Quantification of bedside teaching by an academic hospitalist group

Abstract

Medical educators have raised serious concerns about the decline in bedside teaching and the effect of this decline on trainee skills. We investigated the fraction of time hospitalist attending physicians spend at the bedside during teaching rounds and how often physical examination skills are demonstrated. In a prospective, observational study, the authors investigated the rounding behavior of members of Brigham and Women's Hospitalist Service. For 5 weeks from December 2007 to January 2008, interns and residents rotating on the hospitalist service reported in a daily e-mail (1) total time spent with their attending during attending rounds, (2) time spent inside patient rooms during attending rounds, and (3) whether or not a physical examination finding or technique was demonstrated by their hospitalist attending. A total of 61 observations were reported (66% response). Hospitalists spent an average of 101 minutes on teaching rounds and an average of 17 minutes inside patient rooms or 17% of their teaching time at the bedside. Bedside teaching occurred during 61% of teaching sessions and physical examination teaching occurred during 38% of teaching sessions. Rounds that included time spent at the bedside were longer on average than rounds that did not include time spent at the bedside (122 vs. 69 minutes, P < 0.001). Bedside teaching makes up approximately 17% of the time that hospitalists at this medical center spend on teaching rounds. Physical examination teaching has become infrequent. Research to clarify optimal strategies to improve bedside teaching and its value in patient care is needed.