Merchant Naseema B, Federman Daniel G
From the Department of Medicine, Yale University School of Medicine, New Haven, and the VA CT Health Care System, West Haven, Connecticut.
South Med J. 2017 Aug;110(8):531-537. doi: 10.14423/SMJ.0000000000000689.
Bedside rounds/rounding (BDR) is an important tool for patient-centered care and trainee education. This study aimed at understanding the attitudes toward BDR among residents and attending physicians.
A survey was conducted using the Qualtrics survey tool. Responses were measured using a five-point Likert scale.
The survey was sent to 301 attending physicians and 195 residents. Attending physicians conducted BDR 19% of the time. The preferred mode of rounding for residents was hallway and/or conference room rounding (67%). The major barriers to BDR were concern for causing confusion in or alarm to patients (attending physicians 49%, residents 77%) and prolongation of rounds (attending physicians 47%, residents 72%). The major advantages to BDR were increased likelihood of using patient-friendly language (attending physicians 84%, residents 69%) and the potential to improve trainees' oral presentations and physical examination skills (attending physicians 71%, residents 54%). Attending physicians reported having adequate skills to conduct BDR (95%) and potential opportunity to be better teachers with this mode of rounding (69%). Residents reported having some previous experience with BDR (46%) and agreed that BDR is an important skill for residents (62%). Only 34% of residents agreed that BDR allowed them to learn more about patient care compared with other modes of rounding, however.
Our study showed that our participants perceive BDR positively. Endorsed benefits include the ability to use patient-friendly language, the potential to improve trainees' clinical skills, and an opportunity to become better teachers. The reported major barriers to BDR were potential concern for patient confusion and prolongation of rounds. Despite some prior exposure reported by residents and adequate attending skills, the frequency and preference for BDR remains low and the residents remain uncertain about the educational value of BDR. The evaluation of other factors that contribute to the low frequency of BDR needs further consideration. Furthermore, each residency program may differ in the patterns of perception toward BDR and these should be formally assessed before implementing this patient-centered mode of rounding.
床边查房是患者中心护理和实习生教育的重要工具。本研究旨在了解住院医师和主治医师对床边查房的态度。
使用Qualtrics调查工具进行调查。回答采用五点李克特量表进行衡量。
调查发送给了301名主治医师和195名住院医师。主治医师进行床边查房的时间占19%。住院医师更喜欢的查房方式是在走廊和/或会议室查房(67%)。床边查房的主要障碍是担心给患者造成困惑或恐慌(主治医师占49%,住院医师占77%)以及查房时间延长(主治医师占47%,住院医师占72%)。床边查房的主要优点是更有可能使用对患者友好的语言(主治医师占84%,住院医师占69%)以及有潜力提高实习生的口头陈述和体格检查技能(主治医师占71%,住院医师占54%)。主治医师报告称具备进行床边查房的足够技能(95%),并且通过这种查房方式有潜力成为更好的教师(69%)。住院医师报告称之前有过一些床边查房的经验(46%),并认同床边查房是住院医师的一项重要技能(62%)。然而,只有34%的住院医师同意与其他查房方式相比,床边查房能让他们更多地了解患者护理。
我们的研究表明,我们的参与者对床边查房持积极看法。认可的好处包括能够使用对患者友好的语言、有潜力提高实习生的临床技能以及有机会成为更好的教师。报告的床边查房的主要障碍是对患者困惑的潜在担忧和查房时间延长。尽管住院医师报告有过一些先前的接触且主治医师具备足够技能,但床边查房的频率和偏好仍然较低,住院医师对床边查房的教育价值仍不确定。对导致床边查房频率低的其他因素的评估需要进一步考虑。此外,每个住院医师培训项目对床边查房的认知模式可能不同,在实施这种以患者为中心的查房模式之前,应进行正式评估。