Teaching Rounds Research Articles

The Chang Gung Memorial Hospital Microsurgery Fellowship: A Review of 1 Year of Experience.

Sir: The microsurgery fellowship at the Chang Gung Memorial Hospital in Taiwan was founded in 1984 by Professor Fu Chan Wei.1 The Department of Plastic and Reconstructive Surgery offers a 1-year fellowship in microsurgery. The fellowship setup, diversity and number of cases, and high success rate make it a sought target for training. In this article, I share my personal experience from a 1-year fellowship as a guide tool for those considering microsurgery training at this prestigious institution. FELLOWSHIP SETUP This fellowship is provided by the Division of Microsurgery at the Department of Plastic and Reconstructive Surgery. In total, 6 to 8 fellows are selected annually for duration of 1 year. Different areas of reconstruction are covered during the fellowship, and rotations can be customized based on the need and interest of the fellows, and these areas include head and neck reconstruction, breast reconstruction and lymphedema surgery, upper limb reconstruction, lower limb and trauma reconstruction, peripheral nerve, and facial reanimation. The fellowship is based on the principle of mentorship, and the year is composed of six 2-month rotations, where in each rotation, the team is composed of the professor, the fellow, and 1 resident. The fellow is engaged actively in the clinical and operative activity including the preoperative planning and postoperative care. There is no assigned on-call schedule for the fellow; however, he/she is expected to be in any flap takeback for the team as part of the learning experience. Table 1 summarizes the structure of the fellowship.Table 1.: Fellowship StructureEDUCATION Activities that emphasize educational value to enrich the theoretical knowledge and surgical judgment skills are as follows: Biweekly plastic surgery grand rounds: Valuable review of topics in plastic surgery, updates, and new researches are discussed. Weekly microsurgery teaching rounds: During this meeting, a review of scientific microsurgery articles, book chapters, and all cases mandates exploration during that week. Thirty-four scientific articles and 8 book chapters were reviewed this year. Operative education: Formal teaching about surgical cases is done at the day of surgery where there will be a full presentation of the cases followed by relevant literature review. SURGICAL CASES AND WORKLOAD There was an average of 3 operative days, with 2 rooms running simultaneously, and 1½ clinic days each week. The cases included microsurgical cases (free flaps, peripheral nerve surgery, and lymphatic surgery), pedicle flap, and secondary revision for all procedures. I was involved in a total of 164 cases: 101 microsurgical cases, 4 pedicled flaps, and 59 nonmicrosurgical cases. Table 2 summarizes the areas and flaps for reconstruction.Table 2.: Area of Reconstruction and Types of Free FlapRESEARCH OPPORTUNITY AND FUNDING There are ample opportunities for research in different aspects of reconstructive microsurgery. Funding is not promised for the fellow during this year. CONCLUSIONS The microsurgery fellowship at the Chang Gung Memorial Hospital provides an unparalleled opportunity to learn, understand, and practice microsurgery. I personally liked the fellowship setup, diversity and surgical loads, and the advanced techniques used here, which I think are reproducible and essential to achieve competency in microsurgery. ACKNOWLEDGMENTS The author would like to acknowledge all the professors at the Department of Plastic Surgery and the Ministry of Foreign Affairs of Taiwan (MOFA).

Application of SBAR for nurse students morning rounds in operation room

Objective To identify the effect of SBAR (situation, background, assessment, recommendation) in OR (operating room) nursing teaching rounds. Methods According to internship turns, routine group (even number, Group A: 68 students) and SBAR group (odd number, Group B: 70 students) were chosen by drawing lots. Group A used conventional mode for history report, while Group B used SBAR mode. Students' performance was evaluated by OR nurse students' rounds standard scale and the reporting time was recorded. Each nurse students filled in Communication Self-efficacy Evaluation Form on the fifth week in OR. The information was input into excel. The results of the two groups were compared with SPSS 11, and the data were analyzed by chi square test and t test. Results The average reporting quality score was 16.74 for Group A, and 18.66 for Group B. The average score of Group B was higher than that of Group A. Compared with the cases scores above 18 between the two groups, the result was statistically significant, P=0.039. The average score of communication Self-efficacy in Group A was 42.88, while it was 44.94 in Group B, which showed that Group B had better score than that of Group A. Significant differences was found between the two groups when compared the cases with score above 45, P=0.010. The average reporting time was (2.42±1.16) minutes for Group A and (2.32±1.21) for Group B, and there is no significant differences between the 2 groups. Conclusion SBAR is helpful for improving students communication Self-efficacy, and making progress on nursing round reporting quality, and it is worth promoting in clinical teaching. Key words: Clinic teaching; SBAR (situation, background, assessment, recommendation); Ope-rating room

Multiple and Concurrent Arrhythmia.

Given the unique interventional emphasis in our specialty, Teaching Rounds in Cardiac Electrophysiology has frequently centered on the pearls and pitfalls associated with electrogram analysis and complications of lead implant extraction or ablation and in mapping complex arrhythmia circuits. In this issue of Circulation: Arrhythmia and Electrophysiology , Fabrizio et al,1 in a refreshing departure from this norm, take us to a more classic medical teaching rounds relevant to rhythm management. They present a patient with multiple changing malignant rhythm disorders resulting from caffeine toxicity. Their submission is replete with clinical diagnostic dilemmas, treatment difficulties, and also a succinct but comprehensive discussion of caffeine toxicity and the heart. See Article by Fabrizio et al Most often in the electrophysiology laboratory, we deal with one primary arrhythmia in a patient, some which occur in structurally normal hearts and others specifically related to structural cardiac disease. Occasionally, multiple disparate arrhythmias are related, and most of these are well recognized by electrophysiologists. Accessory pathway–related supraventricular tachycardia and atrial fibrillation, atrioventricular (AV) node reentrant tachycardia, and outflow tract ventricular tachycardia (VT) are well-recognized examples. Multiple and changing tachycardias emerging in a relatively short time frame may also occur in the setting of myocarditis or other changing substrate. Less commonly, more than one unrelated rhythm disorder may be present at the same time, such as 2 different VTs producing a bidirectional pattern or the concurrent atrial tachycardias and VTs of digitalis toxicity. Fabrizio et al discuss the less well appreciated occurrences of multiple as well …

Bedside Education Will Be More Important than Now in the Age of Artificial Intelligence

The birth of the scientific revolution, brought forth by Vesalius and Copernicus in 1543, marked the beginning of a new age. However, the changes such as treatment effectiveness, survival rate, prevalence of specific diseases, etc. had not yet become clear during the 16th century. In the early 17th century, Boerhaave emphasized bedside teaching and practice. His attitude influenced numerous students and educators, so many medical students visited hospital wards where he worked. From the late 18th to 19th centuries, Jenner’s smallpox vaccination, Pasteur’s anthrax and rabies vaccinations, and Koch’s four postulates used to detect pathogens were developed using the scientific research method, which initiated big changes for medicine. Flexner, credited for reporting the new medical education system, adopted scientific medicine. He believed medical students must study basic medical science since it could be the foundation of clinical medicine and lead to a revolution in the field. He proposed a new medical curriculum composed of two-years of basic medicine and two-years of clinical medicine, which has been used more than 100 years. During the late 20th century, bedside teaching rounds decreased gradually as scientific medicine has become popular. Many medical educators in many articles have proposed bedside education as an effective method for medical learning. Despite the advent of the age of artificial intelligence and the changing of medical environments in the near future, bedside education will be more useful and important for medical students, educators, and patients as it is a traditional method and essential for patients who desire a more personal approach.

Attending physicians’ attitudes towards physical exam and bedside teaching

This article was migrated. The article was marked as recommended. Background: Medical education has experienced a gradual shift away from traditional bedside attending rounds, from 75% of rounds occurring at bedside in the 1960s to about 30% today. Aim: To examine attending physicians' attitudes towards bedside teaching and physical exam. Methods: Anonymous survey of medical attendings in six academic hospitals. Results: 77% of respondents (n=97) completed the survey. The vast majority (89%) of attendings concurred that physical diagnosis skills are essential, felt that more emphasis on bedside teaching is needed (77%), and believed that bedside teaching should be a priority (71%). Additionally, 87% reported that bedside rounds are important to patient care. Yet, only 31% reported conducting teaching rounds at bedside. Finally, only 5% of attendings trained outside the US expressed fear of poor teaching performance in front of house staff, compared with US trained attendings (28%, p=0.023). Conclusion: Physicians are spending less and less time at the bedside, particularly those trained within the United States. At a time when the U.S. healthcare system is struggling to meet the increasing demand of escalating costs and declining patient satisfaction, the return to bedside teaching may be a surprisingly simple and untapped solution.

Particulars concerning specialist/general practitioner joint teaching rounds in community health center

专科和全科联合教学查房能满足知识、技能、全科思维全方位提高的要求，适合培养全科医师。目前社区卫生机构层面的联合教学查房经验不足，文章从选择恰当病例、查房前精心准备、查房中各司其职三方面阐述联合教学查房中的细节，为相关师资提供参考，以使教学查房达到更好的效果。

Evaluation of the effect of teaching rounds of the multidisciplinary joint radiotherapy department

Objective To explore the effect of the joint teaching rounds of the multidisciplinary radio-therapy. Methods 54 clinical college students of Grade 2013 was selected as the control group, adopting the traditional single teaching ward round model, while 58 clinical college students of Grade 2014 was se-lected as the research group, adopting the multidisciplinary joint radiation operation mode. By contrasting the satisfaction questionnaire, calculating and delineating the target volume error rate and the theory exami-nation results, the effect of teaching ward round was evaluated. Results ①According to the survey, the research group’s satisfaction in teaching methods, stimulating students' enthusiasm for learning, improving their clinical thinking ability and consolidating the knowledge (respectively 91.38%, 86.21%, 82.76%, 93.10%), was higher than that of the control group (75.93%, 68.52%, 62.96%, 77.78%), and the difference was statistically significant (chi square values were 4.95 5.05, 6.25, 5.36; P<0.05). ②The research group’s pass rate in delineation of Gross Target Volume (GTV) and the Clinical Target Volume (CTV) was (82.76%, 86.21%), higher than that of the control group (53.70%, 62.96%), and the difference was statistically signifi-cant (chi square values were 14.36, 9.48; P<0.01). ③Research group’s score in clinical Three Basics and oncology theory achievement was(88.75±5.23) and (82.72±3.69), higher than the control group [(81.88±613), (80.74±3.25) points], and the difference was statistically significant (t=6.40 respectively, 3.01; P< 0.05). Conclusion Radiotherapy department’s multi-disciplinary joint ward round helps to improve the teaching quality. Key words: Multiple disciplines; Joint rounds; Radiotherapy department

The practice and exploration of improving the teaching quality of clinical practice under the background of the outstanding doctor training

In 2012, the Ministry of Education, Ministry of Health jointly issued the notice of implementation of the outstanding doctor training plan, which stressed the need to identify the dominant position of students in learning, and strengthened the training of medical ethics and clinical practice ability of medical students. Our hospital actively explored how to improve the teaching quality of clinical practice under the culture background of excellent doctor education. We constructed undergraduate clinical practice teaching management framework of school /secondary college — educational department /teaching and research section — three disciplines / subspeciality, established clinical skills teaching and research sec-tion, cleared responsibilities of all levels, improved the clinical teaching management system, and strengthened the practice teaching and medical students' clinical skills training, and standardized teaching rounds and lectures. We also promoted the teaching and learning through clinical skills competition, and at the same time, we paid attention to the cultivation of students' medical humanities and medical science spirit, so that students could obtain better clinical practice effect, and promote the development of the reform and development of hospital education and teaching. Key words: Outstanding doctor training; Clinical practice; Teaching management; Clinical skills training; Medical humanities education

Patients' Attitude toward Breaking Bad News; a Brief Report.

Delivering bad news is a stressful moment for both physicians and patients. The purpose of this investigation was to explore the patients' preferences and attitudes toward being informed about the bad news. This cross-sectional study was done on patients admitted to Imam Khomeini Hospital, Sari, Iran, from September 2014 to February 2015. Patient attitude regarding breaking bad news was evaluated using a reliable and valid questionnaire. 130 patients were evaluated (61.5% male, mean age = 46.21 ± 12.1 years). 118 (90.76%) participants believed that the patient himself/herself should be informed about the disease's condition. 120 (92.30%) preferred to hear the news from a skillful physician and 105 (80.76%) believed that emergency department is not a proper place for breaking bad news. Based on the results of the present study, most participants believed that the most experienced and skillful physician should inform them completely regarding their medical condition. At the same time they declared that, it is best to hear bad news in a calm and suitable place and time rather than emergency department or hospital corridors during teaching rounds.

Application of clinical nursing teaching pathway on teaching round of nursing students

Objective To explore the effects of new teaching round mode in clinical nursing teaching. Methods A total of 40 nursing undergraduate students were divided into intervention group and control group from August 2013 to March 2014. The students of intervention group were treated with nursing teaching round mode guided by clinical nursing teaching pathway. The learning effects were evaluated using a self-designed questionnaire after the intervention. Results The scores of consolidating basic knowledge, arousing students′ interest of learning, improving learning ability and oral expression ability in the intervention group are higher than those of control group. The differences between the two groups were statistically significant (t=3.066, 3.681, 2.124, 1.852; P<0.05). Conclusions The nursing teaching round mode guided by clinical nursing teaching pathway with updated teaching content and methods can improve the efficiency and the quality of clinical nursing teaching. Key words: Nursing students; Clinical nursing teaching pathway; Teaching rounds; Teaching quality

Management of electronic social networks by students of medicine: The case of publication of photographs with patients and professional medical conduct.

The socio-demographic characterization of medical students at the Pontificia Universidad Javeriana in Cali, Colombia, was made using a survey and focus group discussion to collect information on access to the Internet, management of electronic social networks and the dissemination of photographs with patients taken during medical teaching rounds, a practice that constitutes a breach of professional medical conduct. To identify the management of social electronic networks by students of medicine with respect to the publication of photographs with patients. A descriptive cross-sectional study was undertaken to characterize students of medicine at the Pontificia Universidad Javeriana in Cali. Of the 423 students enrolled in January 2013, 299 participated in a survey designed with the software Cardiff TELEform®, version 10.0. Twenty students were also selected at random for a focus group discussion on the publication of photographs with patients on electronic social networks. Of the students surveyed, 97.6% claimed to be active users of at least one of the main electronic social networks (96.2% Facebook, 70.5% Instagram and 44.1% Twitter). Of these, 52 (17.6%) admitted having published a photograph showing patient care on at least one occasion. Most of the students had smartphones and user profiles on the main social electronic networks, on which they disseminated photographs of patients taken during teaching rounds, as well as images of various activities which could have ethical and legal implications and contravene standards of professional medical conduct.

The reflection after the first round of curriculum implementation of "3+ 2" assistant general practitioners training comprehensive clinical course

In the first teaching round of comprehensive clinical course of 3+2 assistant general practitioners' standardized training, we formulated the teaching principle of general, grass-roots, two-way referral. We used the case introduction teaching method, selected the five-year system undergraduate teaching material as the basic book, referred to disease guide to write teaching notes, and carried out the collective lesson preparation work in order to guarantee the teaching effect. In the next teaching round, we will put forward the teaching outline should be close to the actual needs of teaching object. We will prepare special teaching materials in which the difficulty will be still held in the five-year system undergraduate teaching material level. Through the symptoms teaching, students will know how to treat the sickness. The lesson will serve the community medical work needs and continue the in-depth discussion in the general, horizontal, and comprehensive aspects. The teachers should continue to carry out the exploration in improving the teaching method and teaching quality. Key words: Assistant general practitioner; 3+2 training model; Comprehensive clinical course; Course improvement

A pilot study of team learning on in-patient rounds.

Medical trainees often do not receive structured teaching during in-patient rounds. To assess whether the addition of a collaborative team learning technique would improve the learning experience on a general medicine in-patient team. Eight learners participated in this pilot study. Learning teams consisted of internal medicine residents and third-year medical students on a general medicine in-patient rotation. The experimental curriculum covered four common topics: cardiac stress testing; syncope; pneumonia; and valvular heart disease. Sessions had the following format: (1) each learner answered five self-assessment questions using an immediate feedback technique; (2) learners were divided into groups of two or three to discuss their answers; (3) the teaching doctor led a discussion to clarify and summarise, and also distributed a handout delineating key learning points. Control sessions consisted of the usual teaching rounds. Learners were e-mailed a daily online survey asking them to rate the rounds and handouts on a Likert scale. Medical trainees often do not receive structured teaching during in-patient rounds All of the learners rated the collaborative team learning intervention as either 'excellent' or 'very good'. Learners also indicated that they found the take-away handout valuable, and positive responses were also noted in the survey comments. A novel collaborative team learning technique resulted in high ratings of teaching rounds by medical residents and medical students. Learners found the sessions engaging, high yield, and educationally valuable. This interactive discussion-based teaching method could be used to enhance the learning experience during teaching rounds on medical, surgical and subspecialty services.

The strange case of Dr. William Gowers and Mr. Sherlock Holmes.

Not long after I had embarked on my neurological career at University College Hospital, William Gooddy’s advice to me at the end of a teaching round on Ward 5.2 came straight from William Osler. To study the phenomena of neurological disease without books was to sail an uncharted sea, but to study books without patients was not to go to sea at all. Only his book recommendations were unusual. He advised me to read The Complete Works of Sherlock Holmes , described later by its author Arthur Conan Doyle as ‘the fairy kingdom of romance’, and Marcel Proust’s A la Recherche du Temps Perdu. Much later I realized it had been his clever way of introducing a young man beginning the long apprenticeship of neurology to William Gowers, his predecessor (Frances Walshe separated the two of them) at University College Hospital. The Baker Street sleuth’s method of crime detection soon proved of far greater value than anything I had read in Brain’s Diseases of the Nervous System. Each time I took the clinical history from a patient I remembered Holmes’s words to John Openshaw in The Five Orange Pips , ‘Pray give us the essential facts from the commencement and I can afterwards question you as to those details which seem to me to be most important’. I came to see detective work as a metaphor for diagnostic acumen. In a 10-minute 1927 cinematographic recording Arthur Conan Doyle explains, ‘I thought I would try my hand at writing a story where the hero would treat crime as Dr Bell treated disease’. Joseph Bell, a surgeon at the Edinburgh Royal Infirmary, was able to divine the origins, occupation and past history of his patients from their attire, appearance and demeanour. This left a great impression on the young medical student. In …

G418(P) Paediatric oncology junior doctor confidence survey

Aims Following a Paediatric Oncology MDT event reviewing themes of ‘Teamwork and Integration’ the department was keen to explore how confident trainees are at managing Oncology patients and how teamwork could be improved within the department. Methods In October 2013 a Confidence Survey was disseminated to the current cohort of SHOs and SpRs. Confidence and support questions were answered on a scale rating system, and space given for additional comments. Results were analysed and change implemented in January 2014 with re-audit in August 2014. Results Initial survey numbers were small with a poor response rate (39%). However in those that responded clear themes emerged. No trainees were aware of when the Oncology MDT meeting occurs, and none felt part of the Oncology team. 66% of trainees felt Oncology teaching and clinical exposure failed to meet their curriculum needs. In general the registrars felt more confident managing patients and reassuringly most felt supported by the team. In the free-flow comments, there was demand to attend oncology clinics and spend more time on the Oncology Unit. Trainees requested teaching expansion beyond febrile neutropenia and to include practical advice regarding management plans. Based on this feedback changes were implemented. This included clearer highlighting of the Oncology department, introduction of weekly ward round attendance for trainees including once a week grand round teaching, teaching sessions allocated to cover curriculum topics, introduction of weekend plan stickers and an individual patient summary front sheet. Re-audit in August 2014 showed an improved response rate (50%). There was an improvement in awareness of MDT meetings and feeling of teamwork. 70% of trainees felt Oncology teaching and exposure met their needs. Conclusions The changes clearly show an improvement in both confidence and feeling of support by the Oncology Team. By changing the clinical environment through introduction of daily ward rounds the team is better integrated and ad-hoc teaching has improved. The introduction of the summary sheets and weekend plans has helped on a day-to-day practical basis of managing patients, and has also helped junior doctors gain a better understanding of different conditions and specific management plans.

Nurses' perceived benefits of trauma nursing rounds (TNR) on clinical practice in an Australian emergency department: a mixed methods study.

Trauma nursing rounds (TNR) are a unique type of bedside teaching round that facilitate discussion of individual trauma patient's condition and care, and provide a novel and innovative approach to nursing education in an informal setting. This study introduced TNR to the emergency department in an Australian metropolitan hospital. Registered nurses, assistants-in-nursing, and nursing students participated in seven TNR over a 12-week period. The primary care nurse presented the trauma case utilising a modified handover tool. This was followed by discussion of the patient's condition and management among all those present including the patient. A participant questionnaire provided feedback from the nurses about TNR perceived benefits. A representative sample of participants was subsequently interviewed. Fifty-three participants attended the rounds, 47 responded to the questionnaire, and nine were interviewed. Participants were universally positive about the TNR structure and its potential impact on clinical practice. Interviewees indicated that TNR have the potential to enhance collegiality, and allow the patients and their families to be involved and informed in their care. The introduction of TNR was successful. TNR provide the potential to improve assessment and care of trauma patients, promote collaborative learning, and promote patients' understanding and involvement in their care.

Challenges of the ward round teaching based on the experiences of medical clinical teachers

Challenges of the ward round teaching based on the experiences of medical clinical teachers

Neonatal respiratory therapist-led rounds can improve staff satisfaction and timeliness of respiratory interventions.

Interdisciplinary rounding is used to establish and communicate patient care goals and monitor progress toward goal attainment. This study describes staff satisfaction and process outcomes associated with respiratory therapist (RT)-led interdisciplinary rounds in the neonatal ICU. We hypothesized improved staff satisfaction, execution of orders within 30 min of order entry into the electronic medical record, and communication of accurate and complete data during rounds to the interdisciplinary team. Nurses, RTs, nurse practitioners, residents, and attending physicians completed the 13-question survey eliciting demographic information and evaluating staff engagement and professional satisfaction. The survey was anonymous and confidential, and informed consent was implied. Process data were collected for a 10-d period at 2 intervals through direct observation of the rounding process and electronic medical record review. Descriptive statistics reported patient demographics, responses to job satisfaction and engagement survey questions, the number of patients who were visited in daily rounds, the number and type of orders given during rounds, and the number of respiratory orders that were addressed in multidisciplinary teaching rounds rather than during respiratory rounds. The chi-square test was used to determine differences in the proportion of inaccurate and incomplete data communicated during rounds between the 2 data collection periods. The Mann-Whitney U test was used to determine differences in the timeliness of electronic medical record order entry and time to order completion. A 94.8% survey response rate (n = 55) was obtained. Seventy-six percent of participants reported improved communication. Sixty-nine percent of participants reported improved teamwork. Eighty-six percent of orders were implemented immediately after electronic medical record entry. Correct information was provided on 95% and 99.3% of patients (P < .066) and complete information on 93% and 96% of patients (P = .41). Implementation of respiratory rounds improved staff satisfaction and the timeliness of completing respiratory orders. Spot monitoring at intermittent intervals verified process sustainability.

A piece of my mind. Bedside teaching rounds reconsidered.

A piece of my mind. Bedside teaching rounds reconsidered.

Reviving post-take surgical ward round teaching

Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p < 0.0001) and perceived learning (p < 0.0001). Consultant surgeons were supportive of the teaching initiative. Support from CTFs on busy PTSWRs optimised student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff.