Improving bedside teaching: findings from a focus group study of learners.
OBJECTIVE
Literature reviews indicate that the proportion of clinical educational time devoted to bedside teaching ranges from 8% to 19%. Previous studies regarding this paucity have not adequately examined the perspectives of learners. The authors explored learners' attitudes toward bedside teaching, perceptions of barriers, and strategies to increase its frequency and effectiveness, as well as whether learners' stages of training influenced their perspectives.


METHODS
Six focus group discussions with fourth-year medical students and first- or second-year internal medicine residents recruited from the Boston University School of Medicine and Residency Program in Internal Medicine were conducted between June 2004 and February 2005. Each 60- to 90-minute discussion was audiotaped, transcribed, and analyzed using qualitative methods.


RESULTS
Learners believed that bedside teaching is valuable for learning essential clinical skills. They believed it is underutilized and described many barriers to its use: lack of respect for the patient; time constraints; learner autonomy; faculty attitude, knowledge, and skill; and overreliance on technology. Learners suggested a variety of strategies to mitigate barriers: orienting and including the patient; addressing time constraints through flexibility, selectivity, and integration with work; providing learners with reassurance, reinforcing their autonomy, and incorporating them into the teaching process; faculty development; and advocating evidence-based physical diagnosis. Students focused on the physical diagnosis aspects of bedside teaching, whereas views of residents reflected their multifaceted roles as learners, teachers, and managers.


CONCLUSIONS
Bedside teaching is valuable but underutilized. Including the patient, collaborating with learners, faculty development, and promoting a supportive institutional culture can redress several barriers to bedside teaching.
Williams
Keith N
KN
Boston University School of Medicine, 715 Albany St., Vose 320, Boston, MA 02118, USA. Keith.Williams@bmc.org
Ramani
Subha
S
Fraser
Bruce
B
Orlander
Jay D
JD
D001291:Attitude of Health Personnel; D002982:Clinical Clerkship; D002983:Clinical Competence; D003142:Communication; D003299:Cooperative Behavior; D004503:Education, Medical, Graduate; D004504:Education, Medical, Undergraduate; D005180:Faculty, Medical; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D010817:Physician-Patient Relations; D013337:Students, Medical; D013663:Teaching