Exam room presentations and teaching in outpatient pediatrics: effects on visit duration and parent, attending...

To examine the effects of exam room presentations and teaching (ERPT) in a busy outpatient pediatric setting on visit duration and on parent, preceptor, and resident perceptions.

This 8-week, 2-method crossover study compared first-year pediatric resident patient presentations and attending physician teaching and discussion in the exam room (ERPT) with conference area presentation and teaching (CAPT). Outcome measures included visit duration, parent satisfaction, and resident/attending physician perceptions. Differences were analyzed using chi2 (parent surveys), t tests (visit duration), and signed rank tests (Attending Physician and Resident Surveys).

Three hundred forty patient encounters were studied (151 ERPT vs 189 CAPT) that involved 15 first-year pediatric residents and 15 attending physicians. Visit durations were equivalent. Parent satisfaction was high in both methods. Attending physicians favored ERPT for adding opportunities to evaluate resident competencies, provide informed feedback, and role model. Attending physicians felt that ERPT decreased resident comfort level when discussing sensitive topics. Residents were less comfortable with ERPT for discussing sensitive topics and felt somewhat embarrassed when they did not know the answer to attending physicians' questions. Residents reported that ERPT presentations permitted attending physicians to demonstrate more physical exam skills and to observe interactions, enabling more informed feedback.

ERPT and CAPT require similar time and result in high parent satisfaction. Although residents are a little less comfortable with ERPT, attending physicians are better able to observe, evaluate, and give feedback on resident skills and to role model and teach physical diagnosis.