Bedside Skills Research Articles

IMRA/SRS Delphi consensus on international standards for common core components of robotic surgical training design

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to provide recommendations for core considerations in robotic training design across diverse training environments internationally. A literature search was performed and an international steering committee (AG, KL, JW, HM, TC) proposed key components for contemporary robotic training design and a modified Delphi approach was used to gather stakeholder opinion. The outcomes were then discussed at a face-to-face international expert consensus at the IMRA educational session at the Society of Robotic Surgery (SRS) meeting and final voting was conducted on outstanding items. Stakeholders included robotic surgeons, proctors, trainees and robotic surgical training providers. There was consensus achieved in 139 statements organised into 15 themes. There was 100% agreement that standardised themes in robotic curricula may improve patient safety. Key take-home messages include—training curricula should be multiplatform, non-technical skills are an important component of a robotic curriculum as well as console and bedside skills, clinically relevant performance metrics should be used for assessment where available, the reliance on cadaveric and live animal models should be reduced as high-fidelity synthetic models emerge, and stepwise component training is useful for advanced procedural training. These consensus recommendations are intended to guide design of fit for purpose contemporary robotic surgical curricula. Integration of these components into robotic training pathways internationally is recommended.

What Bedside Skills Could the Modern Rheumatologist Possess? Part II. "Certain Technical Procedures".

Rheumatologists have never been reluctant to adopt procedures that might enhance their diagnostic or therapeutic powers. Their propensity to penetrate the joints of the patients they were treating set them apart from the general internist. Since the 1980s, when a chance to look inside the joints they were treating attracted a few rheumatologists, other things that could be done at the bedside emerged with now an array of bedside procedures that could be part of a rheumatologist's skill set. Besides gains in diagnosis and/or therapy, each constitutes a chance to restore the physical contact between physician and patient, riven by factors of the last decade, such as electronic medical records and COVID. With such contact so important to satisfaction of the patient and physician alike, acquisition of proficiency in certain technical procedures described herein offers one path to begin restoring rheumatology to the richly fulfilling practice it once was.

Peer-to-peer clinical teaching by medical students in the formal curriculum

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

What Bedside Skills Could the Modern Rheumatologist Possess? Part I. The Basics.

The hands-on aspect of rheumatologic practice serves to balance its more cerebral features with the everyday necessity to touch patients to assess their condition, obtain samples for diagnosis, and deliver therapy, all cementing the important bond between patient and physician. Factors over recent years, ranging from the intercession of the electronic medical record to COVID, have weakened this bond, which we must restore if the practice of rheumatology is to return to previous levels of satisfaction. We review herein, in 2 parts, the many ways rheumatologists may interact physically with patients, with hope that pursuit of these measures can enhance satisfaction of physician and patient alike. This first installment reviews those simple skills in place before more involved technical bedside skill began to evolve over the last half century.

Flipping the classroom in neurological bedside teaching: a prospective controlled study

BackgroundBedside 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.MethodsIn 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.ResultsTheoretical 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).ConclusionsUsing 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.

Evaluation of a graduate nurse residency program: A retrospective longitudinal study

BackgroundThere is an urgency to retain nurses globally. Evidence has shown that nurse residency programs promote retention of new graduate nurses. However, there is a dearth of studies examining the impact of nurse residency programs longitudinally. AimTo evaluate the impact of a transition-to-practice program on new graduate nurses' practice confidence and job satisfaction over 24 months. DesignA retrospective longitudinal study. SettingA 1200-bed public tertiary academic hospital. ParticipantsNew graduate nurses from local universities who joined the hospital and were enrolled in the Graduate Nurse Residency Program (n = 104). MethodsThe program was conducted for 24 months and consisted of modules on bedside knowledge and skills, and a mentorship program with senior nurse leaders. Practice confidence and job satisfaction were measured using the Casey-Fink graduate nurse experience survey. The survey was administered four times over the 24 months as part of the program. Data was analyzed using repeated measures ANOVA. ResultsPractice confidence increased and job satisfaction decreased over the 24 months. Practice confidence total score at 6 months and an extended probation period were factors associated with attrition during the 24-month clinical practice. ConclusionsThis is the first longitudinal study to demonstrate the impact of a transition-to-practice program in a multiethnic Asian setting. The Graduate Nurse Residency Program enhanced the practice confidence of new graduate nurses.

Master clinical teachers and personalised learning.

Clinical history taking and physical examination are two of the most important competencies of physicians. In addition to informing diagnoses, these activities build rapport and establish relationships between caregivers and patients. Despite this, emphasis on the assessment of bedside clinical skills is declining. To prepare our students for clinical work, we began a clinical competency, personalised teaching programme in which students perform a history and physical examination in front of a master clinical teacher (MCT) approximately every 2 weeks throughout their core clerkship year. The MCT works with the student in a clinical encounter, providing personalised bedside instruction on all features of being a clinician including bedside manner, history-taking skills, physical examination skills, and clinical reasoning. The MCT then provides an assessment of student's competency development and gives feedback to the student about what they do well and where they have opportunities for growth. Assessment data are collected and tracked longitudinally across the clerkship phase to ensure that each student is progressing developmentally. With over 6000 observations of student performance, we are able to discern competency development and growth over time. We can identify if a student is not improving as expected during their clerkship phase and intervene by providing extra practice and training. This core clerkship teaching programme has been well received by both students and instructors and has led us to pilot this approach during the post-clerkship phase of our medical training.

A Multi-Institutional Needs Assessment in the Development of a Robotic Surgery Curriculum: Perceptions From Resident and Faculty Surgeons

The growing adoption of robotic-assisted surgery mandates residents must acquire robotic skills. No standardized curriculum for robotic surgery exists. Therefore, programs have developed their own curricula, which are often unstructured and based on resource availability. With this strategy programs may not adhere to scholarly approaches in curriculum development. We aimed to obtain a multi-institutional needs assessment to address training needs and identify integral components of a formalized robotic surgery curriculum. A 10-question survey was distributed to general surgery residents. A separate 7-question survey was sent to robotic faculty surgeons at 3 institutions. Survey questions queried demographics, opinions regarding robotic training, proficiency definitions, and identification of procedures and instructional strategies for a curriculum. Mann- Whitney U test and Fisher's exact test were performed to compare responses amongst residents and faculty. Spearman's correlation was used to identify relationships between experience or post-graduate year (PGY) with response selection. Both residents and faculty believed robotic training should start in the PGY1 (55.1% vs 52%; p = 0.58). Faculty recognized robotic training to be more important compared to residents (84% vs 58.1%; p < 0.05). Both groups considered a minimum of 21 to 40 robotic cases to be sufficient exposure during training (p = 0.30). Cholecystectomy (82.4% vs 72%; p = 0.261), ventral hernia repair (89.2% vs 88%; p = 1.0), inguinal hernia repair (91.9% vs 92%; p = 1.0), and right colectomy (83.8% vs 80%; p = 0.7) were considered to be the most appropriate robotic procedures during training. Both groups concurred that bedside (91.9% vs 100%; p = 0.33) and console skills training (97.3% vs 100%; p = 1.0), small group simulation (94.6% vs 72% p = 0.005), and independent practice (87.8% vs 92% p = 0.73), were instructional strategies vital to a curriculum. Faculty considered online didactic modules (96% vs 59.5%; p < 0.05) to be more important, whereas residents favored small group experiences for fundamental skills (94.6% vs. 72%; p < 0.05) and procedure-based simulation (96% vs 64%; p < 0.05). Our targeted needs assessment identified requisite components of a robotics curriculum, which are feasible and accepted by both residents and faculty. Medical educators can use this as a resource to develop a formal robotics training curriculum.

The effectiveness of bedside handover training to improve knowledge, attitudes, and skills among nurses

Bedside handover is a strategy to improve communication accuracy during handovers so nurses can share information between them, involve patients in nursing care, and improve patient's environment safety. Bedside handovers have been carried out at Public Hospitals in Aceh Province, Indonesia but it has not been systematically and optimally implemented. Limited knowledge about bedside handover can reduce the quality of nursing care provided by nurses. The nurses’ knowledge limitation can be increased through training about bedside handover. This study aimed to determine the effectiveness of bedside handover training to improve the knowledge, attitudes, and skills among nurses. This study was a quasi-experimental study with one group pre- and post-test design. The convenience sampling method was used to collect data from 64 nurses working in a public hospital in the capital of Aceh Province. All participants were provided two-days training (three-hours a day) about bedside hand over. Program effectiveness was assessed one week before and after program training completion using a paper-based questionnaire and an observation list. Data were analysed using parametric statistical tests and paired t -test. Results of the study shows that there was a statistically significant increase of nurses’ knowledge ( t = 3.77; p = 0,000), nurses’ attitudes ( t = 8.29; p = 0,000), and nurses’ skills ( t = 11.83; p = 0.000) following the program training completion. Bedside handover training is an effective strategy to increase the nurses’ knowledge, attitudes, and skills. The training can be considered as an alternative strategy to improve bedside handover knowledge, attitudes, and skills among nurses in hospitals setting.

PICU Overnight INTerprofessional Education of Residents (POINTER): Leveraging Bedside Experience to Improve Resident Bedside Care.

Resident education rarely includes training in the hands-on mechanics of care delivery; however, these bedside skills and knowledge are necessary for patient care and crucial when time and resources are limited. Nurses and respiratory therapists are content experts in this arena yet are rarely asked to provide formal education to resident physicians. Leveraging their bedside experience to enhance resident instruction represents a unique opportunity to address this area of need while working to improve interprofessional collaborative practice through interprofessional education (IPE).1At Children's Hospital of Philadelphia, an intensive care unit (ICU) hospitalist, nurse, and respiratory therapist developed a bedside care curriculum to deliver to pediatric and emergency medicine residents during their 1-month ICU rotation using nurses and respiratory therapists as educators. The primary aim of the PICU Overnight INTerprofessional Education of Residents (POINTER) program was to improve resident bedside care knowledge. Secondary aims were to increase resident comfort with and participation in bedside care and promote interprofessional collaboration.An informal needs assessment identified content areas of interest which were formulated into 4 hands-on sessions by the team: code cart and push-pull fluid delivery system (CCPP), arterial lines (AL), central and peripheral venous access (CPVA), and tracheostomy and respiratory management (TR). Thirty-minute sessions were delivered Monday through Thursday nights (content rotated weekly) to align with resident Q4 call schedule and to avoid conflicts with daytime educational opportunities; timing was flexible to accommodate unit acuity as well as educator and resident availability. Sessions were conducted in-unit using available materials and at bedside when feasible (eg, to demonstrate arterial line setup). Educators signed up to teach during regularly scheduled shifts using a shared calendar. The curriculum had no associated developmental or ongoing costs, and maintenance required less than 1 hour of administrative work per week.The POINTER program was prospectively evaluated using pre- and post-surveys to measure resident knowledge, comfort, and participation in bedside care. The curriculum and interprofessional collaboration were assessed using open-ended questions and a modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration survey.Ninety-eight residents and 27 respiratory therapists and nurse educators participated over 10 months (August 2020-May 2021), and residents attended a median of 3 sessions. Survey completion rate (pre- and post-curriculum) was 51% (50 of 98) for residents and 43% (10 of 23) for educators.Residents demonstrated increased bedside care knowledge and comfort overall (both P&lt;.001; Table). Residents who attended the CCPP, AL, or TR session showed improved comfort with these skills (P&lt;.001, P&lt;.001, P=.018, respectively), and residents who attended the AL session increased knowledge (P=.004) and participation (P&lt;.001) compared to those who did not attend. Residents self-reported that POINTER improved their knowledge (84%, 42 of 50), made them better clinicians/residents (72%, 36 of 50 unique residents), increased their pre-post understanding of the nurse/respiratory therapist knowledge base (60%, 30 of 50, P&lt;.001), and the program should continue (76%, 38 of 50). Residents' attitudes toward physician-nurse collaboration did not change, though they were high at baseline (median score 39/40). Educators enjoyed participating (90%, 9 of 10 educators) and felt they became better teachers (80%, 8 of 10).Resident comments included: “Practical,” “Unique way to learn hands-on skills,” “It filled a gap in our knowledge,” and “I loved...to learn from RTs and RNs! They have a lot of knowledge, and we rarely have formalized time for education with them.”Educator comments included: “I enjoyed helping the residents learn…and get hands-on training,” and “I had taken for granted what the residents know.... They don't have as much experience or understanding as I thought, and they need that to help make medical decisions.”In conclusion, we successfully developed and deployed a novel IPE-based resident overnight curriculum utilizing bedside nurses and respiratory therapists as educators at low cost. Participants appreciated its practical, interdisciplinary nature and increased their knowledge, comfort with, and participation in bedside care. Given its flexibility and customizability, POINTER is likely generalizable to any field with bedside care provided by non-physicians willing to educate learners.

Moral Injury.

Moral Injury.

Upgrading Bedside Skills - A Must in Caring for the Elderly

Upgrading Bedside Skills - A Must in Caring for the Elderly

Nurses' Experiences with Implementation of a Postcesarean Birth Opioid-Sparing Protocol.

Opioid-sparing protocols have significantly reduced opioid use postcesarean birth through maximizing nonpharmacologic and nonopioid pain management tools. This study explored nurses' experiences with an opioid-sparing protocol at a single institution, where inpatient opioid prescribing was reduced by over half. Focus groups were used to identify key facilitators and barriers to implementation of the opioid-sparing protocol. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Focus groups were recorded, transcribed, thematically coded, and analyzed for barriers and facilitators using predetermined CFIR domains. Three focus groups of nurses who care for women during postpartum were conducted in March and April 2019. Fourteen nurses participated. They were all women, with an average of 9.3 years (SD = 5.4) of maternity nursing experience. Facilitators of implementation were: 1) high satisfaction with the intervention's efficacy; 2) awareness of opioid harms promoting readiness for opioid-sparing efforts; 3) adequate staffing and the culture of evidence-based practice; and 4) bedside skills in pain management to identify patients' needs. The most significant barrier was a lack of nurse engagement with protocol development and implementation. An increased partnership among the interprofessional team members through all stages of implementation is necessary for the success and sustainability of best patient care practices.

Determining the utility of peer-assisted learning to enhance clinical skills at the bedside in a Postgraduate Homoeopathic Institute

Objectives: Despite considerable clinical material in hospitals, students often cannot hone their bedside skills; these skills need continuous practice and input from teachers and medical officers (MOs). Making such inputs frequently available to students in busy wards and casualties is very demanding. We, therefore, conducted this study to explore the utility of peer-assisted learning (PAL) as an alternative to enhance students’ clinical skills at the bedside in a Postgraduate Homoeopathic Institute. This study was conducted at a 100-bedded Homoeopathic PG institute hospital with a 24-h emergency ward where various clinical conditions and emergency cases are treated. The objectives of the study were to study the role of PAL in enhancing clinical skills in terms of receiving the patient, history taking, clinical examination, and developing collaborative and constructive practices at the bedside and exploring the role of PAL in developing a conducive atmosphere of learning and to enhance sensitivity to peers. Materials and Methods: An orientation session and checklist were created after input from MOs and through a pilot study of 25 Part one senior. The students were educated regarding the concept and were asked to take up one case every week to observe and discuss each other’s clinical skills for 12 weeks with the help of a checklist. A retrospective pre-questionnaire was used to analyze the enhancement of clinical bedside skills. The MO analyzed these using the same questionnaire and collectively analyzed student performance at the end of 12 weeks. Results: Student responses were evaluated statistically using the Wilcoxon matched pairs signed-rank test (P ≤ 0.05). The results revealed a significant change in history-taking attitude, history-taking skills and knowledge, examination skills, investigation correlations, interpersonal relationships, and learning atmosphere. Conclusion: The process of PAL enables student physicians to improve their clinical knowledge, skills, and attitude along with interpersonal relations. This process also enables collaborative and constructive learning and improves students’ sensitivities, allowing them to learn from each other.

Impact of Fellows-as-Teachers Workshops on Teaching Rounds: An Observational Study in an ICU.

Prospective pre-/postintervention observational study of ICU rounds. Tertiary-care medical ICU with both pulmonary critical care and critical care medicine fellowships. ICU teaching teams. Fellows attended immersive workshops on promoting clinical reasoning, managing the learning environment, teaching bedside skills, and developing situational awareness on ICU rounds. After the workshops, faculty physicians were encouraged to have fellows routinely lead afternoon rounds. We gathered data from direct observations of ICU rounding activities, residents' evaluations of rounds from surveys, and faculty physicians' written comments on fellows' performance in the ICU from end-of-rotation evaluations. Data were analyzed using descriptive statistics, nonparametric comparative tests, and chi-square tests for categorical data. A total of 61 ICU rounding sessions were observed with 501 discrete provider-patient interactions. Survey responses were collected from a total of 53 residents preintervention and 34 residents postintervention. We reviewed 72 open-ended faculty comments on fellows' end-of-rotation evaluations, with 22 occurring postintervention. During the postintervention period, fellows were significantly more likely to make clinical decisions, explain their reasoning, provide teaching points, and ask questions on rounds. Additionally, we observed significantly higher quality written feedback on end-of-rotation evaluations by faculty physicians. However, residents generally harbored neutral or negative perceptions about the educational value of fellow-led rounds postintervention. Fellows' contributions to patient care and teaching on ICU rounds increased for several months after our fellows-as-teachers workshops. Despite limitations and contamination in our design, our data suggest that similarly designed curricula may promote fellow engagement, possibly at the expense of residents' education.

I Will Be at Your (Bed)Side – The Role of Bedside Echocardiography for Non-Cardiologists

As the availability of portable echocardiographic equipment is becoming more and more widespread, physicians can add a powerful tool to their bedside examination skills, thus helping them to more effectively face the growing complexity of patients admitted to internal medicine departments or the emergency room. Focused cardiac ultrasound (FoCUS) can be defined as a goal-directed, simplified, qualitative examination performed at the bedside using portable echocardiographic devices. FoCUS is not meant to be a substitute for a standard 2D color Doppler echocardiographic examination. Nevertheless, it can provide rapid and reliable information when limited to basic questions, even when performed by non-cardiologists with brief training. Furthermore, a focused cardiac ultrasound examination maximizes its diagnostic role when integrated with an ultrasonographic assessment of the lung, abdomen and deep veins, in a multisystem approach that is particularly dear to internists. In this article, we will focus on the specific targets of a focused cardiac ultrasound examination, as well as the most common pitfalls that can be encountered in ultrasonographic practice. We will also address the application of FoCUS in the management of two typical scenarios in clinical practice, such as dyspnea and non-post-traumatic hypotension.

Breathing life into bedside teaching in the era of COVID-19

Bedside skills have been declining over the last two decades, with multiple studies reporting increasing reliance on investigations and technology in making diagnostic decisions. During the Covid-19 crisis, even less time is spent at the bedside, and physical examinations seem markedly truncated or non-existent. It is possible that cost of health care, doctor-patient relationships, and the clinical reasoning skills could be seriously impacted by ongoing decrease in bedside skills and the teaching of these skills. Careful history taking and hypothesis-driven physical examination still form the backbone of clinical reasoning and lead to parsimonious investigations. Overreliance on investigations could drive up costs of healthcare if every diagnosis depends on a head to toe scan. In this paper, we describe strategies for bedside teaching that are relevant and applicable even during the pandemic and an era of physical distancing. These strategies are categorised as: before, during and after patient interactions at the bedside. These strategies can be adapted to normal clinical teaching situations as well as challenging situations such as the current pandemic when physical distancing is mandated.

A Qualitative Exploration to Understand Hospitalists' Attitude Toward the Patient Experience Scoring System.

Patient’s perception of their inpatient experience is measured by the Center for Medical Services’ (CMS) administered Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey. There is scant existing literature on physicians’ perceptions toward the HCAHPS scoring system. Understanding hospitalist knowledge and attitude toward the HCAHPS survey can help guide efforts to impact HCAHPS survey scores by improving the patient’s perception of their hospital experience. The goal of this study is to explore hospitalists’ knowledge and perspective of the physician communication domain of the HCAHPS survey at an academic medical center. Seven hospitalists at an academic medical center were interviewed for this report using a semistructured interview. Thematic analysis approach was used to analyze data. Open, line-by-line coding was performed on all 7 transcripts. Categories were derived in an inductive fashion. Categories were refined using the techniques of constant comparison and axial coding. We generated themes reflecting hospitalists’ knowledge of the HCAHPS scoring system, their perception of the HCAHPS scoring system and the impact of the HCAHPS scoring system on their practice. While hospitalists acknowledged physician–patient communication is a challenging area to study, they are unlikely to embrace the feedback provided by HCAHPS surveys. There is a need to deploy tactics that provide timely and actionable feedback to providers on their bedside communication skills.

Disconnections between medical education and medical practice: A neglected dilemma

ABSTRACT Medical practice has changed profoundly over the past 60 years. Many changes have also been made in medical education, often with a view to countering adverse aspects of highly specialised, commercialised and bureaucratised modern medical practice. Regardless of the state of the world today and of the variety of changes that may occur in the years ahead, excellence in the application of bedside skills and technological advances, accompanied by excellence in humanistic aspects of caring for patients as people, will remain preeminent goals at the heart of medical practice. Powerful social forces that negatively influence practice cannot be counteracted through changes in medical education alone and need to be addressed directly within health systems. Shifting healthcare towards a valued social service is arguably essential for improving both public and individual health through more widespread universal access to high quality and effectively integrated health care.

Aftermath of COVID-19: Need for developing novel bedside communication skills?

Aftermath of COVID-19: Need for developing novel bedside communication skills?