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The Art of Bedside Rounds: A Multi-Center Qualitative Study of Strategies Used by Experienced Bedside Teachers

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ABSTRACT

BACKGROUND

Medical educators believe bedside rounds are effective for the delivery of patient-centered care, and are necessary in helping trainees acquire competence in clinical care. Although recommendations for bedside rounds have been reported, a recent, systematic assessment of strategies used by current-day bedside teachers was needed to advance knowledge of this teaching method.

OBJECTIVE

To identify and understand bedside teachers’ 1) preparatory steps, 2) patient selection, and 3) role allocation during the process of bedside rounds.

DESIGN

A qualitative inductive thematic analysis using transcripts from audio-recorded, semi-structured telephone interviews.

PARTICIPANTS

Internal medicine physicians (n = 34) who perform bedside rounds from ten academic US institutions (2010–2011).

APPROACH

A purposive sampling strategy was utilized to identify physicians who were active inpatient attending physicians and met specific inclusion criteria for “bedside rounds.” A total of 34 interviews were completed, and each was recorded and transcribed verbatim. A thematic analysis extracted key themes pertaining to the three objectives.

KEY RESULTS

Most respondents (51 %) were associate or full professors, with an average of 14 years of academic experience. Attending physicians prepared using trainee-specific, patient-specific and disease-specific information, while also mentally preparing for bedside rounds. They sought trainee buy-in and learning objectives, reviewed expectations and methods to ensure patient comfort, and provided early guidance with bedside encounters. Patients were selected if they required immediate care, were new to the service, or had a high educational value, while patients were deferred if unavailable, unwilling, or unable to communicate. The team members’ roles during bedside rounds varied, with trainees being given graduated autonomy with increased experience.

CONCLUSIONS

Bedside teachers’ methods for preparation, patient selection, and role allocation during bedside rounds enhance trainees’ education within the workplace. Strategies used by experienced bedside teachers can be used for faculty development efforts aimed at promoting this activity.

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Acknowledgements

The authors would like to thank all participants for volunteering their time to be interviewed, the Shadyside Foundation for funding this project, and Heather Stuckey DEd (Assistant Professor of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine) for her editorial review of the manuscript.

Funding

This study was funded by the University of Pittsburgh Medical Center’s Shadyside Thomas H. Nimick, Jr. Research Fund and the Shadyside Hospital Foundation.

Conflicts of Interest

The authors declare that they do not have any conflicts of interest.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Jed D. Gonzalo MD MSc.

Additional information

At the time of the study, the lead author (J.G.) was a General Internal Medicine Medical Education Fellow, Clinical Fellow in Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

APPENDICES

APPENDICES

Tables 4, 5

Table 4 Participating Institutions and Interview Questions Used with 34 Faculty Physicians from Ten US Academic Medical Centers, 2010–2011
Table 5 Preparation Strategies for Bedside Rounds Utilized by Bedside Teachers from Ten US Academic Institutions (n = 34)

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Gonzalo, J.D., Heist, B.S., Duffy, B.L. et al. The Art of Bedside Rounds: A Multi-Center Qualitative Study of Strategies Used by Experienced Bedside Teachers. J GEN INTERN MED 28, 412–420 (2013). https://doi.org/10.1007/s11606-012-2259-2

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  • DOI: https://doi.org/10.1007/s11606-012-2259-2

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