The Road Back to the Bedside

Elder, Andrew; Chi, Jeff; Ozdalga, Errol; Kugler, John; Verghese, Abraham

doi:10.1001/jama.2013.227195

Cited by 42 publications

(33 citation statements)

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“…In addition to the opportunity to learn proper techniques for history-taking and examination, modeling is essential for teaching physician-patient communication skills and professionalism, 4 and this pilot provided further opportunity for such learning.…”

Section: Flow and Organization Of Examinationmentioning

confidence: 99%

“…Numerous editorial and opinion articles have been published in recent years highlighting the decline in bedside skills education for medical trainees and the effect of this on patient care. [1][2][3][4] Despite this knowledge, it is currently estimated that only 8%-19% of learning is done in the presence of the patient. 5 Barriers to bedside teaching include devaluation of teaching and inadequate faculty development to promote bedside teaching skills among faculty.…”

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confidence: 99%

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Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning

et al. 2017

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Objective: To evaluate the effect of scheduled bedside skills modeling for third-year medical students on their neurology clerkship.Methods: During the 2012-2014 academic years, 56 third-year medical students participated in a curricular pilot program involving a scheduled bedside skills modeling experience during the first week of their neurology clerkship, whereas 131 students underwent the typical rotation. The experience consisted of observing a faculty member conduct a comprehensive encounter on a new outpatient. To promote active learning, students were provided an observation guide to document questions and observations. An anonymous survey was conducted at the end of each clerkship block assessing student exposure to bedside skills modeling. Using qualitative thematic analysis, observation guide statements were transcribed and coded into emergent learning themes.Results: A total of 57.4% (95% confidence interval [CI] 43.3%-71.5%) of students in the modeling group reported observing both a comprehensive history and neurologic examination vs 37.5% (95% CI 28.2%-46.8%) in the nonmodeling groups (p 5 0.023). A total of 253 observation statements were transcribed and coded from the observation guides. The most common learning themes included (1) strategies for performing a neurologic examination, (2) techniques for eliciting a neurologic history, and (3) importance of detail and thoroughness of the history and examination.Conclusions: Our study demonstrated that there was a significant increase in structured observation by students of neurologic bedside skills with the inclusion of a scheduled modeling experience, and we provide a qualitative description of the most common learning themes associated with this experience. Neurology ® 2017;88:e236-e239 GLOSSARY CI 5 confidence interval.In the modern medical era, bedside skills have become devalued with increased reliance on medical technological advances and the electronic health record. Numerous editorial and opinion articles have been published in recent years highlighting the decline in bedside skills education for medical trainees and the effect of this on patient care.1-4 Despite this knowledge, it is currently estimated that only 8%-19% of learning is done in the presence of the patient.5 Barriers to bedside teaching include devaluation of teaching and inadequate faculty development to promote bedside teaching skills among faculty.6,7 Modeling of clinical encounters has been shown to improve both physical examination and procedural skills, and can be effective for teaching humanism and professionalism values. 8-10The aim of this study was to evaluate whether a scheduled modeling experience for third-year medical students starting their neurology clerkship increased overall student exposure to clinical skills modeling during the clerkship. In addition, we intended to discover using qualitative thematic analysis what specific learning points were acquired during the experience. Dentistry third-year neurology clerks participated in a pilot aimed at ...

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Section: Flow and Organization Of Examinationmentioning

confidence: 99%

mentioning

confidence: 99%

Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning

et al. 2017

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“…Although the role of bedside skills, particularly physical examination, is increasingly questioned in technologically driven western healthcare environments, I doubted that these skills were being deliberately de-emphasised in a national medical curriculum, in this country, at this time. 6 But, whatever the explanation, their low curricular profi le made the lack of rigorous assessment less surprising.…”

Section: In Praise Of Clinical Examinationsmentioning

confidence: 99%

In praise of clinical examinations

Elder

2014

Clinical Medicine

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“…The time that residents spend in direct contact with patients has decreased from over 20% of their workday in the 1990's to less than to 10% in recent years [2][3][4][5]. Many factors contribute to this shift away from the bedside, including the electronic health record (EHR), duty hour regulations, and operational pressures in academic medical centers [6][7][8][9][10][11][12]. It is not surprising that less time at the bedside has contributed to a measurable decline in physical exam skills [13][14][15][16][17], in part due to a decreased emphasis on physical diagnosis teaching and practice [7,15,18,19].…”

Section: Introductionmentioning

confidence: 99%

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

et al. 2017

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Background: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. Methods: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). Results: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. Conclusions: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

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The Road Back to the Bedside

Cited by 42 publications

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Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning

Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning

In praise of clinical examinations

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

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