Patient perceptions of bedside teaching rounds

Abstract

Over recent years the training of medical students and residents has moved away from the bedside. Various authors have cited barriers to bedside teaching, many of which are patient-centred and involve issues such as patient embarrassment and humiliation, and lack of patient cooperation.1 The patient's bedside is where both medical students and residents are introduced to the art of physical diagnosis and where they are able to view the essential components of professionalism and humanism. Bedside teaching rounds also allow medical students and residents to translate basic science into clinical medicine. Yet time spent teaching and learning at the bedside has significantly decreased. The aim of this study was to evaluate patients' comfort with bedside teaching, as well as patient perceptions of the educational value of bedside training for both patients and learners. A total of 67 patients, who were admitted to an in-patient medical service at an academic tertiary hospital over a 10-month period during 2009–2010, were selected to take part in weekly physical diagnosis rounds. Within 24 hours of the completion of rounds, a patient questionnaire was administered by a medical student who was unknown to the patient and had not been present during the rounds. The questionnaire addressed three domains: the patient's perceived experience of the rounds; the educational benefit of the rounds, and the doctor's ability to serve as a role model at the bedside. The questionnaire consisted of a series of 10 statements, agreement with which was indicated using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Means and standard deviations (SDs) were calculated. The patients disagreed or strongly disagreed with the statements that the rounds disrupted their morning or made them more upset about their illnesses (mean ± SD: 1.7 ± 1.0 and 1.5 ± 0.5, respectively). Patients agreed or strongly agreed that the rounds gave them opportunities to express their feelings about their illnesses (mean ± SD: 4.2 ± 0.9). Patients agreed or strongly agreed that the rounds were carried out in a way that showed respect for them as people (mean ± SD: 4.4 ± 0.6). Patients agreed or strongly agreed that their involvement in rounds gave them a sense of contributing to the education of doctors (mean ± SD: 4.5 ± 0.5) and demonstrated the importance of teaching physical diagnosis skills (mean ± SD: 4.5 ± 0.5). Lastly, patients agreed or strongly agreed that the attending physician was an excellent role model (mean ± SD: 4.5 ± 0.5). Results from the questionnaire revealed that patients had positive experiences and views of the rounds, felt positively about the educational benefits of bedside physical diagnosis rounds and believed that the attending physician was a positive role model at the bedside. The findings of this study should encourage attending physicians to return to the time-honoured tradition of teaching at the bedside, not only for the educational benefit of students and residents, but also for the potential benefit of patients.