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Identifying and overcoming the barriers to bedside rounds: a multicenter qualitative study
Jed D Gonzalo1, Brian S Heist, Briar L Duffy
1Dr. Gonzalo is assistant professor of medicine and public health sciences and assistant dean for health systems education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. At the time of this research, he was general internal medicine medical education fellow and clinical fellow in medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Heist is assistant professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. At the time of this research, he was general internal medicine medical education fellow and clinical fellow in medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Duffy is assistant professor of medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota. Dr. Dyrbye is associate professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. Dr. Fagan is professor of medicine, Alpert Medical School of Brown University, Providence, Rhode Island. Dr. Ferenchick is professor of medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan. Dr. Harrell is associate professor of medicine, University of Florida College of Medicine, Gainesville, Florida. Dr. Hemmer is professor of medicine and vice chairman for educational programs, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Kernan is professor of medicine, Yale University School of Medicine, New Haven, Connecticut. Dr. Kogan is associate professor of medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Rafferty is assistant professor of medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Dr. Wong is associate professor of medicine, Loma Linda University School of Medicine, Loma Linda, California. Dr. Elnicki is professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylv
Bedside rounds in teaching hospitals face decline due to system and physician barriers. Creating learner-centered environments and faculty development are key to overcoming challenges and promoting this effective teaching strategy.
Area of Science:
- Medical Education
- Healthcare Systems
- Clinical Teaching
Background:
- Bedside rounds, a recommended teaching strategy, have seen a decline in academic medical centers.
- Identifying barriers and effective strategies is crucial for its revival.
Purpose of the Study:
- To investigate reasons for the decrease in bedside rounds.
- To identify barriers to implementing bedside rounds.
- To explore methods for overcoming trainee apprehension and strategies for faculty education.
Main Methods:
- Qualitative inductive thematic analysis of semistructured interviews.
- 34 inpatient attending physicians from 10 academic U.S. institutions were interviewed.
- Analysis focused on themes of barriers, trainee apprehension, and faculty education.
Main Results:
- Physician- and system-related factors contribute to the decline; barriers include systems, time, and physician-specific issues.
- Six themes emerged for addressing resident apprehensions: partnerships, safe environments, experience, educational value, respecting time, and highlighting patient impact.
- Faculty development, culture change, and shadowing were identified as faculty education strategies.
Conclusions:
- Systems and time are primary barriers to bedside rounds.
- Learner-oriented environments effectively address resident apprehensions.
- Existing strategies from experienced teachers can inform faculty development for promoting bedside rounds.
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