title: Exam room presentations and teaching in outpatient pediatrics: effects on visit duration and parent, attending physician, and resident perceptions.
abstract: OBJECTIVE
  To examine the effects of exam room presentations and teaching (ERPT) in a busy outpatient pediatric setting on visit duration and on parent, preceptor, and resident perceptions.
  
  
  METHODS
  This 8-week, 2-method crossover study compared first-year pediatric resident patient presentations and attending physician teaching and discussion in the exam room (ERPT) with conference area presentation and teaching (CAPT). Outcome measures included visit duration, parent satisfaction, and resident/attending physician perceptions. Differences were analyzed using chi2 (parent surveys), t tests (visit duration), and signed rank tests (Attending Physician and Resident Surveys).
  
  
  RESULTS
  Three hundred forty patient encounters were studied (151 ERPT vs 189 CAPT) that involved 15 first-year pediatric residents and 15 attending physicians. Visit durations were equivalent. Parent satisfaction was high in both methods. Attending physicians favored ERPT for adding opportunities to evaluate resident competencies, provide informed feedback, and role model. Attending physicians felt that ERPT decreased resident comfort level when discussing sensitive topics. Residents were less comfortable with ERPT for discussing sensitive topics and felt somewhat embarrassed when they did not know the answer to attending physicians' questions. Residents reported that ERPT presentations permitted attending physicians to demonstrate more physical exam skills and to observe interactions, enabling more informed feedback.
  
  
  CONCLUSIONS
  ERPT and CAPT require similar time and result in high parent satisfaction. Although residents are a little less comfortable with ERPT, attending physicians are better able to observe, evaluate, and give feedback on resident skills and to role model and teach physical diagnosis.
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. ray.baker@cchmc.org
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Baker
authors.forename: Melissa
authors.initials: M
authors.lastname: Klein
authors.forename: Zeina
authors.initials: Z
authors.lastname: Samaan
authors.forename: William
authors.initials: W
authors.lastname: Brinkman
mesh_terms: D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D009819:Office Visits; D010290:Parents / Q000523:psychology*; D010372:Pediatrics / Q000193:education*; D013997:Time Factors