Ramirez Jason, Singh Jason, Williams Adrienne A
From the Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore and the Family Medicine Department, University of Illinois at Chicago College of Medicine, Chicago.
South Med J. 2016 Feb;109(2):112-5. doi: 10.14423/SMJ.0000000000000419.
Many barriers have been cited in reference to why bedside teaching rounds have decreased in frequency during graduate medical education. One perceived barrier to the use of bedside teaching rounds is a fear of it causing patient discomfort or dissatisfaction. The objective of this study was to compare patient perception of bedside versus nonbedside teaching rounds.
Study participants were adults admitted to a family medicine inpatient team at a large university teaching hospital. Upon admission, participants were randomized to receive bedside or nonbedside teaching rounds conducted by a team consisting of medical students, family medicine residents, and one attending physician. Each participant completed a questionnaire administered on the day of discharge assessing patients' perception of their involvement in medical decision making, trust in the medical team, satisfaction with care, and provider compassion. Statistical analysis was performed to examine any differences between the two groups.
The vast majority of the sample indicated that they knew what they were being treated for in the hospital (n = 105, 98%), reported the medical team spent an adequate amount of time with them (n = 100, 94%), and reported the medical team explained the diagnosis and care in easy-to-understand terms (n = 101, 94%). On 1- to 5-point scales, participants reported that the medical team involved them in making decisions (4.62, standard deviation [SD] 0.72), they trusted the medical team (4.91, SD 0.32), they were satisfied with their care (4.85, SD 0.38), and their medical team was compassionate toward them (4.84, SD 0.44). Overall levels of satisfaction were positive on all of the measures, with no statistical significance between the two groups regarding measures of involvement in medical decision making, trust in the medical team, and satisfaction with care. Interestingly, subjects perceived level of compassion of their medical team to be significantly higher with a bedside teaching approach compared with a nonbedside approach.
Despite concerns that bedside teaching rounds may lead to patient discomfort, this study found no evidence supporting this perception. In fact, patients may perceive a medical team that engages in bedside teaching rounds as being more compassionate providers, supporting a patient-centered argument that teaching rounds should return to the bedside.
关于研究生医学教育期间床边教学查房频率降低的原因，人们提到了许多障碍。使用床边教学查房的一个明显障碍是担心它会导致患者不适或不满。本研究的目的是比较患者对床边教学查房和非床边教学查房的看法。
研究参与者为一家大型大学教学医院家庭医学住院团队收治的成年人。入院时，参与者被随机分配接受由医学生、家庭医学住院医师和一名主治医师组成的团队进行的床边或非床边教学查房。每位参与者在出院当天完成一份问卷，评估患者对其参与医疗决策、对医疗团队的信任、对护理的满意度以及医护人员的同情心的看法。进行统计分析以检验两组之间的任何差异。
绝大多数样本表示他们知道自己在医院接受何种治疗（n = 105，98%），称医疗团队与他们相处的时间足够（n = 100，94%），并表示医疗团队用通俗易懂的语言解释了诊断和护理（n = 101，94%）。在1至5分的量表上，参与者表示医疗团队让他们参与决策（4.62，标准差[SD] 0.72），他们信任医疗团队（4.91，SD 0.32），他们对护理感到满意（4.85，SD 0.38），并且他们的医疗团队对他们富有同情心（4.84，SD 0.44）。所有指标的总体满意度均为积极，两组在参与医疗决策、对医疗团队的信任和对护理的满意度方面无统计学差异。有趣的是，与非床边教学方法相比，采用床边教学方法时，受试者认为其医疗团队的同情心水平明显更高。
尽管有人担心床边教学查房可能会导致患者不适，但本研究没有发现支持这种看法的证据。事实上，患者可能会认为参与床边教学查房的医疗团队是更有同情心的医护人员，这支持了以患者为中心的观点，即教学查房应该回到床边。
