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Great teachers-effective and efficient

Attending rounds: What do the all-star teachers do? Merritt FW, Noble, MN. Prochazka AV, Aagaard  EM & Stickrath CR(2017) Medical Teacher, 39:1, 100-104

Tags:  inpatient, rounds, learner satisfaction, teaching

Reviewed by Patricia McBurney

What was the study question?

Which teaching activities do residents and students on inpatient general internal medicine services perceive as most effective?

How was the study done?

This study was performed in 4 teaching hospitals affiliated with a large public medical school from July 2010–March 2012.   Fourth year medical student observers used a pre-defined checklist to record teaching activities (9 choices) and location (bedside, hallway, or conference room).  Total teaching activities per rounding session and per patient were tallied. Time for rounds was noted.  After rounds, all trainees were asked to complete a Likert scale documenting the effectiveness of rounds.

What were the results?

82 rounding sessions, 56 unique attendings and 279 trainees (both students and residents) were studied.   Each rounding session was stratified into 1 of 3 groups based on perceived teaching effectiveness. 

Of the 9 teaching activities on the checklist, 3 were performed more frequently by the most effective attendings: answering specific patient-care related questions (77% [most effective teachers] versus 66% [middle group of effective teachers] versus 47%[least effective], p = .003), teaching on learner-chosen topics (8% versus 2% versus 2%, p=.02), and providing feedback to learners on rounds (31% versus 10% versus 0.05%, p= .001).

The most effective attendings had more teaching activities per patient (2.1 versus 1.4 versus 1.5, p=.03) but did not take any more time.  The setting for rounds did not change effectiveness; however, 89% of the observed rounding sessions were at the bedside.

What are the implications of these findings?

This study gives wonderful insight in how to get the greatest educational impact during rounds without spending more time.   At the same time, I wonder ifIthere’s a way to improve the quality of the teaching methods perceived as less effective (such as physical exam teaching.) 

Editor’s Note:  Yet another study to demonstrate that great teaching isn’t about teaching more—it’s about teaching better. (JG)

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