Shields Helen M, Honan James P, Goldsmith Jeffrey D, Madan Rachna, Pelletier Stephen R, Roy Christopher L, Wu Lindsey C
Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Harvard Graduate School of Education, Cambridge, MA, USA.
Adv Med Educ Pract. 2020 Dec 1;11:921-929. doi: 10.2147/AMEP.S277008. eCollection 2020.
Morning bedside rounds remain an essential part of Internal Medicine residency education, but rounds vary widely in terms of educational value and learner engagement.
To evaluate the efficacy of an intervention to increase the number and variety of questions asked by attendings at the bedside and assess its impact.
We conducted a randomized, controlled trial to evaluate the efficacy of our intervention.
Hospitalist attendings on the general medicine service were invited to participate. Twelve hospitalists were randomized to the experimental group and ten hospitalists to the control group.
A one-hour interactive session which teaches and models the method of asking questions using a non-medical case, followed by practice using role plays with medical cases.
Our primary outcome was the number of questions asked by attendings during rounds. We used audio-video recordings of rounds evaluated by blinded reviewers to quantify the number of questions asked, and we also recorded the type of question and the person asked. We assessed whether learners found rounds worthwhile using anonymous surveys of residents, patients, and nurses.
Blinded analysis of the audio-video recordings demonstrated significantly more questions asked by attendings in the experimental group compared to the control group (mean number of questions 23.5 versus 10.8, p< 0.001) with significantly more questions asked of the residents (p<0.003). Residents rated morning bedside rounds with the experimental attendings as significantly more worthwhile compared to rounds with the control group attendings (p=0.009).
Our study findings highlight the benefits of a one-hour intervention to teach faculty a method of asking questions during bedside rounds. This educational strategy had the positive outcome of including significantly more resident voices at the bedside. Residents who rounded with attendings in the experimental group were more likely to "strongly agree" that bedside rounds were "worthwhile".
晨间床边查房仍是内科住院医师培训教育的重要组成部分，但查房在教育价值和学习者参与度方面差异很大。
评估一项干预措施的效果，该措施旨在增加主治医师在床边提出问题的数量和种类，并评估其影响。
我们进行了一项随机对照试验来评估干预措施的效果。
邀请了普通内科病房的住院医师参加。12名住院医师被随机分配到实验组，10名住院医师被分配到对照组。
一个小时的互动课程，通过一个非医学案例教授并示范提问方法，随后通过医学案例角色扮演进行练习。
我们的主要结果是查房期间主治医师提出问题的数量。我们使用由不知情的评审人员评估的查房音频视频记录来量化提出问题的数量，并且我们还记录了问题类型和被提问的人。我们通过对住院医师、患者和护士进行匿名调查来评估学习者是否认为查房是有价值的。
对音频视频记录的盲法分析表明，与对照组相比，实验组主治医师提出的问题明显更多（平均问题数为23.5对10.8，p<0.001），对住院医师提出的问题也明显更多（p<0.003）。与对照组主治医师的查房相比，住院医师将与实验组主治医师的晨间床边查房评为明显更有价值（p=0.009）。
我们的研究结果突出了一项为期一小时的干预措施的益处，该措施旨在教授教员在床边查房时的提问方法。这种教育策略产生了积极的结果，即在床边显著增加了更多住院医师的参与。在实验组与主治医师一起查房的住院医师更有可能“强烈同意”床边查房是“有价值的”。
