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Rubisch HPK, Blaschke AL, Berberat PO, Fuetterer CS, Haller B, Gartmeier M. Student mistakes and teacher reactions in bedside teaching. Adv Health Sci Educ Theory Pract 2023; 28:1523-1556. [PMID: 37170035 PMCID: PMC10174607 DOI: 10.1007/s10459-023-10233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers' reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.
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Affiliation(s)
- Hannah P K Rubisch
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna-Lena Blaschke
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Pascal O Berberat
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Cornelia S Fuetterer
- Institute of AI and Informatics in Medicine, Technical University of Munich (TUM), TUM School of Medicine, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Technical University of Munich (TUM), TUM School of Medicine, Munich, Germany
| | - Martin Gartmeier
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany.
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Jackson H, MacBride C, Taylor L, Carey M, Higgins MF. Patients' attitudes to bedside teaching after the COVID-19 pandemic. Ir J Med Sci 2023:10.1007/s11845-023-03558-5. [PMID: 37917306 DOI: 10.1007/s11845-023-03558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Bedside teaching (BST) is a method of structured clinical teaching where the patient is central in education. We had previously explored the patients' perceptions of BST using both a qualitative research study and validation of a questionnaire, both showing strong support by patients for BST once basic rules of respect and confidentiality are followed. With the COVID-19 pandemic, clinical education transitioned to online/virtual learning. AIM The aim of this study was to explore patients' attitudes towards reintroduction of BST as the pandemic restrictions have lifted. METHODS Patients were invited to complete a validated questionnaire exploring their attitudes towards BST. A descriptive analysis was performed. Results were compared to a previous study performed before the COVID-19 pandemic. RESULTS Four hundred patients consented to complete the questionnaires. Participants included women attending for antenatal (40%), postnatal (33%) and gynaecology issues (28%). Most patients (> 94%) reported that they were happy to be involved in BST. Patients believed that they should not be asked to participate in BST should they feel stressed or unwell (69%). These findings were the same as our previous study, performed prior to the pandemic. CONCLUSION This study shows extensive and persisting patient support for BST. BST is unique in that it allows students to gain a deeper understanding of the disease which are hard to elicit through online/virtual methods.
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Affiliation(s)
- Hayley Jackson
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Claire MacBride
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Laura Taylor
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Michael Carey
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - Mary F Higgins
- UCD School of Medicine, University College Dublin, Dublin, Ireland.
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland.
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Ahmed H, King AB, Mohamed N, Mokaya E, Chapman K, Leonard R. Perception versus reality: analysis of time spent on bedside rounds in an academic ICU (Intensive Care Unit). BMC Med Educ 2023; 23:274. [PMID: 37085853 PMCID: PMC10120486 DOI: 10.1186/s12909-023-04243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/08/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Despite its importance, teaching at the bedside is declining over time. This purported decline has not been quantified. Quantifying bedside teaching is challenging, and we found only one study quantifying bedside teaching on a hospitalist service. OBJECTIVE We conducted a study to understand the prevalence of bedside teaching in our medical intensive care unit. METHODS We conducted a single-center single-unit study in the medical intensive care unit of an academic tertiary care institution. We used a survey tool to assess perceived time spent on bedside teaching, quality of teaching, and total rounding time. In parallel, independent observers objectively measured time spent on rounds and on bedside teaching. Residents were asked to complete the survey once a week. Independent observers collected data daily and weekly averages were obtained. RESULTS 43 responses were collected over a 4-month period. Most respondents (73%) reported a total rounding time of either 90-120 min or greater than 120 min. Median reported bedside teaching time was 16-20 min with 16 respondents (37%) reporting less than 15 min and 27 respondents (63%) reporting 16 min or more. The amount of time spent on bedside teaching was reported as adequate or more than adequate by 77% (33) of respondents with 58% (25) reporting that bedside teaching was very or extremely effective in helping them learn. Mean census reported by the independent observers was 12.75 patients per team. Bedside teaching represented an average of 12% of total rounding time, 16.85 min per day. While total rounding time increased with increasing census, there was no decline in bedside teaching time. CONCLUSION It is reported that bedside teaching has decreased over time. Our study has demonstrated that bedside teaching occurs in our Medical ICU, and though it represents a minority of the time spent on rounds, residents still reported teaching in the ICU to be adequate.
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Affiliation(s)
- Haroon Ahmed
- West Virginia University Health Sciences Center, Morgantown, WV, USA.
| | - Austin B King
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Nada Mohamed
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Erica Mokaya
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Kyle Chapman
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Rachel Leonard
- West Virginia University Health Sciences Center, Morgantown, WV, USA
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Donroe JH, Soares S, Sofair AN. Strategies to Improve Teaching Point-of-Care Ultrasound at the Bedside. Med Sci Educ 2023; 33:577-581. [PMID: 37261030 PMCID: PMC10226959 DOI: 10.1007/s40670-023-01772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 06/02/2023]
Abstract
Point-of care-ultrasound (POCUS) is becoming a core clinical skill in many medical specialties. Teaching POCUS at the bedside allows for observation of learners during actual patient encounters, provides a medium for role modeling skills and behaviors, and incorporates all core POCUS competencies. Nonetheless, bedside teaching can be time consuming and intimidating for learners and teachers, and the full benefits of teaching at the bedside can be difficult to attain. We provide strategies for improving bedside POCUS teaching based on our collective experience as medical educators and POCUS instructors at both the undergraduate and graduate levels in medical education.
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Affiliation(s)
- Joseph H. Donroe
- Department of Internal Medicine, Yale School of Medicine, Office MOB 210, 1450 Chapel Street, New Haven, CT 06511 USA
| | - Sarita Soares
- Department of Internal Medicine, Yale School of Medicine, Office MOB 210, 1450 Chapel Street, New Haven, CT 06511 USA
| | - André N. Sofair
- Department of Internal Medicine, Yale School of Medicine, Office MOB 210, 1450 Chapel Street, New Haven, CT 06511 USA
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Heitmann H, Fischer E, Wagner P, Pötter D, Gartmeier M, Schmidt-Graf F. Flipping the classroom in neurological bedside teaching: a prospective controlled study. BMC Med Educ 2023; 23:164. [PMID: 36922824 PMCID: PMC10016155 DOI: 10.1186/s12909-023-04150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Bedside teaching is essential to foster core clinical competences in medical education, especially in Neurology. However, bedside skills are declining and new concepts to enhance the effectiveness of bedside teaching are needed, also in view of limited in-person teaching possibilities in the ongoing pandemic situation. If theoretical knowledge is taught prior to in-person sessions this might allow to better focus on practical application aspects during bedside teaching. We thus aimed to answer the question to what extent such an approach can enhance the effectiveness of neurological bedside teaching. METHODS In this prospective controlled study, neurological bedside courses following a traditional and a flipped classroom (FC) approach were compared with regards to their effects on theoretical knowledge and practical skills of medical students. Evaluations were obtained from 161 students and their lecturers participating in a neurological bedside teaching course at a German university hospital between October 2020 and July 2021. Students were randomly assigned to course dates. However, the 74 students assigned to course dates from May to July 2021 completed a mandatory online preparation course prior to the bedside teaching. These students served as the interventional group (IG) and the remaining 87 students formed the control group (CG). Ratings of knowledge and skills provided by the students and their lecturers on numerical rating scales served as primary outcome measures. Moreover, the time needed to recapitulate theoretical contents during the in-person teaching session was assessed as a secondary outcome measure. Group comparisons were performed using t-statistics. RESULTS Theoretical knowledge upon entering the course was rated significantly higher in the IG by the students (p < 0.001) and lecturers (p = 0.003). Lecturers also rated the practical skills of students in the IG significantly higher (p < 0.001). Furthermore, significantly less time was needed to recapitulate theoretical contents during the in-person session in the IG (p = 0.03). CONCLUSIONS Using a FC approach enhances the effectiveness of in-person neurological bedside teaching. Thus, these concepts are particularly valuable in the ongoing pandemic situation. Moreover, they might allow to reuse e-learning contents developed during the pandemic and to develop future bedside teaching concepts.
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Affiliation(s)
- Henrik Heitmann
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich (TUM), Munich, Germany.
| | - Elisabeth Fischer
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Philipp Wagner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Dennis Pötter
- Department of Anesthesiology and Operative Intensive Care Medicine, Klinikum Dortmund, Dortmund, Germany
- TUM Medical Education Center, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martin Gartmeier
- TUM Medical Education Center, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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Blaschke AL, Rubisch HPK, Schindler AK, Berberat PO, Gartmeier M. How is modern bedside teaching structured? A video analysis of learning content, social and spatial structures. BMC Med Educ 2022; 22:790. [PMID: 36380308 PMCID: PMC9664733 DOI: 10.1186/s12909-022-03855-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/01/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Bedside teaching (BST) is an essential and traditional clinical teaching format. It has been subject to various impediments and has transformed over time. Besides a decrease in bedside time, there has also been a didactic diversification. In order to use time at the bedside effectively and understand the current design of BST, we here offer an evidence-based insight into how BST is practiced. This may serve as a basis for a refinement of its didactic design. METHODS In the current study, we investigate the interrelationships between learning content and the social as well as spatial structures of BST. To this end, we have empirically analysed almost 80 hours of video material from a total of 36 BST sessions with good interrater reliability. RESULTS BST lasted on average 125 min, most of which was spent in plenary and less than a third of the time at the patient's bedside. History taking was primarily practiced at the bedside while case presentations, clinical reasoning and theoretical knowledge were largely taught away from the patient. Clinical examination took place to a similar extent in the patient's room and in the theory room. CONCLUSIONS Even though the filmed BSTs are not purely "bedside", the teaching format investigated here is a typical example of undergraduate medical education. In order to maximize the teaching time available, a suitable learning space should be provided in addition to the bedside. Moreover, the clinical examination should be revised in its general sequence prior to the BST, and conscious decisions should be made regarding the social structure so as to optimize the potential of small groups and plenary sessions.
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Affiliation(s)
- Anna-Lena Blaschke
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Hannah P K Rubisch
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ann-Kathrin Schindler
- DEMEDA (Department of Medical Education), Medical Didactics and Educational Research, Medical Faculty, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Pascal O Berberat
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Martin Gartmeier
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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van Enk A, Nimmon L, Buckley H, Cuncic C, Canfield C, Veerapen K, Holmes C. Presenting cases in front of patients: implications for a key medical education genre. Adv Health Sci Educ Theory Pract 2022; 27:621-643. [PMID: 35366717 DOI: 10.1007/s10459-022-10105-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
Case presentations have been researched as both an important form of intra/inter-professional communication, where a patient's clinical information is shared among health professionals involved in their care, and an equally key discursive tool in education, where learners independently assess a patient and present the case to their preceptor and/or care team. But what happens to the case presentation, a genre that governs physician (and learner) talk about patients, when it is used in patients' presence? While they were commonly used at the bedside in the past, case presentations today are more commonly performed in hallways or conference rooms, out of patient earshot. This paper draws on interview data from a study involving patient-present case presentations in a medical education setting. Our analysis asks what participants' metageneric comments about the encounter can teach us about the genre, about patient involvement in medical education, and about linguistic adaptations to the genre that the profession might make to support patient involvement.
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Affiliation(s)
- Anneke van Enk
- Department of Innovation in Medical Education (DIME), Faculty of Medicine, University of Ottawa, 850 ch. Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Laura Nimmon
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Heather Buckley
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cary Cuncic
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carolyn Canfield
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kiran Veerapen
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cheryl Holmes
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Kwiatkowski A, Shakoor N, Manadan A, Block JA, Khandelwal S. Incorporating interactive workshops into bedside teaching: completion of a multi-modal rheumatology rotation significantly increases internal medicine residents' competency and comfort with comprehensive knee examinations. BMC Med Educ 2022; 22:355. [PMID: 35538536 PMCID: PMC9092684 DOI: 10.1186/s12909-022-03425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Studies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents' competency and comfort with knee examinations when compared to the rotation alone. METHODS Over 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons. RESULTS Fifty-seven residents participated. For both groups, there were improvements between pre- and post-OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post-OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025). CONCLUSION An elective in rheumatology augmented residents' MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.
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Affiliation(s)
- Alysia Kwiatkowski
- Division of Allergy, Immunology & Rheumatology, The State University of New York at Buffalo, Buffalo, NY, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Sonali Khandelwal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Kulkarni SA, Fang MC, Glasheen JJ, Parekh V, Sharpe BA. Characteristics, satisfiers, development needs, and barriers to success for early-career academic hospitalists. BMC Med Educ 2022; 22:278. [PMID: 35418211 PMCID: PMC9008903 DOI: 10.1186/s12909-022-03356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Academic hospitalists engage in many non-clinical domains. Success in these domains requires support, mentorship, protected time, and networks. To address these non-clinical competencies, faculty development programs have been implemented. We aim to describe the demographics, job characteristics, satisfiers, and barriers to success of early-career academic hospitalists who attended the Academic Hospitalist Academic (AHA), a professional development conference from 2009 to 2019. METHODS Survey responses from attendees were evaluated; statistical analyses and linear regression were performed for numerical responses and qualitative coding was performed for textual responses. RESULTS A total of 965 hospitalists attended the AHA from 2009 to 2019. Of those, 812 (84%) completed the survey. The mean age of participants was 34 years and the mean time in hospitalist practice was 3.2 years. Most hospitalists were satisfied with their job, and teaching and clinical care were identified as the best parts of the job. The proportion of female hospitalists increased from 42.2% in 2009 to 60% in 2019 (p = 0.001). No other demographics or job characteristics significantly changed over the years. Lack of time and confidence in individual skills were the most common barriers identified in both bedside teaching and providing feedback, and providing constructive feedback was an additional challenge identified in giving feedback. CONCLUSIONS Though early-career hospitalists reported high levels of job satisfaction driven by teaching and clinical care, barriers to success include time constraints and confidence. Awareness of these factors of satisfaction and barriers to success can help shape faculty development curricula for early-career hospitalists.
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Affiliation(s)
- Shradha A Kulkarni
- Division of Hospital Medicine, Department of Medicine, University of California, 521 Parnassus Avenue, Box 0131, San Francisco, CA, 94143, USA.
| | - Margaret C Fang
- Division of Hospital Medicine, Department of Medicine, University of California, 521 Parnassus Avenue, Box 0131, San Francisco, CA, 94143, USA
| | | | - Vikas Parekh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bradley A Sharpe
- Division of Hospital Medicine, Department of Medicine, University of California, 521 Parnassus Avenue, Box 0131, San Francisco, CA, 94143, USA
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Gong J, Du J, Hao J, Li L. Effects of bedside team-based learning on pediatric clinical practice in Chinese medical students. BMC Med Educ 2022; 22:264. [PMID: 35410211 PMCID: PMC8996540 DOI: 10.1186/s12909-022-03328-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Bedside teaching is a primary educational tool to improve the clinical practice of medical students. As a new medical pedagogical approach, team-based learning (TBL) is gradually being integrated into Chinese medical education programmes to promote clinical reasoning, knowledge application, teamwork and collaboration. The aim of this controlled study is to investigate the effects of TBL on pediatric bedside teaching in medical students. METHODS Thirty medical students in pediatric clinical practice were randomly assigned to an intervention and a control group. Students in the intervention group exposed bedside teaching activity with TBL while students in the control group received traditional bedside teaching. Teaching for the two groups was conducted biweekly, and the same clinical cases were selected for both groups with the same instructors. After six months of clinical practice, the differences of learning outcomes between the two groups were compared through assessments by computer-based case simulations (CCS) and mini-Clinical Evaluation Exercise (mini-CEX). Student feedback following completion of bedside teaching was collected by questionnaire. RESULTS The CCS scores in the intervention group were significantly higher than that in the control group (p < 0.05). The mini-CEX results showed that clinical judgment and counseling skills of the intervention group were higher than those in the control group (p < 0.01). Medical interviewing skills and overall clinical competence in the intervention group were better than those in the control group (p < 0.05). In the questionnaire survey, students in the intervention group believed that bedside teaching activity with TBL could promote active learning ability, improve counseling skills and strengthen teamwork. CONCLUSIONS Application of TBL in bedside teaching not only enhanced clinical practice skills among medical students but also improved their clinical reasoning and counseling skills.
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Affiliation(s)
- Jie Gong
- The Clinical Skills Center, The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Junfeng Du
- Department of Plastic Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China
| | - Jinjin Hao
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lei Li
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Pediatrics, Jingshan People's Hospital, Jingshan, 431800, China.
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Seiwerth I, Bartel S, Herzog M, Schumann G, Pein MK, Gey A, Plontke SK. [Teaching during the COVID-19 pandemic: how do medical students evaluate interactive video-based distance bedside teaching in otorhinolaryngology?]. HNO 2021; 70:140-147. [PMID: 34816295 PMCID: PMC8610107 DOI: 10.1007/s00106-021-01117-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 12/02/2022]
Abstract
Hintergrund Der Beginn der ersten SARS-CoV-2-Pandemie-Welle im März 2020 erforderte erhebliche Umstellungsmaßnahmen in der medizinischen Lehre mit vollständigem Verzicht auf direkten Kontakt von Studierenden und Patienten. Vor diesem Hintergrund wurde das Lehrformat „Unterricht am Patienten“ (UaP) als interaktiver, videobasierter Distanzunterricht am Patienten etabliert und durchgeführt. Fragestellung Ziel der Studie war die Erfassung der studentischen Beurteilung dieses Lehrkonzeptes im Fach Hals-Nasen-Ohren-Heilkunde. Material und Methoden Die Live-Übertragung erfolgte aus einem HNO-Untersuchungsraum zu den im Hörsaal befindlichen Studierenden, welche mit den Patienten interagieren konnten. Makro-, mikro- und endoskopische Untersuchungsbefunde wurden in Echtzeit in den Hörsaal übertragen. Die Evaluation erfolgte anhand eines Online-Fragebogens, welcher 13 geschlossene Fragen (Likert-Skala) beinhaltete, sowie als offenes Feedback in freier Textform. Ergebnisse Die Rücklaufquote lag bei 16,8 % (42 von 250 Studierenden). Davon hatten 85,7 % einen positiven Gesamteindruck, und Tenor war, dass das Konzept angesichts der Umstände gut umgesetzt wurde. Dennoch könne auf einen direkten Patientenkontakt eher nicht verzichtet werden, auch wenn eine teilweise Kompensation durch Videoschaltung möglich sei. Insgesamt wurde das Lehrkonzept als lehrreich empfunden, und die Studierenden konnten sich vorstellen, zukünftig häufiger auch ein solches UaP-Lehrkonzept zu nutzen. Schlussfolgerung Dieses Lehrkonzept kann den direkten Patientenkontakt nicht ersetzen, stellt jedoch speziell im HNO-Gebiet eine gute Alternative dar, wenn durch pandemiebedingte Umstände ein „klassischer“ UaP nicht möglich ist. Aspekte des interaktiven, videobasierten Distanzunterrichts am Patienten könnten auch zukünftig in andere Lehrformate integriert werden.
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Affiliation(s)
- Ingmar Seiwerth
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - S Bartel
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - M Herzog
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.,Klinik für HNO-Krankheiten, Kopf- und Halschirurgie, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland
| | - G Schumann
- Zentraler Dienst 1 - Information und Kommunikation, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - M K Pein
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - A Gey
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - S K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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12
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Thomas C, Plumblee L, Dieffenbaugher S, Talley C. Teaching on Rounds and in Small Groups. Surg Clin North Am 2021; 101:555-563. [PMID: 34242599 DOI: 10.1016/j.suc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions. This article highlights popular methods, including bedside rounds, near-peer teaching, and resident versus attending preceptors, and discusses how teaching on rounds has an impact on patients.
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Affiliation(s)
- Christopher Thomas
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leah Plumblee
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Sean Dieffenbaugher
- Carolinas Medical Center, Atrium Health, Department of Surgery, 1000 Blythe Boulevard, MEB Office 601, Charlotte, NC 28203, USA
| | - Cynthia Talley
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Alsafi Z, Rajabali H. Medical education in the midst of the coronavirus (COVID-19) pandemic-one year later. Int J Surg 2021; 91:106000. [PMID: 34147713 PMCID: PMC8215507 DOI: 10.1016/j.ijsu.2021.106000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Zaid Alsafi
- Hillingdon Hospital, NHS Foundation Trust, United Kingdom.
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Koehler U, Hildebrandt O, Koehler J, Hildebrandt W. [From the anatomical teaching dissection to tuition at the bedside-A historical appraisal]. Wien Med Wochenschr 2021; 171:214-220. [PMID: 33852091 PMCID: PMC8178144 DOI: 10.1007/s10354-021-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022]
Abstract
Zu allen Zeiten waren die Anatomen bemüht, der Medizin wissenschaftliche Grundlagen zu vermitteln. Der Anatom hat den toten Körper zergliedert, um damit den Lebenden zu dienen. Das Verständnis physiologischer und pathophysiologischer Prozesse setzt die Kenntnis der Anatomie voraus. Im Corpus Hippocraticum findet man keinen sicheren Hinweis auf die Durchführung menschlicher Sektionen. In Alexandria wurde um 300 vor Christus zum ersten Mal Anatomie an der menschlichen Leiche gelehrt. Mehr als 1300 Jahre standen die Anatomie und die Heilkunde dann unter dem Einfluss des Galen von Pergamon (131–201 n. Chr.). Der Italiener Mondino dei Luzzi (1275–1326) war der Erste, der den systematischen Anatomieunterricht unter regelmäßiger Einbeziehung von Lehrsektionen in den Lehrbetrieb in Bologna eingeführt hat. Andreas Vesalius (1514–1564) aus Belgien hat in der Neuzeit die wissenschaftlich fundierte Humananatomie begründet und viele Fehler der von Galen tradierten Ansichten der Anatomie korrigiert. Im 17. und 18. Jahrhundert waren die niederländischen Universitäten, allen voran die Universität in Leiden, führend im Hinblick auf die klinische und praktische Studentenausbildung.
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Affiliation(s)
- Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Universitätsklinikum Gießen und Marburg GmbH, Philipps-Universität Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland.
| | - Olaf Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Universitätsklinikum Gießen und Marburg GmbH, Philipps-Universität Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland
| | - Julian Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Universitätsklinikum Gießen und Marburg GmbH, Philipps-Universität Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland
| | - Wulf Hildebrandt
- Medizinische Zellbiologie, Institut für Anatomie und Zellbiologie, Philipps-Universität Marburg, Marburg, Deutschland
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15
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Kurz S, Lohse J, Buggenhagen H, Schmidtmann I, Laufenberg-Feldmann R, Engelhard K. Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching. BMC Med Educ 2021; 21:133. [PMID: 33632210 PMCID: PMC7905916 DOI: 10.1186/s12909-021-02554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested. METHODS Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions. RESULTS This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication. CONCLUSIONS Training with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.
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Affiliation(s)
- Sandra Kurz
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Jana Lohse
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Holger Buggenhagen
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Irene Schmidtmann
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Rita Laufenberg-Feldmann
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Kristin Engelhard
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
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Shetty PA, Magazine R, Chogtu B. Patient outlook on bedside teaching in a medical school. J Taibah Univ Med Sci 2021; 16:50-56. [PMID: 33603632 PMCID: PMC7858025 DOI: 10.1016/j.jtumed.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Pritam A Shetty
- Medical student, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Zhou H, Feng L, Lu Y, Li J, Sun X, Shen C, Zhang W, Chen L, Xu D, Kuang M, Feng H. What is the best option to manage the bedside teaching for Neurology Clerkship -- Demonstration, Simulation or WeChat teaching? MedEdPublish (2016) 2020; 9:286. [PMID: 38073786 PMCID: PMC10698730 DOI: 10.15694/mep.2020.000286.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Neurological clerkship is an important but challenging part of the neurology curriculum, and bedside teaching is essential for clerks to integrate complex theories and skills into practice. Objective: This study aimed to investigate the three bedside teaching methods as modified bedside demonstration, simulation via standard patients as well as WeChat-assisted teaching during neurological clerkship, in order to identify the optimal method. Design: The4 th-year medical students were enrolled during their neurological clerkship. Bedside teaching on topics of acute ischemic stroke, acute myelitis and myasthenia gravis were delivered in a random order of demonstration, simulation and WeChat-assisted teaching. A questionnaire was assigned to each participant at the end of the two-week clerkship to rank the three methods based on their general impression, as well as detailed assessment of clinical abilities and attitudes. Results: A total of 112 clerks were enrolled and 98 were eligible for analysis. For both general and overall ranking, simulation was the most approved bedside teaching method while WeChat-assisted teaching took the least approval among the three. A majority of participants preferred simulation because of the significant improvement on interpretation of diseases, interest in neurology, diagnostic skills, clinical skills, communication skills, empathy and protection of privacy (P<0.05). Demonstration was considered to benefit performance in examination (P=0.009). The ranking of the three methods revealed different consistency between general impression and detailed assessment. More participants tended to underestimate themselves in simulation but to overestimate themselves in WeChat-assisted teaching (P=0.000). Conclusions: Simulation outweigh WeChat-assisted teaching and demonstration by promoting clinical skills, as well as inspiring students' academic interest, compassion and empathy in both the general ranking and the overall ranking. Clerks were tended to underestimate their clinical competence in simulation but overestimate themselves in WeChat-assisted teaching.
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Affiliation(s)
- Hongyan Zhou
- The First Affiliated Hospital of Sun Yat-sen University
| | - Li Feng
- The First Affiliated Hospital of Sun Yat-sen University
| | - Yaru Lu
- The First Affiliated Hospital of Sun Yat-sen University
| | - Jingjing Li
- The First Affiliated Hospital of Sun Yat-sen University
| | - Xunsha Sun
- The First Affiliated Hospital of Sun Yat-sen University
| | - Cunzhou Shen
- The First Affiliated Hospital of Sun Yat-sen University
| | - Weixi Zhang
- The First Affiliated Hospital of Sun Yat-sen University
| | - Ling Chen
- The First Affiliated Hospital of Sun Yat-sen University
| | - Dan Xu
- Curtin University Curtin Medical School
| | - Ming Kuang
- The First Affiliated Hospital of Sun Yat-sen University
| | - Huiyu Feng
- The First Affiliated Hospital of Sun Yat-sen University
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Abstract
Teaching with real patients in the clinical setting lies at the heart of health professional education, providing an essential component to clinical training. This is true of all the health disciplines - particularly medicine, nursing, dentistry, physiotherapy, and dietetics. Clinical tutorials orientate students to the culture and social aspects of the healthcare environment, and shape their professional values as they prepare for practice. These patient-based tutorials introduce students to the clinical environment in a supervised and structured manner, providing opportunities to participate in communication skills, history taking, physical examination, clinical reasoning, diagnosis and management. It is only through participation that new practices are learnt, and progressively, new tasks are undertaken. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and key tips for teaching in the clinical setting. Although there are many competencies developed by students in the clinical setting, our tips for teaching focus on the domains of medical knowledge, interpersonal and communication skills, and professionalism.
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Affiliation(s)
- Annette Burgess
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School - Education Office, The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
- The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia.
| | - Christie van Diggele
- The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris Roberts
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School - Education Office, The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia
| | - Craig Mellis
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School - Central Clinical School, The University of Sydney, Sydney, Australia
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Aringer M, Baerwald C, Bergner R, Feuchtenberger M, Gebhardt C, Hagen M, Keyßer G, Lorenz HM, Witte T. [Rheumatology in German MD curricula]. Z Rheumatol 2020; 80:2-8. [PMID: 33269410 PMCID: PMC7709903 DOI: 10.1007/s00393-020-00933-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Transmitting a substantial amount of basic knowledge in Rheumatology to all medical students is essential for the future medical care of patients with rheumatic diseases for two reasons: on the one hand, future general practitioners will need to master the patterns of rheumatic diseases to recognize them fast enough in new-onset patients and to refer them in time and directly to rheumatologists. On the other hand, the shortage of rheumatologists can only then be relieved in the future when we are able to inspire enthusiasm for our specialty. Adequate rheumatological structures are established only in some of the German faculties of medicine. Structural improvements happen in small steps only but were achieved at several sites. The better the local structures, the higher the chances of committed university teachers in rheumatology to reach all medical students. Probably from 2026 onwards, the learning objectives relevant for examinations will be defined by the national competence-based catalogue of learning objectives in medicine (NKLM), which is currently in the final stages of completion together with the German Federal Institute for Medical and Pharmaceutical Examinations (IMPP). It now appears that systemic autoimmune diseases and inflammatory rheumatic diseases are adequately depicted in this catalogue. If this is achieved, students will know more about these diseases in the future and will diagnose them faster in patients. Work on the NKLM is therefore of highest importance. In addition to the work on the learning objectives, up to date learning materials are required, which have to be available throughout Germany. A Rheumatology script just finished by the committee for medical student education of the German Society of Rheumatology (DGRh) and now available on the DGRh homepage should close this gap.
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Affiliation(s)
- M Aringer
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III und UniversitätsCentrum für Autoimmun- und Rheumatische Erkrankungen (UCARE), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Baerwald
- Rheumatologie, Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - R Bergner
- Sektion Rheumatologie, Medizinische Klinik A, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Deutschland
| | - M Feuchtenberger
- InnKlinikum Altötting und Mühldorf, Standort Burghausen, Burghausen, Deutschland
| | - C Gebhardt
- Medizinische Klinik IV, Sektion Rheumatologie und klinische Immunologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Hagen
- Medizinische Klinik 3, Klinik für Rheumatologie und Immunologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Keyßer
- Arbeitsbereich Rheumatologie, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle/Saale, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Med. Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Häusler M, Bosse HM, Fischbach T, Graf N, von Kleist-Retzow J, Kreuder J. [Alice in the digital wonderland-pediatric teaching during the COVID-19 pandemic]. Monatsschr Kinderheilkd 2020; 169:151-158. [PMID: 33281226 PMCID: PMC7709092 DOI: 10.1007/s00112-020-01076-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic led to a rapid switch from undergraduate classroom teaching to online-teaching; a challenging process for teachers and students. Based on a recent online survey among German pediatric university hospitals the "AG Lehre der DGKJ" (teaching working group of the German Society of Pediatrics and Adolescent Medicine) summarizes latest experiences with e‑learning during the summer term of 2020. The survey participants from 17 pediatric university hospitals report that the large spectrum of e‑learning formats could sufficiently replace classical lectures and seminars but could not fully replace teaching involving direct contact to patients. The introduction of new digital teaching formats is time-consuming, needs high-quality IT infrastructure, should be embedded in a continuous curriculum and provide the possibility of regular exchange between students and teachers. Teachers should be provided with the opportunity for training in didactic methods and IT skills. These results correspond to the literature on e‑learning in general and undergraduate medical education during the COVID-19 pandemic in particular. The experiences summarized here should not only facilitate the development of e‑learning tools during the ongoing pandemic but also stimulate to establish e‑learning as a valuable component of future pediatric medical education. New digital substitutes for teaching involving pediatric patients need to be developed.The statement was drafted by consensus by the German Society of Pediatrics and Adolescent Medicine Working Group on Teaching and approved by the DGKJ board.
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Affiliation(s)
- Martin Häusler
- Sektion Neuropädiatrie und Sozialpädiatrie, Klinik für Kinder- und Jugendmedizin, Uniklinikum RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Hans Martin Bosse
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf UKD, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Thomas Fischbach
- Berufsverband der Kinder- und Jugendärzte, BVKJ e. V. Köln, Mielenforster Str. 2, 51069 Köln, Deutschland
| | - Norbert Graf
- Klinik f. Päd. Onkologie und Hämatologie, Universitätsklinikum, Universität des Saarlandes, Campus Homburg, Gebäude 9, 66421 Homburg, Deutschland
| | | | - Joachim Kreuder
- Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg, Feulgenstr. 10–12, 35385 Gießen, Deutschland
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Ramackers W, Stupak JV, Marcheel IL, Tuffs A, Schrem H, Fischer V, Beneke J. Regression analyses of questionnaires in bedside teaching. BMC Med Educ 2020; 20:371. [PMID: 33081766 PMCID: PMC7574454 DOI: 10.1186/s12909-020-02295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/09/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Students' ratings of bedside teaching courses are difficult to evaluate and to comprehend. Validated systematic analyses of influences on students' perception and valuation of bedside teaching can serve as the basis for targeted improvements. METHODS Six hundred seventy-two observations were conducted in different surgical departments. Survey items covered the categories teacher's performance, student's self-perception and organizational structures. Relevant factors for the student overall rating were identified by multivariable linear regression after exclusion of variable correlations > 0.500. The main target for intervention was identified by the 15% worst overall ratings via multivariable logistic regression. RESULTS According to the students the success of bedside teaching depended on their active participation and the teacher's explanations of pathophysiology. Further items are both relevant to the overall rating and a possible negative perception of the session. In comparison, negative perception of courses (worst 15%) is influenced by fewer variables than overall rating. Variables that appear in both calculations show slight differences in their weighing for their respective endpoints. CONCLUSION Relevant factors for overall rating and negative perception in bedside teaching can be identified by regression analyses of survey data. Analyses provide the basis for targeted improvement.
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Affiliation(s)
- Wolf Ramackers
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | | | | | - Annette Tuffs
- Transplantation Centre, Management-Team, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Department of General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Volkhard Fischer
- Office of the Dean of Studies, Hannover Medical School, Hannover, Germany
| | - Jan Beneke
- Transplantation Centre, Management-Team, Hannover Medical School, Hannover, Germany
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Sarwar S, Aleem A, Nadeem MA. Bed side teaching: Student's perception and its correlation with academic performance. Pak J Med Sci 2020; 36:1204-1209. [PMID: 32968381 PMCID: PMC7501011 DOI: 10.12669/pjms.36.6.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine student’s perception of bedside clinical teaching and to correlate it with their performance in assessment. Methods: This cross-sectional study of correlational survey was conducted at Services Institute of Medical Sciences in September 2019, involving students of final professional year who filled a proforma to rate their bedside teaching experience during clinical rotations using rating scale. Mean scores of items were determined with score < 3 reflecting dis-satisfaction. Mean scores were compared between high and low performing students using student’s t test. Results: Total of 160 students participated. Physical environment domain was assigned lowest scores by students (mean 2.94±0.74) followed by teaching task by teachers (3.04±0.72), group dynamics (3.16±0.81) and patient comfort and attitude towards patient (3.87±0.60). Teaching task by teacher had maximum stems with scores < 3 needing significant improvement. Students with low academic performance were more unsatisfied with group dynamics of bedside teaching (p value 0.009), especially lack of equal opportunities of participation for every member (p value <0.000) in clinical rotations. Conclusion: Small size group with adequate space for bedside training and faculty training can enhance learning experience of students. Ensuring active participation of each group member during bedside learning can improve academic performance of students.
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Affiliation(s)
- Shahid Sarwar
- Dr. Shahid Sarwar, MBBS, FCPS (Med), FCPS (Gastroenterol) MCPS-HPE, FRCP (Edin). Associate Professor, Medical Unit III, Department of Medicine and Gastroenterology, Services Institute of Medical Sciences Lahore, Lahore - Pakistan
| | - Abdul Aleem
- Dr. Abdul Aleem, MBBS. Post Graduate Resident Gastroenterology, Medical Unit III, Department of Medicine and Gastroenterology, Services Institute of Medical Sciences Lahore, Lahore - Pakistan
| | - Muhammad Arif Nadeem
- Dr. Muhammad Arif Nadeem, MBBS, FCPS (Med). Professor of Medicine & Gastroenterology, Medical Unit III, Department of Medicine and Gastroenterology, Services Institute of Medical Sciences Lahore, Lahore - Pakistan
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Rockey NG, Ramos GP, Romanski S, Bierle D, Bartlett M, Halland M. Patient participation in medical student teaching: a survey of hospital patients. BMC Med Educ 2020; 20:142. [PMID: 32381082 PMCID: PMC7206775 DOI: 10.1186/s12909-020-02052-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the common practice of involving in-patients in the teaching of medical students little is known about the experience for patients. This study investigated inpatients' willingness, motivations and experience with participation in medical student bedside teaching. METHODS In-patients at a tertiary hospital who participated in medical student teaching answered a 22 question survey. The survey examined the motivations, impact and overall experience for these patients. RESULTS During July and August of 2019, 111 patients aged 19-93 years completed the survey. Most patients who were approached by preceptors to participate in teaching agreed to participate (74%). Ninety-six percent of patients felt like they could have said no if they had not wanted to participate in medical student teaching. Ninety percent of patients valued the time they spent with students. CONCLUSIONS Most hospital inpatients are willing to participate in medical student teaching in order to be helpful, and most have a positive experience. Preceptors in undergraduate medical education should prioritize a quality informed consent process and understand that the teaching experience can be mutually productive for patients and students.
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Affiliation(s)
- Nathan G Rockey
- Mayo Clinic Alix School of Medicine, 200 1st SW, Rochester, MN, 55905, USA
| | | | - Susan Romanski
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Dennis Bierle
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Matthew Bartlett
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA.
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Abstract
Resident and attending concern about the potential for decreased teaching has been cited as one of the drawbacks to the adoption of family-centered rounds (FCR). Despite these concerns, FCR can enhance clinical education through direct exposure to multiple patients by all team members, as well as by allowing faculty to teach, model, observe, and assess learners' clinical skills more effectively than in nonbedside settings. This article provides many strategies and approaches to bedside teaching designed to enhance education and communication among care team members as well as patients and their families.
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Affiliation(s)
- Thuy L Ngo
- Pediatric Emergency Medicine, Johns Hopkins School of Medicine, 1800 Orleans Street, G-1509, Baltimore, MD 21287, USA.
| | - Rebecca Blankenburg
- Pediatric Hospital Medicine, Stanford School of Medicine, 725 Welch Road, MC 5906, Palo Alto, CA 94304, USA
| | - Clifton E Yu
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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Mancinetti M, Guttormsen S, Berendonk C. Cognitive load in internal medicine: What every clinical teacher should know about cognitive load theory. Eur J Intern Med 2019; 60:4-8. [PMID: 30181017 DOI: 10.1016/j.ejim.2018.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Internal medicine is an appropriate example of specialties in which to teach learners clinical reasoning skills, decision-making, and analytical thinking, as well as evidence-based, patient-oriented medicine. During daily clinical work, general internists always encounter a multitude of situations that lend themselves to educating medical trainees in ambulatory and inpatient settings. Application of existing learning theories to teaching has been shown to optimize teaching ability and to maximize the efficiency of teaching efforts. Cognitive Load Theory explains learning according to three important aspects: the types of memory (working and long-term memory), the learning process and the forms of cognitive load that affect our learning. The aim of this paper is to show the main perspectives and implications of the Cognitive Load Theory on clinical educational practices. It is important to give the right amount of information in the most effective way to learners, thereby making this information more useful. This article presents a concise overview of the basis of the Cognitive Load Theory in its first part, and, in its second part, it exposes the practical applications of this theory with examples. This learning theory will encourage clinical teachers to reflect on how to foster learning in medical trainees in the more effective way.
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Affiliation(s)
- Marco Mancinetti
- Department of Internal Medicine, University and Hospital of Fribourg, Switzerland, Chemin des Pensionnats 2, 1752 Fribourg, Switzerland.
| | - Sissel Guttormsen
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | - Christoph Berendonk
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
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Kriesen U, Altiner A, Müller-Hilke B. Perception of bedside teaching within the palliative care setting-views from patients, students and staff members. Ann Palliat Med 2018; 7:411-419. [PMID: 30180721 DOI: 10.21037/apm.2018.05.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bedside teaching is an essential part of medical education. However, within the setting of palliative care at a university hospital, different needs and interests may collide. On the one hand students need to be prepared for the care for critically ill patients yet on the other, patients require particular tranquility and protection. An analysis of potential harm and benefits resulting from bedside teaching in palliative care is a crucial prerequisite for the organization of bedside teaching in this sensitive setting. METHODS We performed a qualitative study researching the perception and challenges of bedside teaching on the palliative care ward at the Rostock University Medical Center. To that extent, elective courses "Intensive Practical Training in Palliative Care" were held during the summer and winter terms of 2016 and 2016/2017, respectively. Students and team members answered a self-developed questionnaire on the perception of bedside teaching on the palliative care ward. Patients were lead through semi structured interviews later analyzed according to the thematic framework approach. RESULTS A group of 21 students in their clinical years, 20 patients and 19 members of the palliative care team participated in this study. The experience of working with patients in the palliative care setting was very valuable for almost all students. Most patients enjoyed the presence of students on the ward. However, some missed clear cutoff criteria for termination. Students mostly felt comfortable with palliative care patients and did not request professional help for coping with experienced aspects of dying and death. In contrast, members of the palliative care team though were concerned about patients' safety and comfort and requested strict guidance of students during the course. CONCLUSIONS Bedside teaching within the palliative care setting classified a valuable tool for specialized palliative care skills. However, in order to protect the critically ill, students need structured guidance and strict behavioral instructions for presence at the bed side.
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Affiliation(s)
- Ursula Kriesen
- Department Internal Medicine, Clinic III (hematology, oncology, palliative care), Rostock University Medical Center, Rostock University Medical Center, 18057 Rostock, Germany.
| | - Attila Altiner
- Office for Educational Affairs, Rostock University Medical Center, Department General Medicine, Rostock University Medical Center, 18057 Rostock, Germany
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Abstract
This article was migrated. The article was marked as recommended. Infectious diseases, being a cognitive specialty, is commonly perceived to be difficult to teach at the bedside. Most junior doctors have had variable amounts of exposure to infectious diseases as medical students, primarily in the form of lectures as part of a microbiology curriculum. Teaching principles of infectious diseases practice to junior doctors is essential to develop good antibiotic prescribing skills. We suggest a practical guide with 3 x 3 steps to teach infectious disease practice at the bedside. We have attempted to outline the anticipated problems with the instruction of Infectious disease practice in the clinical setting and then have proceeded to adopt an expanded version of the clinical micro-skills model to address those gaps.
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Jennings FL, Mitchell M. Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project. Intensive Crit Care Nurs 2017; 40:35-43. [PMID: 28259523 DOI: 10.1016/j.iccn.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 12/01/2016] [Accepted: 01/01/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. OBJECTIVES The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. METHODS The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. RESULTS There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. CONCLUSIONS Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.
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Affiliation(s)
- Fiona L Jennings
- Princess Alexandra Hospital, Intensive Care Unit, Ipswich Road, QLD 4102, Australia.
| | - Marion Mitchell
- Princess Alexandra Hospital, Intensive Care Unit, Ipswich Road, QLD 4102, Australia; Centre of Health Practice Innovation, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, 170 Kessels Road Nathan, QLD 4111, Australia
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Joyce MF, Berg S, Bittner EA. Practical strategies for increasing efficiency and effectiveness in critical care education. World J Crit Care Med 2017; 6:1-12. [PMID: 28224102 PMCID: PMC5295164 DOI: 10.5492/wjccm.v6.i1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/30/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023] Open
Abstract
Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.
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Cios J, Hoyle JC, Quick A, Brown NV, Walker, Jr. C, Tartaglia K. Bedside direct observation of medical student-performed physical examination is highly rated in student satisfaction. MedEdPublish (2016) 2017; 6:21. [PMID: 38406402 PMCID: PMC10885231 DOI: 10.15694/mep.2017.000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Objectives: To evaluate satisfaction among third year medical students with a bedside teaching exercise comprised of direct observation of student-performed physical examination skills and related feedback. Methods: An observational, cross-sectional study design was employed to study third year medical students undergoing the Neurology clerkship at the Ohio State University College of Medicine between June and October 2015. Immediately following the bedside physical examination teaching exercise, student satisfaction data was obtained in anonymous survey (n=21). In addition, student satisfaction data from the class cohort (n=51), regarding various learning formats in the curriculum, were collected at the end of a 16-week block of rotations including the Neurology clerkship. Data were summarized using descriptive statistics. Results: Most students felt that their level of confidence increased as a result (85.0%, n=17/21), and they felt they would use what they had learned in the future (95%, n=19/21). Only about half of the students felt strongly that reflection on the learning experience was sought (47.6%, n= 10/21). At the end of the 16 weeks block, the Neurology examination exercise was rated among the most highly in student satisfaction (3.35/4, SD=0.89) as compared to procedural workshops (2.76/4, SD= 0.76), other small group topic format (2.78/4, SD= 0.85), and traditional lecture (2.39/ 4, SD= 0.89). Conclusions: The bedside direct observation of physical examination performed by medical students is highly rated in student satisfaction, and students are most satisfied with this format of teaching among all formats studied. Increased opportunity for reflection in this setting represents an area for further development.
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Affiliation(s)
| | | | - Adam Quick
- Ohio State University College of Medicine
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Verghese A, Charlton B, Kassirer JP, Ramsey M, Ioannidis JPA. Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes. Am J Med 2015; 128:1322-4.e3. [PMID: 26144103 DOI: 10.1016/j.amjmed.2015.06.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oversights in the physical examination are a type of medical error not easily studied by chart review. They may be a major contributor to missed or delayed diagnosis, unnecessary exposure to contrast and radiation, incorrect treatment, and other adverse consequences. Our purpose was to collect vignettes of physical examination oversights and to capture the diversity of their characteristics and consequences. METHODS A cross-sectional study using an 11-question qualitative survey for physicians was distributed electronically, with data collected from February to June of 2011. The participants were all physicians responding to e-mail or social media invitations to complete the survey. There were no limitations on geography, specialty, or practice setting. RESULTS Of the 208 reported vignettes that met inclusion criteria, the oversight was caused by a failure to perform the physical examination in 63%; 14% reported that the correct physical examination sign was elicited but misinterpreted, whereas 11% reported that the relevant sign was missed or not sought. Consequence of the physical examination inadequacy included missed or delayed diagnosis in 76% of cases, incorrect diagnosis in 27%, unnecessary treatment in 18%, no or delayed treatment in 42%, unnecessary diagnostic cost in 25%, unnecessary exposure to radiation or contrast in 17%, and complications caused by treatments in 4%. The mode of the number of physicians missing the finding was 2, but many oversights were missed by many physicians. Most oversights took up to 5 days to identify, but 66 took longer. Special attention and skill in examining the skin and its appendages, as well as the abdomen, groin, and genitourinary area could reduce the reported oversights by half. CONCLUSIONS Physical examination inadequacies are a preventable source of medical error, and adverse events are caused mostly by failure to perform the relevant examination.
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Affiliation(s)
- Abraham Verghese
- The Program in Bedside Medicine, Stanford University School of Medicine, Stanford, Calif.
| | - Blake Charlton
- Department of Internal Medicine, University of California, San Francisco
| | - Jerome P Kassirer
- Department of Internal Medicine, Tufts University School of Medicine, Boston, Mass
| | - Meghan Ramsey
- The Program in Bedside Medicine, Stanford University School of Medicine, Stanford, Calif
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif
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Piquette D, Moulton CA, LeBlanc VR. Balancing care and teaching during clinical activities: 2 contexts, 2 strategies. J Crit Care 2015; 30:678-84. [PMID: 25776896 DOI: 10.1016/j.jcrc.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/03/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The goal of this study was to better understand how clinical supervisors integrate teaching interactions with medical trainees into 2 types of clinical activities in the critical care setting: multidisciplinary rounds and medical crises. METHODS We conducted a qualitative, observational study based on an ethnographic approach. We observed the teaching interactions among clinical supervisors and medical trainees during 12 multidisciplinary rounds and 74 medical crises in 2 academic hospitals. Grounded theory methods (theoretical sampling and saturation, inductive thematic coding, and constant comparison) were used to analyze data. RESULTS Two models of integration of teaching interactions into clinical activities are described: the in series model, typical of multidisciplinary rounds and characterized by well-structured learning bubbles uninterrupted by patient care, and the in parallel model, common during medical crises and involving multiple, short learning flashes intricately related to and frequently interrupted by patient care. By adopting a model over the other, supervisors appeared to adapt to 2 contexts that differed in terms of priority, supervisor's understanding of events, and social context of interactions. Each model presented complementary opportunities and limitations for learning. CONCLUSIONS Modern views of medical apprenticeship and clinical teaching need to take into account the specific clinical context in which learning occurs. Teaching interactions that differ in structure and content in response to changing clinical circumstances could impact learning in unique ways. Learning outcomes resulting from different models of integration of teaching into clinical activities need to be further explored.
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Affiliation(s)
- Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada.
| | - Carol-Anne Moulton
- The Wilson Centre, Toronto, ON, M5G 2C4, Canada; Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Vicki R LeBlanc
- The Wilson Centre, Toronto, ON, M5G 2C4, Canada; Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
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Salam A, Siraj HH, Mohamad N, Das S, Rabeya Y. Bedside teaching in undergraduate medical education: issues, strategies, and new models for better preparation of new generation doctors. Iran J Med Sci 2011; 36:1-6. [PMID: 23365470 PMCID: PMC3559110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 02/24/2010] [Accepted: 03/06/2010] [Indexed: 11/12/2022]
Abstract
Bedside teaching is a vital component of medical education. It is applicable to any situation where teaching is imparted in the presence of patients. In teaching in the patients' presence, learners have the opportunities to use all of their senses and learn the humanistic aspect of medicine such as role modeling, which is vital but difficult to communicate in words. Unfortunately, bedside teaching has been on the decline. To investigate the reasons for the decline in bedside teaching, its importance and its revival, a review of literature was carried out using PubMed and other data bases. The review revealed that the major concerns of bedside teaching were time constraint, false preceptors' concern about patients' comfort, short stay of patients in hospitals, learner distraction by technology, lack of experience and unrealistic faculty expectation. Whatsoever the reasons, bedside teaching cannot be replaced with anything else. There are newer approaches of effective bedside teaching, and the core focus of all such approaches is educational process. A bedside teacher must learn how to involve patients and learners in the educational processes. Moreover, bedside teaching is the process through which learners acquire the skills of communication by asking patients' permission, establishing ground rules, setting time limit, introducing the team, diagnosing learner, diagnosing patient, conducting focused teaching, using simple language, asking patient if there is any question, closing with encouraging thanks, and giving feedback privately. It is most important to ensure a comfortable environment for all participants, the learner, the patient and the bedside teacher. Ongoing faculty development programs on educational processes and realistic faculty expectations may overcome the problems.
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Affiliation(s)
- Abdus Salam
- Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Harlina Halizah Siraj
- Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nabishah Mohamad
- Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Srijit Das
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yousuf Rabeya
- Department of Pathology, Blood Transfusion Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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