients and improve the emotional and social well-being of learners. Displaying kindness during bedside or classroom teaching would engrain its importance in the professional identity formation of future generations of physicians.

"It is great what we have learned from each other!" - Bedside teaching in interprofessional small groups using the example of Parkinson's disease

Background

While patient care often involves interprofessional collaboration, interprofessional teaching formats with participants from medical and physiotherapy fields are still rare. Furthermore, interprofessional education often takes place as separate courses and is not integrated into the clinical curriculum. Therefore, the goal of this project was to develop and implement interprofessional content into bedside teaching.

Course development

The clinical subject of the course was "Parkinson's disease", as this condition allowed for the exemplary demonstration of interprofessional teamwork and different competencies. Through interprofessional bedside teaching and a specific clinical context, interprofessionalism was intended to be integrated and experienced as natural part of clinical practice. The bedside teaching was complemented with work in break-out groups and a lecture.

Evaluation

The course was first conducted in the winter semester 2021/22. Participants were medical and physiotherapy students. Teaching teams were also interprofessional. A concurrent evaluation was carried out using the University of the West of England Interprofessional Questionnaire (UWE-IP) before and after course participation. UWE-IP scores in all sub-scales indicated a positive attitude, except for the "Interprofessional Learning" scale among physiotherapy students, which reflected a neutral attitude. Significant group differences were observed in the same scale at the pre-course time point between medical and physiotherapy students (p<0.01) and among medical students before and after course participation (p=0.02).

Conclusion

The course proved to be well-suited for integrating interprofessional content into clinical education and can serve as a model for future teaching units. The evaluation reflected a positive attitude toward interprofessional learning.

The influence of patient-centered teaching on medical students' stigmatization of the mentally ill

Aim

Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated.

Method

This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis.

Results

In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2p=.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen.

Conclusion

Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients.

Effective bedside teaching as a foundation doctor

Bedside teaching is a key component of education at medical school, particularly in the clinical years. It provides an invaluable opportunity for students to practise examining patients, and further develops their communication and professional skills. Doctors who have newly graduated from medical school are often expected to provide such teaching to medical students placed on their wards. However, foundation doctors often receive little to no training for bedside teaching and there is limited literature on practical tips on how to enhance bedside teaching. Here we consider the three stages of effective bedside teaching: preparation, teaching and evaluation.

Peer Role-Play Simulation: A Valuable Alternative to Bedside Teaching During the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic dramatically affected every aspect of life worldwide. Contact restrictions and social distancing during the epidemic has led to the suspension of bedside teaching (BST) and shifting to online didactic teaching and other methods of active learning. We implemented peer role-play simulation (PRPS) during the pandemic to compensate for the suspended BST. This study aims to explore the effectiveness of PRPS in developing the students' verbal communication, empathy and clinical reasoning skills compared to BST.

METHODS

This is a cross-sectional observational study conducted in Jazan University faculty of medicine with the study sample including all medical students enrolled in 5th and 6th year during the academic year 2020-21. Data collection involved using a web-based validated questionnaire.

RESULTS

Most of the students (84.1%) rated bedside teaching (BST) as extremely beneficial or beneficial in developing verbal communication skills compared to 73.3% for peer role-play simulation (PRPS). A similar pattern was found in empathy skills development with 84.1% for bedside compared to 72.2% for PRPS. The pattern is reversed with the development of clinical reasoning skills with 77.7% rating BST as beneficial or extremely beneficial compared to 81.2% for PRPS.

CONCLUSION

Overall, peer role-play is generally a valuable and trustworthy method in the absence of bedside teaching for enhancing clinical reasoning skills of medical students during the COVID-19 pandemic from students' perspective. It is less efficient than bedside teaching in enhancing communication skills. It cannot wholly replace bedside teaching, although it can be used reliably for that purpose in exceptional circumstances when bedside teaching cannot be implemented.

A multisite randomized trial of implicit versus explicit modeling in clinical teaching

PURPOSE

Faculty modeling of desired behaviors has historically been a part of the apprenticeship model of clinical teaching, yet little is known about best practices for modeling. This study compared the educational impact of implicitly versus explicitly modeled communication skills among U.S. medical students.

METHOD

Fourth-year medical students from six U.S. academic medical centers were randomly assigned one simulated clinical encounter in which faculty provided either implicit or explicit modeling of important communication skills. Outcomes were assessed by electronic surveys immediately before and after the simulations. Students were blinded to the purpose of the study.

RESULTS

Students in the explicit arm were more likely to correctly cite two of the three key specific communication elements modeled by faculty: deliberate body position (53.3% vs. 18.6%, p < 0.001) and summarizing patient understanding (62.2% vs. 11.6%, p < 0.001). More students in the explicit study arm reported faculty 'demonstrated a key behavior that they wanted me to be able to perform in the future' (93.2% versus 62.8%, p = 0.002). Participating faculty stated they would modify their teaching approach in response to their experiences in the study.

CONCLUSIONS

In a multi-center randomized trial, explicit faculty role-modeling led to greater uptake of communication knowledge, greater recognition of skills, and a greater sense that faculty expected these skills to be adopted by students. These results must be considered in the context, however, of a simulated environment and a short timeframe for assessing learning with students who volunteered for a simulated experience.

Bedside Teaching in Rural Family Medicine Education in Japan

Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.

Using Mixed Reality Headsets to Deliver Remote Bedside Teaching During the COVID-19 Pandemic: Feasibility Trial of HoloLens 2

Background

COVID-19 has had a catastrophic impact in terms of human lives lost. Medical education has also been impacted as appropriately stringent infection control policies precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not.

Objective

This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching.

Methods

Two MR sessions were led by senior doctors wearing the HoloLens headset. The trainers selected patients requiring their specialist input. The headset allowed bidirectional audiovisual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of the COVID-19 pandemic on bedside teaching, and the MR sessions were evaluated using pre- and postround questionnaires, using Likert scales. Data related to clinician exposure to at-risk patients and use of personal protective equipment (PPE) were collected.

Results

Prequestionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (median 7, IQR 6-7). Postsession questionnaires showed that, overall, users subjectively agreed the MR session was helpful to their learning (median 6, IQR 5.25-7) and that it was worthwhile (median 6, IQR 5.25-7). Mixed reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use.

Conclusions

This study is proof of principle that HoloLens can be used effectively to deliver clinical bedside teaching. This novel format confers significant advantages in terms of minimizing exposure of trainees to COVID-19, reducing PPE use, enabling larger attendance, and delivering convenient and accessible real-time clinical training.

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study

BACKGROUND

Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students' confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods.

OBJECTIVE

To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19-safe environment using SimMan 3G.

METHODS

Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session.

RESULTS

In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature.

CONCLUSIONS

Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.

Virtual bedside teaching for pharmacy students during their final term at LMU Munich

At Ludwig-Maximilians-Universität (LMU) bedside teaching (BT) for pharmacy students has been in place since 2014. To continue offering BT during the contact restrictions imposed by the authorities in 2020, the course was digitalised, and virtual bedside teaching implemented. Using Moodle, the original concept was divided into smaller sections and presented, e.g. in the form of video sequences. All sections of the course were accessed asynchronously by the students. Tasks were individually processed and evaluated. Virtual awards were used to increase the students' motivation. Contact with each other was possible via posting in available forums or the weekly online chat consultation. A total of 70 students successfully completed the course. The evaluation of the course was very positive, with mainly technical difficulties that were criticized. The students' feedback will be implemented in the course concept for the winter term.

Bedside teaching without bedside - an introduction to clinical reasoning in COVID-19 times

Introduction: The Corona virus pandemic rendered most live education this spring term impossible. Many classes were converted into e-learning formats. Teaching at the bedside (BST) seemed unfeasible under the circumstances. BST and clinical reasoning as its major outcome is introduced at the beginning of semester 5, henceforth all BST refers to this first presentation. Project outline: To ensure proficiency of current 5^th semester students in future BST sessions, the introduction could not be cancelled albeit teaching with patients was. Knowing that the practical learning objectives of bedside teaching cannot be mirrored in online formats, a compensating module to teach the concept of BST and clinical reasoning had to be designed. Summary of work: To facilitate an understanding of the concept of bedside teaching with a focus on clinical reasoning we developed paper cases and a survey in Microsoft Forms following the history and examination path used in live BST with the addendum of clinical reasoning tables. For the first paper case, a personal feedback was provided for the clinical reasoning tables. A sample solution was provided later for self-feedback on the whole case. The first case was completed by 87, the second by 40 of 336 students. Response to individual feedback was positive. Students still missed hands-on training in history taking and examination with patients. Discussion: Paper cases cannot fully substitute BST. However, given the prime directive during the pandemic to protect our patients, this module engaged around one third of the cohort. The review of uploaded clinical reasoning tables gave proof to the sufficient students' grasp of clinical reasoning. Conclusion: Albeit not an exhaustive substitute for BST, this online module seems a feasible way to convey clinical reasoning strategies to students.

Changing Paradigms of Bedside Clinical Teaching

Education has continued to evolve since the existence of mankind. We have now become more well-equipped and refined our teaching methodology over time. Despite all the progress made, we still continue to rely on bedside huddle for teaching. Globalization has facilitated learning in culturally diverse environment. Grand rounds, noon lectures and conferences help the millennial house-staff to effectively translate their concepts to hands-on clinical experience. Useful teaching strategies like story-telling, connecting, simplifying, playing hierarchy make learning more fun and engaging. Multidisciplinary collaborative learning has eased conceptualization and retention of practical knowledge. Our education system now focuses more on patient-centered, case-based learning system.

Peer Observations: Enhancing Bedside Clinical Teaching Behaviors

Background

Medical training relies on direct observations and formative feedback. After residency graduation, opportunities to receive feedback on clinical teaching diminish. Although feedback through learner evaluations is common, these evaluations can be untimely, non-specific, and potentially biased. On the other hand, peer feedback in a small group setting or lecture format has been shown to be beneficial to teaching behaviors, however, little is known if peer observation using a standardized tool followed by feedback results in improved teaching behaviors. Therefore, the objective of this study was to examine if feedback after peer observation results in improved inpatient teaching behaviors.

Methods

This study was conducted at a tertiary care hospital. Academic hospitalists in the Division of Hospital Medicine developed a standardized 28-item peer observation tool based on the Stanford Faculty Development Program to observe their peers during bedside teaching rounds and provide timely feedback after observation. The tool focused on five teaching domains (learning climate, control of session, promotion of understanding and retention, evaluation, and feedback) relevant to the inpatient teaching environment. Teaching hospitalists were observed at the beginning of a two-week teaching rotation, given feedback, and then observed at the end of the rotation. Furthermore, we utilized a post-observation survey to assess the teaching and observing hospitalists’ comfort with observation and the usefulness of the feedback. We used mixed linear models with crossed design to account for correlations between the observations. Models were adjusted for gender, age, and years of experience. We tested the internal validity of the instrument with Cronbach’s alpha.

Results

Seventy (range: one to four observations per faculty) observations were performed involving 27 teaching attendings. A high proportion of teachers were comfortable with the observation (79%) and found the feedback helpful (92%), and useful for their own teaching (88%). Mean scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach’s alpha of 0.81 showing high internal validity.

Conclusions

Peer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors. The success of this approach resulted in the expansion of peer observation to other Divisions within the Department of Internal Medicine at our Institution.

Bedside teaching: everybody's but nobody's responsibility

Evidence shows dwindling levels of bedside teaching for medical students in the UK, especially in district general hospitals. Lack of individual responsibility has resulted in disengagement in teaching. Based on a quality improvement project (QIP) at a District General Hospital, we suggest some ways this could be addressed. We suggest here that harnessing support from the medical education lead, incentivizing teaching, allocating student-junior doctor groups to harbor personal responsibility, providing a supportive framework, and educating about barriers to teaching can all be used to develop an effective teaching program.

Questioning Style and Pimping in Clinical Education: A Quantitative Score Derived from a Survey of Internal Medicine Teaching Faculty

Construct: Pimping is a controversial pedagogical technique in medicine, and there is a tension between pimping being considered as "value adding" in some circumstances versus always unacceptable. Consequently, faculty differ in their attitudes toward pimping, and such differences may be measurable and used to inform future research regarding the impact of pimping on learner outcomes.

BACKGROUND

Despite renewed attention in medical education on creating a supportive learning environment, there is a dearth of prior research on pimping. We sought to characterize faculty who are more aggressive in their questioning style (i.e., those with a "pimper" phenotype) from those who are less threatening.

APPROACH

This study was conducted between December 2015 and September 2016 at Johns Hopkins University. We created a 13-item questionnaire assessing faculty perceptions on pimping as a pedagogical technique. We surveyed all medicine faculty (n = 150) who had attended on inpatient teaching services at two university-affiliated hospitals over the prior 2 years. Then, using responses to the faculty survey, we developed a numeric "pimping score" designed to characterize faculty into "pimper" (those with scores in the upper quartile of the range) and "nonpimper" phenotypes.

RESULTS

The response rate was 84%. Although almost half of the faculty reported that being pimped helped them in their own learning (45%), fewer reported that pimping was effective in their own teaching practice (20%). The pimping score was normally distributed across a range of 13-42, with a mean of 24 and a 75th percentile cutoff of 28 or greater. Younger faculty, male participants, specialists, and those reporting lower quality of life had higher pimping score values, all p < .05. Faculty who openly endorsed favorable views about the educational value of pimping had sevenfold higher odds of being characterized as "pimpers" using our numeric pimping score (p ≤ .001).

CONCLUSIONS

The establishment of a quantitative pimping score may have relevance for training programs concerned about the learning environment in clinical settings and may inform future research on the impact of pimping on learning outcomes.

How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school

OBJECTIVE

As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs.

DESIGN

Analysis of routinely collected data.

SETTING

One Polish medical school.

PARTICIPANTS

Complete OSCE records for 462 second-year students and 445 third-year students.

OUTCOME MEASURES

OSCE scores by matriculation year.

RESULTS

In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG - tasks which had not been included in the second-year preclinical training.

CONCLUSION

Our results suggest the importance of preclinical training in a CS laboratory to improve students' competence in physical examination at the completion of introductory clinical clerkships during the first clinical year.

Bringing mini-chalk talks to the bedside to enhance clinical teaching

Chalk talks - where the teacher is equipped solely with a writing utensil and a writing surface - have been used for centuries, yet little has been written about strategies for their use in medical education. Structured education proximal to patient encounters (during rounds, at the bedside, or in between patients in clinic) maximizes the opportunities for clinical learning. This paper presents a strategy to bring mini-chalk talks (MCTs) to the bedside as a practical way to provide relevant clinical teaching by visually framing teachable moments. Grounded in adult learning theory, MCTs leverage teaching scripts to facilitate discussion, involve learners at multiple levels, and embrace the increased retention associated with visual aids. These authors provide specific recommendations for the design and implementation of MCT sessions including what topics work well, how to prepare, and how to involve and engage the learners.

ABBREVIATIONS

ADHD: Attention Deficit Hyperactivity Disorder; MCT: Mini-chalk talks.

Palliative Care Bedside Teaching: A Qualitative Analysis of Medical Students' Reflective Writings after Clinical Practices

CONTEXT

A mandatory course in palliative care (PC) is organized for all final-year medical students at the University of Navarre. It consists of 24 lectures, 4 workshops, and 1 scheduled five hour clinical PC service experience at two different sites. In the 48 hours after the visit and related to the clinical experience, each student has to complete a 500-word reflective writing (RW) piece.

OBJECTIVE

To investigate how a brief PC clinical experience helps equip the medical student.

METHODS

Qualitative study of RW. Two researchers produced a content analysis of students' RW. They collaboratively developed themes and categories with a constant review of the classification tree and an exhaustive collection of quotes. Differences between services were analyzed (λ²).

RESULTS

One hundred sixty-seven RW were analyzed from the 197 students on the course (response rate 85%). Six major themes emerged: All the students identified central aspects of PC work dynamics; students acquired specific PC knowledge (86%); the personal influence of the experience was reported (68%); students described how patients and their caregivers deal with the patients' illness (68%); students talked about the essence of PC and essential aspects of medicine (42%); students reported spontaneously having changed their assumptions about PC (15%); and they realized that the experience was relevant to all clinical practice. Categories such as teamwork, the expression of patients' and caregivers' feelings, and family devotion showed statistical differences between services (λ² p < 0.05).

CONCLUSION

A short bedside clinical experience in PC, encouraging student reflection, provides a deeper understanding of PC and even of core medicine values. The data we gather cannot explain only new skill acquisition but seems to suggest a life-changing personal experience for the student.

Patients' attitude towards bedside teaching in Tunisia

OBJECTIVE

To assess patient' reaction towards bedside teaching at the University Hospital of Monastir (Tunisia) and to identify the factors that may influence it.

METHODS

A cross-sectional study was conducted during December 2012 at the University Hospital of Monastir. Each department, except the psychiatric department and the intensive care units, was visited in one day. All inpatients present on the day of the study were interviewed by four trained female nurses using a structured questionnaire.

RESULTS

Of the 401 patients approached, 356 (88.8%) agreed to participate. In general, the results demonstrate that patients were positive toward medical students' participation. The highest acceptance rates were found in situations where there is no direct contact between the patient and the student (e.g. when reading their medical file, attending ward rounds and observing doctor examining them). As the degree of students' involvement increased, the refusal rate increased. Gender, age, educational level, marital status and the extent of students' involvement in patient's care were identified as the main factors affecting patients' attitude.

CONCLUSIONS

Taking advantage of this attitude, valorizing patient role as educator and using further learning methods in situations where patient's consent for student involvement was not obtained should be considered to guarantee optimal care and safety to patients and good medical education to future physicians.

Toward a more professional and practical medical education: a novel Central European approach

We here present an innovative curriculum for a complete medical education that conforms to the current European Bologna system of academic training. The curriculum aims at raising doctors who are excellently prepared for clinical work over as short a time as 5 years; it provides a comprehensive, yet shorter than usual, education that strongly pronounces the importance of increasing the students' practical clinical competences and rigorously excludes superfluous contents. The curriculum encompasses 52 modules, 32 at the bachelor's and 20 at the master's level. Already at the level of the bachelor degree, full employability is given; the students finish the master's course as medical doctors optimally prepared to manage patients at the level of postgraduate medical education. The structure of the curriculum is modular; each modular component is essential for medical education and contains an average of five European Credit Transfer System credits, amounting to 150 hours of education. Depending on the subspecialty, the courses include lectures, seminars, practical laboratory training, and clinical training at varying quantities. In addition to attendance times, sufficient time slots are prepared for self-study in lectures, seminars, and practical work. With our curriculum, we provide an easily applicable backbone for a modern course of medicine that can be installed also at smaller academic institutions.

Engaging Medical Students in the Basic Science Years with Clinical Teaching

Education of future medical practitioners involves the stewarding of knowledge and skills, and the development of values required for responsible practice. Students must not only master a vast amount of knowledge and theory but also understand how to apply it. A key challenge for medical educators is to approach this in a balanced and integrated manner, particularly within the basic science years of the medical program. The purpose of this article is to consider how the clinical environment, teaching methods, assessment, and feedback impact on the engagement of junior medical students.

First year clinical tutorials: students' learning experience

BACKGROUND

Bedside teaching lies at the heart of medical education. The learning environment afforded to students during clinical tutorials contributes substantially to their knowledge, thinking, and learning. Situated cognition theory posits that the depth and breadth of the students' learning experience is dependent upon the attitude of the clinical teacher, the structure of the tutorial, and the understanding of tutorial and learning objectives. This theory provides a useful framework to conceptualize how students' experience within their clinical tutorials impacts their knowledge, thinking, and learning.

METHODS

The study was conducted with one cohort (n=301) of students who had completed year 1 of the medical program at Sydney Medical School in 2013. All students were asked to complete a three-part questionnaire regarding their perceptions of their clinical tutor's attributes, the consistency of the tutor, and the best features of the tutorials and need for improvement. Both quantitative and qualitative data were collected and analyzed using descriptive statistics.

RESULTS

The response rate to the questionnaire was 88% (265/301). Students perceived that their tutors displayed good communication skills and enthusiasm, encouraged their learning, and were empathetic toward patients. Fifty-two percent of students reported having the same communications tutor for the entire year, and 28% reported having the same physical examination tutor for the entire year. Students would like increased patient contact, greater structure within their tutorials, and greater alignment of teaching with the curriculum.

CONCLUSION

Situated cognition theory provides a valuable lens to view students' experience of learning within the clinical environment. Our findings demonstrate students' appreciation of clinical tutors as role models, the need for consistency in feedback, the importance of structure within tutorials, and the need for tutors to have an understanding of the curriculum and learning objectives for each teaching session.

Bedside teaching in medical education: a literature review

Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession, but its use is declining. A literature review was conducted to reveal its strengths, the causes of its decline and future perspectives, the evidence with regard to learning clinical skills and patient/student/teacher satisfaction. PubMed, Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching. Articles regarding the above-mentioned subjects were included. Bedside teaching has shown to improve certain clinical diagnostic skills in medical students and residents. Patients, students/residents and teachers all seem to favour bedside teaching, for varying reasons. Despite this, the practice of bedside teaching is declining. Reasons to explain this decline include the increased patient turnover in hospitals, the assumed violation of patients' privacy and an increased reliance on technology in the diagnostic process. Solutions vary from increasingly using residents and interns as bedside teachers to actively educating staff members regarding the importance of bedside teaching and providing them with practical essentials. Impediments to bedside teaching need to be overcome if this teaching modality is to remain a valuable educational method for durable clinical skills.

Medical and surgical ward rounds in teaching hospitals of Kuwait University: students' perceptions

BACKGROUND

Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students' perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners.

METHODS

A pretested questionnaire was used to collect data from 141 medical students during the 2012-2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest) to 5 (highest). Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance.

RESULTS

Only 17 students (12.1%) declined to participate in the study. The students' current competency scores (for competencies taught within both disciplines - medical and surgical) were significantly lower than the scores indicating students' expectations (P < 0.001). The best-taught competency was bedside examination, in both medical (mean: 3.45) and surgical (mean: 3.05) ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001).

CONCLUSION

Both medical and surgical ward rounds were deficient in meeting the students' expectations. Medical educators should utilize the available literature to improve the bedside teaching experience for their students.

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

Objective: With regard to bedside teaching (BST), which has an important function in medical education for practicing history taking and clinical examination, only few studies can be found which define recommendations for its realization. However, difficulties with this teaching method are often reported in evaluations. Hence, the goal of this study is to collect important general requirements for bedside teaching and to identify important aspects of patient selection.

Methods: A newly designed questionnaire with closed and open questions concerning the organisation, the execution and the design of BST as well as patient selection was sent to a total of 134 teachers from the departments of surgery, internal medicine and psychiatry. The collected data were analysed using quantitative and qualitative methods.

Results: Teachers from internal medicine were significantly older than teachers from both other disciplines. In surgery, a significantly higher number of hours was taught by younger residents. Patient consent and the match of their diseases to the learning objectives were stated to be the most important factors for patient selection across disciplines. Psychiatrists put significantly more emphasis on patients’ German language skills according to their own declaration. By trend, an acute deterioration of the state of health was mentioned more often in surgery to lead to an exclusion from BST.

Conclusion: With regard to planning of content, organisation and patient selection for BST, aspects mentioned by teachers as well as discipline specific characteristics should be considered for and addressed during teacher trainings.

Are medical students accepted by patients in teaching hospitals?

BACKGROUND

Worldwide, patients are the cornerstone of bedside teaching of medical students. In this study, the authors aimed to assess patients' acceptability toward medical students in teaching hospitals of the Faculty of Medicine of Kuwait University.

METHODS

Ninehundred and ninety five patients were approached in 14 teaching hospitals; 932 patients agreed to participate (refusal rate is 6.3%). A self-administered questionnaire was used to collect data.

RESULTS

In general, higher acceptance of students by patients was found when there is no direct contact between the patient and the student (e.g., reading patients' files, presenting in outpatient clinic, observing doctors performing examination or procedures) compared to other situations (e.g., performing physical examination or procedures). Pediatrics patients showed higher acceptance of students compared to patients in other specialties, while Obstetrics/Gynecology patients showed the highest refusal of students. Gender of patients (especially females) and students appeared to affect the degree of acceptance of medical students by patients. Majority of the patients (436; 46.8%) believed that the presence of medical students in hospitals improves the quality of health care.

CONCLUSION

Patients are an important factor of bedside teaching. Clinical tutors must take advantage of patients who accept medical students. Clinical tutors and medical students should master essential communication skills to convince patients in accepting students, thus improving bedside teaching. Also, using simulation and standardization should be considered to address scenarios that most patients are unwilling to allow students to participate.

Medical student case presentation performance and perception when using mobile learning technology in the emergency department

BACKGROUND

Hand-held mobile learning technology provides opportunities for clinically relevant self-instructional modules to augment traditional bedside teaching. Using this technology as a teaching tool has not been well studied. We sought to evaluate medical students' case presentation performance and perception when viewing short, just-in-time mobile learning videos using the iPod touch prior to patient encounters.

METHODS

Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos.

RESULTS

Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p=0.032). There was no difference when the presentations were summed for the entire rotation (p=0.671). The reliable (alpha=0.97) survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations.

CONCLUSIONS

Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. Clinical educators should consider whether, in an instance where live bedside or direct interactive teaching is unavailable, using just-in-time educational videos on a handheld device might be useful as a supplemental instructional strategy.

Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships

BACKGROUND

Preclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students' expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships.

AIMS

To assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships.

METHODS

Investigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships.

RESULTS

Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation.

CONCLUSIONS

Preclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning.

A qualitative study of the meaning of physical examination teaching for patients

BACKGROUND

Physical examination teaching using actual patients is an important part of medical training. The patient experience undergoing this type of teaching is not well-understood.

OBJECTIVE

To understand the meaning of physical examination teaching for patients.

DESIGN

Phenomenological qualitative study using semi-structured interviews.

PARTICIPANTS

Patients who underwent a physical examination-based teaching session at an urban Veterans Affairs Medical Center.

APPROACH

A purposive sampling strategy was used to include a diversity of patient teaching experiences. Multiple interviewers triangulated data collection. Interviews continued until new themes were no longer heard (total of 12 interviews). Interviews were recorded and transcribed verbatim. Coding was performed by two investigators and peer-checked. Themes were identified and meanings extracted from themes.

KEY RESULTS

Seven themes emerged from the data: positive impression of students; participation considered part of the program; expect students to do their job: hands-on learning; interaction with students is positive; some aspects of encounter unexpected; range of benefits to participation; improve convenience and interaction. Physical examination teaching had four possible meanings for patients: Tolerance, Helping, Social, and Learning. We found it possible for a patient to move from one meaning to another, based on the teaching session experience.

CONCLUSIONS

Physical examination teaching can benefit patients. Patients have the potential to gain more value from the experience based on the group interaction.

An Evaluation on Medical Students' Satisfaction with Clinical Education and its Effective Factors

PURPOSE

To evaluate medical students' satisfaction with clinical education during medical internship and the effects of variables in the organizational domain on satisfaction.

METHOD

A cross-sectional descriptive analytic study in 2000 identified students' satisfaction with clinical education in medical students of Tehran University of Medical Sciences. Students' satisfaction was assessed by a modified job satisfaction questionnaire. Clinical education was classified into; outpatient, bedside and theoretical teaching.

RESULTS

Overall satisfaction with clinical education was 38.8%; outpatient and bedside teaching 52% each and theoretical education 70.8%. Overall satisfaction had a significant association with approach to common and epidemic diseases, class size, and the course planning.

CONCLUSION

Based on the present study, we conclude that clinical education should be reevaluated in our university with the specific attention to the class size, variety of diseases and course planning considered for each session in clinical education.