Time-at-bedside and competency acquisition: a secondary analysis of GM-ITE domain scores in Japanese resident...

Direct bedside learning is recognized as essential for clinical skill development, yet its domain-specific effects on competency acquisition have not been fully elucidated. We examined how self-reported time-at-bedside was associated with performance across four GM-ITE competency domains.

We performed a nationwide multicenter, cross-sectional study of Japanese first- and second-year postgraduate resident physicians who took the General Medicine In-Training Examination (GM-ITE) in late 2022. Time-at-bedside was defined as the average self-reported time per day a resident spent providing direct care at the patients' bedside and was stratified into six categories: C1 (10-20 min/day), C2 (30-50 min/day), C3 (60-80 min/day), C4 (90-110 min/day), C5 (120-140 min/day), and C6 (≥ 150 min/day). Data on time-at-bedside were collected through an electronic survey conducted immediately after the GM-ITE. A linear mixed-effects model was employed to examine the association between time-at-bedside and four GM-ITE competency-specific scores-medical interview and professionalism (MP), symptomatology and clinical reasoning (CR), physical examination and clinical procedures (PP), and disease knowledge (DK).

Of 5,344 residents analyzed, more time-at-bedside showed only weak associations with MP and CR scores. In contrast, PP and DK scores increased in a dose-response pattern. Compared to C1, PP adjusted score differences were 0.3 (95% confidence interval [95% CI]: 0.07 to 0.48) in C2, 0.5 (95% CI: 0.27 to 0.73) in C3, 0.6 (95% CI: 0.13 to 1.01) in C5. Similarly, DK adjusted score differences were 0.6 (95% CI: 0.23 to 0.94) in C2, 0.5 (95% CI: 0.18 to 0.96) in C3, and 0.6 (95% CI: 0.16 to 1.66) in C5.

In Japanese clinical residency, more time-at-bedside was associated with the acquisition of physical examination skills, clinical procedure skills, and disease knowledge. Future prospective longitudinal cohort studies are warranted to determine whether more time-at-bedside can accelerate these competencies.