Patient Satisfaction with Bedside Teaching Rounds Compared with Nonbedside Rounds.

Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers. Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores. A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p < 0.001), from a mean score of 18.45 (95% confidence interval [CI] = 17.92 to 18.98) to 21.30 (95% CI = 20.69 to 21.91), a large effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p < 0.001) among pediatric residents. Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning.

Aim: The rapid change in many fields in the global sense and the need for transformation due to this change has also affected the field of medical sciences; therefore, revisions have been required in medical education practices. For this reason, medical education is considered as one of the fields where change occurs fast. This study aims to examine the Grand Rounds model in terms of continuing medical education and lifelong learning through the analysis of its planning, implementation, and evaluation process. Methods: This traditional literature review, in the context of continuing medical education and lifelong learning, was conducted to examine the planning, implementation and evaluation processes of grand rounds, especially in the United States. In Pubmed, Scopus and Google Scholar search engines, the keywords "Clinical Rounds", "Medical Rounds", "Bedside Teaching Rounds", "Medicine Rounds" and "Ward Rounds", which are called "classical clinical learning cycle", were searched. Then, the studies that included the term “Grand Rounds” model were examined.Results: The grand rounds are designed to follow up-to-date diagnosis and treatment methods, to encourage knowledge sharing among faculty members, to contribute to the lifelong learning skills of students and faculty members, to create an active learning environment for assistants and students, and to share the faculty’s experiences with other stakeholders. It has been observed that the Grand Rounds, which was created in the context of adult learning theory and lifelong learning, has a more comprehensive process than traditional clinical rounds, is applied both in pre-graduate and postgraduate medical education and with the participation of health professionals from various disciplines. The most important stage of the Grand Rounds is planning. Therefore, there are some key elements that should be considered by the organizing committee that will carry out the planning process. These elements include shaping the content around the themes that will meet the needs of the participants, determining the appropriate learning outcomes, and deciding on the presentations that will contribute to the development of students' skills such as clinical reasoning, problem solving and decision making. During the implementation process, sufficient time should be allowed for the participants to discuss, interact, and share information about the subject. After Grand rounds, both the content in the learning cycles and the presenters should be evaluated with valid and reliable tools.Conclusions: Integration of Grand rounds into continuous medical education in Turkey is strongly recommended in terms of providing broader lifelong learning opportunities for medical students, resident physicians and medical educators.

To the editors: We applaud the effort by Gonzalo et al. to increase bedside rounding by internal medicine residents1. However, we do wish to comment on their study’s expressed motive, a perceived downward trend in the fraction of medical education taking place at the bedside. Among the many physician-educators lamenting this trend since the 1960s, LaCombe’s 1997 commentary in the Annals of Internal Medicine has been particularly influential2. His statement that, “In the old days, 30 years ago, 75% of teaching was at the bedside. … By 1978, that figure had decreased to 16%” has been widely repeated in the literature on bedside teaching, including in the article by Gonzalo et al. The 1964 study from which LaCombe derived his 75% “baseline,” however, actually reported that 75% of dedicated teaching sessions for ward-based medical students included time at the bedside3. Forty-five years later, in 2009, the frequency of trips to the bedside during teaching rounds remained fairly stable at 61%4. The percentage of time on teaching rounds spent at the bedside has also stayed similar over time compared to the 16% cited by LaCombe, ranging from 19.2%5 in 1965 to 17%4 in 2009. This is not to say that bedside teaching—critical for training in humanism, physical exam, and other clinical skills poorly amenable to either classroom instruction or written assessment—is not under pressure from technology, work hour limitations, rapid patient turnover and the ever-expanding canon of raw medical knowledge. Work to study and promote bedside teaching should be motivated by the technique’s intrinsic value rather than by a misconception that bedside instruction is on the decline.

This study examines the efficacy of medical education methods in improving the knowledge base and clinical skills of participants attending a 2-day miniresidency course in HIV infection. Instructional methods included: a didactic lecture format, diagnostic algorithm presentation, color slide photographic demonstration, bedside teaching rounds, and “meet-the-professor” sessions. Questions to assess the various instructional formats were administered and teaching methods were evaluated. Fifty-seven Thai physicians, highly exposed to HIV patient care duties, completed both precourse and postcourse tests. Overall, significant improvement was noted in participant's final global test score. However, discrepancies existed among the efficacy of instructional methods. Recognizing physical signs of HIV infection, as taught by slide photographs, revealed a high baseline level of expertise. Statistically significant postcourse gains were made in physician's diagnostic decision-making ability and basic knowledge of HIV and AIDS taught respectively by the methods of a teaching algorithm and didactic lecture. Despite the latter, participants performed poorly regarding HIV case management. This observation may be related to test design and cultural differences but likely underscores the difficulty in imparting clinical HIV management skills to course participants over a short period of time. Future continuing medical education (CME) courses intended to enhance physician care for the HIV infected must strive to refine evaluation methods for assessing case management skills while exploring innovative instructional techniques when current methods are ineffective.

The authors present the curricular elements of a palliative care experience for internal medicine residents at the Medical College of Wisconsin (MCW) and the Zablocki Veterans Affairs Medical Center (ZVAMC), Milwaukee, Wisconsin. To improve resident physicians' knowledge and skills in palliative care, a structured clinical/educational experience was integrated into an existing required geriatrics rotation for senior medicine residents. Each month, two residents rotate simultaneously in the palliative care and the geriatrics evaluation and management units at the ZVAMC. The curricular elements of palliative care include prognostication, assessment and management of pain and nonpain symptoms in end-of-life care. The geriatrics component emphasizes mechanisms of aging, pathophysiology of common geriatric diseases, clinical pharmacology and psychosocial aspects of geriatric care. Teaching methods include direct patient care, bedside teaching rounds, lectures, and multidisciplinary and family meetings. Rotation design avoided conflicting time demands on the residents. In a prerotation/postrotation knowledge self-assessment questionnaire, residents (n = 28) indicated significant knowledge improvement in all palliative care domains taught during the experience. The rotation was well integrated into the existing curricular elements in geriatrics and palliative medicine at MCW. This combined rotation can serve as a reference for educators interested in developing new or enhancing existing palliative care training programs.

This article was migrated. The article was marked as recommended. Background: Bedside teaching used to be an integral component of undergraduate medical education. In recent times, however, there has been a steady decline in the use of bedside teaching. This has occurred despite students, clinicians and patients viewing bedside teaching as valuable. Aims: This review aims to appraise the current literature surrounding the perspectives in bedside teaching and evaluate its role within modern medical education. Methods: A literature search was conducted in PubMed, Cochrane Library, and Ovid to identify appropriate studies. The journal articles were obtained by conducting sensitive and appropriate searches using keywords. All studies were examined comprehensively by the authors for suitability for inclusion. Results: 2,770 records were identified from the initial search. An additional 3 records were identified after discussion with experts in the field. 583 duplicates were identified in the pool of records initially sourced. Of the remaining 2,190 records, 1,930 were excluded after inclusion and exclusion criteria were applied to their titles and abstracts. A further 252 records were excluded from the remaining 260 records after inclusion and exclusion criteria were applied to their full-texts. The remaining eight articles were reviewed by both authors and were deemed suitable for inclusion to the review. Conclusion: The review showed that there is evidence in the literature to show that students, clinicians, and patients regard bedside teaching as beneficial. Discussions highlighted that bedside teaching can aid competency-based education models and cannot be replaced by simulation-based education. These results illustrate that, while there is evidence to show that bedside teaching holds value in medical education today, further studies should be conducted aiming to display long-term outcomes of bedside teaching.

Bedside teaching remains a cornerstone of clinical education, yet concerns persist about its impact on patients’ comfort and confidence in the care they receive. Contemporary literature suggests that, when done well, bedside rounds can enhance patient understanding, satisfaction, and engagement without compromising privacy or dignity. However, little is known about the specific effect of short, structured bedside teaching sessions on patients’ confidence in hospital wards. This prospective research evaluates whether brief (10-15 minute) bedside teaching encounters, integrated into routine ward rounds, influence patients’ confidence in their treating team. Adult inpatients in medical wards were allocated to either standard ward rounds or ward rounds incorporating short bedside teaching sessions led by senior residents with medical students present. Patient confidence was measured within 24 hours of the round using a validated patient-confidence questionnaire adapted from instruments assessing trust and confidence in physicians, alongside secondary outcomes of perceived communication quality and willingness to ask questions. We hypothesised that patients exposed to short bedside teaching would report higher confidence scores than those receiving usual care. Preliminary analyses indicate that patients generally welcome bedside teaching, particularly when they are introduced to students, consent is explicitly obtained, and the teaching emphasises clear explanations and shared decision-making. Patients in the intervention group showed higher mean confidence scores and reported better understanding of their diagnosis and management plan, without increases in reported discomfort or concerns about privacy. These findings suggest that carefully structured short bedside teaching sessions can strengthen patient confidence while preserving the educational value of bedside rounds. Embedding patient-centred principles into such encounters may help reconcile educational needs with patient expectations in busy hospital wards.

INTRODUCTION:The family members’ presence during teaching rounds is introduced as a challenging issue. The outcomes of family presence during teaching rounds in adult care settings is an under investigate issue. The propose of this study was to determining the effect of family presence at teaching rounds on patient's anxiety and satisfaction in cardiac intensive care unit (CICU).MATERIALS AND METHODS:In this double-blind randomized controlled trial, 60 patients who were hospitalized in CICU were selected based on inclusion criteria and then assigned into 2 groups (with and without family members presence during teaching round), equally by the random minimization method. The patient's anxiety score was measured before and after rounds on the Spielberger State-Trait Anxiety Inventory (STAI). Furthermore, the patient's satisfaction about various clinical aspects of round was measured by a self-reported questionnaire. The data were analyzed by SPSS software using Kolmogorov–Smirnov test, Chi-square test, independent sample and paired sample t-test, at the significance level of 0.05.RESULTS:The study groups were similar in terms of demographic variables. In the family members presence group, the STAI score significantly decreased after intervention (P = 0.001). Furthermore, in this group, the after-intervention STAI score was significantly lower than family absence group (P = 0.011). The mean changes of patient's satisfaction about quality of round score in family member presence group were significantly higher than family absence group (P = 0.001).CONCLUSIONS:Family presence during teaching rounds led to patient's lower anxiety and higher satisfaction score.

Aim The aim of this study is to evaluate the impact of changes made to third-year students’ Surgical bedside teaching with the inclusion of surgical teaching fellows, as compared to the initial survey results. Method Post-event, retrospective, optional questionnaire formed of 5 Questions evaluated by a Likert scale and 2 open-ended Questions. First Cycle: 2022-2024 Year 3 BSMS Student, 40 responses Second cycle: September – December 2024 Year 3 BSMS students, 11 responses Results Changes: Smaller teaching groups, improved communication between the Fellows and surgical teams, improved teaching material. Most students agreed that Surgical Ward Round Bedside Teaching sessions with dedicated fellows effectively enhanced clinical knowledge and skills. Compared to an initial 48%, 60% strongly agreed that teaching fellows were engaging and approachable during Surgical Ward Round Teaching. Also, the majority agreed that they felt comfortable asking questions and seeking clarification during the Teaching sessions. However, 55% agreed that Bedside Teaching sessions were well-organized and focused on relevant surgical/clinical cases compared to an initial 35%. When asked, ‘How could the bedside/Ward Round teaching sessions be improved?’ – Responses revolved around suggesting including more teaching fellows on ward rounds, a de-brief session of the patients on the ward, and having clearer learning objectives, more structured as well as spending more time on history taking and examinations. Conclusions The introduction of surgical teaching fellows has had a positive impact on the students’ Surgical Teaching experience. However, there is still room for future refinement, and further enhancement strategies are in progress.

Are university-based residency training programs lacking in resident education of proper diagnosis and treatment for common skin and breast lesions?

6074 Background: Patient (pt) understanding of cancer clinical trials (CCT) is often poor. However, pt satisfaction with the informed consent process may be independent of this, as pts have variable information needs, and preferences for involvement in medical decision-making. We aimed to establish the level of pt satisfaction with the process of giving informed consent to CCT, and to determine whether satisfaction correlates with objective understanding and pt preferences. Methods: A sample of 100 pts participating in a CCT were surveyed about their: satisfaction with the consent process; level of understanding of the CCT using the Quality of Informed Consent (QuIC) questionnaire; preference for amount of information; preference for involvement in medical decision-making; depression/anxiety using the Hospital Anxiety and Depression Scale. Measures were completed within 2 weeks of CCT enrolment. Results: Analysis of the first 72 pts. Median age was 55 (29–75), 60% male, 11% were depressed and 18% anxious. 97% of pts recorded a high level of satisfaction with their decision to enrol. 84% wanted to know as much information as possible. 32% preferred that their doctor make decisions about treatment and 38% preferred joint decision-making. Pt preferences for level of involvement in decision-making were strongly associated with their perceived level of involvement in the decision (P = 0.007). 28% of pts perceived that the doctor had made the decision. No correlation was found between pt satisfaction and: objective level of understanding (R = 0.157); depression (R = -0.095); or anxiety (R = -0.069). Satisfaction was correlated with self-assessed understanding (R = 0.44; p<0.001). Pt satisfaction was higher among pts who preferred as much information as possible (P=0.045) and those who perceived having been told every possible detail (P<0.001). Conclusion: Pt satisfaction with the process of giving informed consent to CCT is very high, but does not correlate with objective understanding about the CCT. Pt preference for degree of involvement in medical decision-making is highly variable. High satisfaction coupled with suboptimal knowledge has important ethical implications. No significant financial relationships to disclose.

Letters and Corrections1 November 1982Guidelines for Teaching RoundsD.A. VAUGHAN, M.D.D.A. VAUGHAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-97-5-782_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The editorial by Frame (1) contained several helpful guidelines for organizing teaching rounds for internal medicine residents.During the past 5 years, I have served as attending physician for a rural community outreach program for senior residents from an urban teaching hospital. I have tried to improve the quality of teaching rounds, but have found these rounds to be time-consuming.After reading the editorial, I drew up new guidelines for teaching rounds that I gave to the residents and have followed for the past several months. We have saved enough time to allow for more bedside teaching...

Introduction: Medical students have long provided informal, structured academic support for their peers in parallel with the institution’s formal curriculum, demonstrating a high degree of motivation and engagement for peer teaching. This qualitative descriptive study aimed to examine the perspectives of participants in a pilot peer teaching programme on the effectiveness and feasibility of adapting existing student-initiated peer bedside teaching into formal bedside teaching. Methods: Study participants were senior medical students who were already providing self-initiated peer-led bedside clinical teaching, clinicians who co-taught bedside clinical skills teaching sessions with the peer teachers and junior students allocated to the bedside teaching sessions led by peer teachers. Qualitative data were gathered via evaluation form, peer teacher and clinician interviews, as well as the observational field notes made by the research assistant who attended the teaching sessions as an independent observer. Additionally, a single Likert-scale question on the evaluation form was used to rate teaching effectiveness. Results: All three peer teachers, three clinicians and 12 students completed the interviews and/or questionnaires. The main themes identified were teaching effectiveness, teaching competency and feasibility. Teaching effectiveness related to the creation of a positive learning environment and a tailored approach. Teaching competency reflected confidence or doubts about peer-teaching, and feasibility subthemes comprised barriers and facilitators. Conclusion: Students perceived peer teaching effectiveness to be comparable to clinicians’ teaching. Clinical peer teaching in the formal curriculum may be most feasible in a hybrid curriculum that includes both peer teaching and clinician-led teaching with structured training and coordinated timetabling. Keywords: Peer Teaching, Undergraduate Medical Education, Bedside Teaching, Medical Students

BackgroundClinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs.Methods/designWe propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment.The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6 months post-intervention, using 95 % confidence intervals. A linear multilevel regression will be used to adjust the model.DiscussionThe identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance.Trial registrationClinicalTrials.gov: NCT02210442.

Patient safety is a key aspect in modern healthcare that has a significant impact on quality and patient satisfaction. This study aims to determine the relationship between the implementation of patient safety and the level of inpatient satisfaction in the Aisyah Room of Sekarwangi Hospital, Sukabumi Regency. The research design used was quantitative with a cross-sectional approach. A total of 91 inpatients were selected at random and asked to fill out a structured questionnaire. The results showed that 96.7% of patients rated the implementation of patient safety in the good category and 94.5% stated a high level of satisfaction. The results of statistical analysis using the Pearson Chi-Square test showed a significant relationship (p = 0.000) between patient safety implementation and patient satisfaction. This indicates that improving the quality of patient safety implementation can directly increase patient satisfaction during hospitalization. These findings emphasize the importance of consistent safety strategies and patient-centered nursing services. Hospitals are advised to continue to strengthen patient safety culture through regular training, a transparent incident reporting system, and oversight of standard operating procedures. In addition, management involvement in fostering a work climate that supports safety is needed. The use of information technology in safety reporting and monitoring can also speed up risk identification and follow-up. By prioritizing the principles of prudence and effective communication between medical personnel, the quality of service can be improved comprehensively. This study also implies that efforts to improve safety not only have an impact on reducing medical risks, but also on increasing patients' positive perceptions of hospital services. Periodic evaluations, patient education, and active involvement in medical decision-making are important factors in maintaining and improving the quality of safe, effective, and satisfactory health services.