The art of bedside rounds: A multi-center qualitative study of strategies used by experienced bedside teachers

Jed D. Gonzalo, Brian S. Heist, Briar L. Duffy, Liselotte Dyrbye, Mark J. Fagan, Gary Ferenchick, Heather Harrell, Paul A. Hemmer, Walter N. Kernan, Jennifer R. Kogan, Colleen Rafferty, Raymond Wong, D. Michael Elnicki

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

BACKGROUND: Medical educators believe bedside rounds are effective for the delivery of patient-centered care, and are necessary in helping trainees acquire competence in clinical care. Although recommendations for bedside rounds have been reported, a recent, systematic assessment of strategies used by current-day bedside teachers was needed to advance knowledge of this teaching method. OBJECTIVE: To identify and understand bedside teachers' 1) preparatory steps, 2) patient selection, and 3) role allocation during the process of bedside rounds. DESIGN: A qualitative inductive thematic analysis using transcripts from audio-recorded, semi-structured telephone interviews. PARTICIPANTS: Internal medicine physicians (n = 34) who perform bedside rounds from ten academic US institutions (2010-2011). APPROACH: A purposive sampling strategy was utilized to identify physicians who were active inpatient attending physicians and met specific inclusion criteria for "bedside rounds." A total of 34 interviews were completed, and each was recorded and transcribed verbatim. A thematic analysis extracted key themes pertaining to the three objectives. KEY RESULTS: Most respondents (51 %) were associate or full professors, with an average of 14 years of academic experience. Attending physicians prepared using trainee-specific, patient-specific and disease-specific information, while also mentally preparing for bedside rounds. They sought trainee buy-in and learning objectives, reviewed expectations and methods to ensure patient comfort, and provided early guidance with bedside encounters. Patients were selected if they required immediate care, were new to the service, or had a high educational value, while patients were deferred if unavailable, unwilling, or unable to communicate. The team members' roles during bedside rounds varied, with trainees being given graduated autonomy with increased experience. CONCLUSIONS: Bedside teachers' methods for preparation, patient selection, and role allocation during bedside rounds enhance trainees' education within the workplace. Strategies used by experienced bedside teachers can be used for faculty development efforts aimed at promoting this activity.

Original languageEnglish (US)
Pages (from-to)412-420
Number of pages9
JournalJournal of general internal medicine
Volume28
Issue number3
DOIs
StatePublished - Mar 2013

Keywords

  • medical education
  • medical education-faculty development
  • medical education-qualitative methods
  • patient-centered care

ASJC Scopus subject areas

  • Internal Medicine

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    Gonzalo, J. D., Heist, B. S., Duffy, B. L., Dyrbye, L., Fagan, M. J., Ferenchick, G., Harrell, H., Hemmer, P. A., Kernan, W. N., Kogan, J. R., Rafferty, C., Wong, R., & Elnicki, D. M. (2013). The art of bedside rounds: A multi-center qualitative study of strategies used by experienced bedside teachers. Journal of general internal medicine, 28(3), 412-420. https://doi.org/10.1007/s11606-012-2259-2