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PubMed1986

Teaching the resident in internal medicine. Present practices and suggestions for the future.

There appears to be a trend to move clinical teaching from bedside to conference room. While much emphasis is placed on conducting teaching rounds, no one asks how they are conducted. To evaluate how teaching is done, questionnaires on composition of teaching services and management of rounds including resident, patient care, attending, and teaching rounds were sent to 463 medicine residency programs. Responses were solicited from the program directors and chief residents. Two hundred twenty-one responded, but only for 123 programs did both the program director and the chief resident respond; these 123 programs formed the basis of our study. Fifteen percent of teaching rounds were held only in conference rooms, while 77% were made both at bedside and in conference rooms. The figures for attending rounds were 7% and 74%, respectively. Our data indicate a trend away from bedside teaching to the conference room.

Internal Medicine↗
PubMed2001

Effects of billing and documentation requirements on the quantity and quality of teaching by attending physicians.

PURPOSE: The Health Care Financing Administration's guidelines for billing and documentation by attending physicians have increased the amount of time that attending physicians spend documenting the services that they provide for patients. This study assessed the impact of these guidelines on attending physicians' teaching of housestaff on inpatient medical wards. METHOD: A survey of 92 housestaff from the department of medicine at one teaching hospital was conducted in 1998 to determine how attending physicians' billing and documentation requirements, clinic responsibilities, teaching styles, and inpatient census affected the quantity and quality of their teaching. The questionnaire included a rank-order analysis of factors affecting quantity and quality of attending physicians' teaching, as well as a five-point Likert scale assessing the quality of attending physicians' teaching. RESULTS: All housestaff responded. A total of 39% of housestaff perceived billing and documentation requirements to be the major detriment to quantity of teaching by attending physicians, and 30% perceived these requirements to be the major detriment to quality of teaching by attending physicians. Housestaff perceived more teaching and higher-quality teaching on services where attending physicians did not perform billing and documentation during teaching rounds. CONCLUSION: Billing and documentation requirements are a major detriment to the quantity of teaching on inpatient services, especially when faculty attempt to meet these requirements during teaching rounds.

Attitude of Health Personnel↗
PubMedDate not supplied

Implementation of collaborative practice through interdisciplinary rounds on a general surgery service.

Interdisciplinary teaching rounds were initiated on a general surgery service at a university teaching hospital. These rounds were designed to promote more efficient patient care by providing an opportunity for enhanced communication among health-care professionals. Improved collaboration is a prerequisite for implementation of critical paths and case management. The authors describe their methods of rounds development and the impact of the rounds on patient outcomes.

Case Management↗
PubMed1995

Measuring the use of the population perspective on internal medicine attending rounds.

BACKGROUND: The population perspective (risk-factor assessment, prevention, epidemiology, and the social aspects of illness) is increasingly important in medical school and residency curricula. The authors designed an observational study to assess the population-perspective content of internal medicine teaching rounds led by attending physicians at the Columbia-Presbyterian Medical Center. METHOD: During eight months in 1992 a trained research assistant used a structured observation form in observing attending rounds. Population scores were calculated by totaling the number of times population-perspective topics were mentioned during each case presentation (one point was awarded per mention, with an additional point being added for discussions lasting 30 seconds or more). Chi-square tests and unpaired t-tests were used to compare scores between teams with one generalist and one subspecialist attending physician and teams with two subspecialists. RESULTS: Fifteen teams and 368 patient presentations were observed. The mean population scores were 24.5 for teams with generalist attending physicians and 17.9 for teams with subspecialists only (p < .0001). The population scores for individual case presentations ranged from 2 to 55. CONCLUSION: The population-perspective topics were raised more frequently on the internal medicine teaching rounds when a generalist attending physician was present than when there were only subspecialist attending physicians.

Clinical Medicine↗
PubMed2002

Round out your department.

Clinical teaching rounds extend the staff orientation process without extending the budget.

Clinical Competence↗
PubMed2006

A teaching ward round in infectious diseases - a pilot module.

The ongoing care of patients requires close communication between general practitioners and hospital specialists. In 2005, the General Practice Liaison Office and Department of Infectious Diseases at The Canberra Hospital designed a pilot module to promote interaction between GPs and hospital specialists and to provide an educational opportunity for GPs to be updated on the hospital practice of managing infectious diseases. The simplicity of the module is the key to its generalisability outside Canberra and Australia.

Attitude of Health Personnel↗
PubMed1998

Students' satisfaction and perceptions of attending physicians' and residents' teaching role.

BACKGROUND: Changes in the health care system imply that fewer patients will be admitted to hospitals and attending physicians will be devoting more time to clinical activities with less time for student education. METHODS: Surveys of third-year students were conducted for 5 consecutive years at Jefferson Medical College at the end of the required 6-week surgical clerkship at the university hospital or at one of the eight affiliates. RESULTS: The numbers of new inpatients and outpatients encountered by students were not significantly related to students' overall satisfaction. The ratings of teaching rounds and conferences were significant predictors of satisfaction with the clerkship, as were the ratings of residents' teaching. CONCLUSIONS: As medical education shifts to ambulatory settings, didactic teaching such as rounds and conferences should be maintained and efforts to enhance the teaching skills of residents should be encouraged.

Clinical Clerkship↗
PubMed1986

Use of a general medical setting to teach medical students about neurosis.

A new way of teaching medical students about minor psychiatric illnesses is described. Psychiatric morbidity on general medical wards was identified, using medical students to administer the screening instrument to all routine admissions and interview possible cases. This was linked to a weekly teaching round in the same setting conducted by a psychiatrist. Advantages of this method of teaching were (1) it increased the overall numbers of patients clerked by our students during their psychiatric clerkship; (2) it increased the number of cases of neurosis seen by students as compared with psychotic illnesses; and (3) it related teaching on psychiatric conditions to settings where most students would eventually practise. The aim was both to increase the students' factual knowledge about minor psychiatric illnesses as encountered in these settings, and to improve their skills at identifying and treating such illnesses. An attempt was made to measure the effectiveness of this teaching method. All students showed an improvement in test scores, whether taught under the new regime or not, but it proved impossible to distinguish those taught on medical wards from those taught primarily in psychiatric wards. The implications of this finding are discussed. There was uniformly positive feedback from the students who took part in the study.

Clinical Clerkship↗
PubMed1997

An evaluation of teaching methods utilized during an HIV miniresidency course for Thai physicians.

This study examines the efficacy of medical education methods in improving the knowledge base and clinical skills of participants attending a 2-day miniresidency course in HIV infection. Instructional methods included: a didactic lecture format, diagnostic algorithm presentation, color slide photographic demonstration, bedside teaching rounds, and "meet-the-professor" sessions. Questions to assess the various instructional formats were administered and teaching methods were evaluated. Fifty-seven Thai physicians, highly exposed to HIV patient care duties, completed both precourse and postcourse tests. Overall, significant improvement was noted in participant's final global test score. However, discrepancies existed among the efficacy of instructional methods. Recognizing physical signs of HIV infection, as taught by slide photographs, revealed a high baseline level of expertise. Statistically significant postcourse gains were made in physician's diagnostic decision-making ability and basic knowledge of HIV and AIDS taught respectively by the methods of a teaching algorithm and didactic lecture. Despite the latter, participation performed poorly regarding HIV case management. This observation may be related to test design and cultural differences but likely underscores the difficulty in imparting clinical HIV management skills to course participants over a short period of time. Future continuing medical education (CME) courses intended to enhance physician care for the HIV infected must strive to refine evaluation methods for assessing case management skills while exploring innovative instructional techniques when current methods are ineffective.

Adult↗
PubMed2004

Internal regulations and general guidelines of a neurosurgical department and training programme.

It is strongly recommended that general guidelines and internal regulations be laid down in written form by the department. The guidelines regulate the general workflow and related trainee duties and responsibilities, education and research, special procedures for particular diseases and conditions (standards of care). Regarding general workflow of the department, the following items should be laid down once in written form: time table of department, working hours, admission procedures, medical records directives, responsibilities on wards and in the emergency unit, patient information, discharge procedures, outpatient consultations, call schedule and on-call duty plan, as well as week-end and holiday regulations for rounds on wards and ICU. Regarding education and research, the following items should be written down: conferences and teaching rounds, policies on presentations and publications, policies regarding meetings and courses, research leave and vacation plan. The written definition of standards of care is still considered optional in neurosurgery at the present time.

Certification↗
PubMedDate not supplied

A survey of pediatric oncology nurses' perceptions of parent educational needs.

Educating parents of children with cancer is a primary nursing responsibility in pediatric oncology. A survey using Delphi techniques was conducted with nurses attending a Children's Oncology Group Nursing Workshop to identify priority educational topics from pediatric oncology nurses' perspective. In round 1 of the survey, nurses were asked to identify 5 priority educational topics and 5 topics they spend the most time teaching parents. Twenty-four educational categories were identified by 199 nurses, and responses were sorted by category and frequencies tabulated. Information about treatment was the most frequently cited priority. Bone marrow suppression (BMS) was the second most important priority and was the topic nurses spent most time in teaching. Round 2 of the survey was sent via e-mail to 132 consenting participants from round 1. Nurses were asked to rate the importance of the categories from round 1 (presented in random order) during 4 time periods (diagnosis, initial treatment, maintenance, and off therapy). Nurses reported different teaching priorities across the continuum of treatment. Of note, teaching about end-of-life issues and alternative therapy were ranked as low in importance across all time points. These findings can be used to inform educational programs and materials development for parents of children with cancer.

Adaptation, Psychological↗