Bedside rounding and teaching for Junior Hospitalists CHAMP Program AY 24.25

Fostering Effective and Collaborative Teaching Skills for a Junior Hospitalist on Rounds and at the Bedside

Eric Barna MD

Professor of Medicine and Medical Education

Rex Hermansen

Assistant Professor of Medicine and Medical Education

When on the inpatient service, what are the barriers to teaching/getting to the bedside?

Overview of our Journey

1

Review the importance of bedside rounds for teaching and patient care

2 Describe general teaching skills to enhance the rounding experience

3 Identify core elements that strengthen the team experience

4 Construct an effective bedside teaching plan

Know…

Perceived barriers to teaching can be overcome.

Do… Set expectations and foster a warm and welcoming

environment.

Feel…While preparation is half the battle, you are always teaching.

Get Your Bearings

❑ Understand the culture

❑ Evaluate the “rhythm” of the teaching service (shadow when possible)

❑ Clarify institutional expectations

❑ Strive for excellence not perfection

❑ Revisit, Reassess, Reset

STEP ONE: Getting Back to the Bedside

Perceived Barriers to Bedside Rounding and Teaching

Journal of Academic Medicine: A multicenter qualitative study sampled 34 inpatient Attending Physicians from 10 U.S academic institutions. The following categories of barriers to bedside rounding/teaching were identified: Time Patient Driven Systems Issues PhysicianRelated Culture shift

Overcoming Barriers

Patient Related

Physician Related System Related

Lack of bedside skill

Lack of comfort

Trainee inefficiency

EMR

Shorter LOS

Limited workday

Conferences

Inefficiency

Increased acuity

Patient privacy /HIPPA

Patients understanding

Educational value

Patient centered care is always patient preferred

Where is the Value at the Bedside?

Methods: Recruited faculty from 10 institutions including clerkship directors + prior research experience in medical education and conducted bedside rounds

Data Collection/Analysis: Digitally recorded one to one interviews identifying themes and categories generating a codebook to facilitate analysis

Results: All 10 institutions participated 34 interviews conducted focus was directed at key thematic areas

The Magic of Bedside Rounding

STEP TWO: Team Building

Educational Cycle Feedback

GOALS

Successful Attending Rounds

❑Participants: 125Faculty/Residents/Students

5IMresidencyprograms

75%wereresidentsorstudents

❑Participantsrated70attributesofSuccessfulattendingrounds Journal of General Internal

Cognitive Mapping

Study Findings

Setting the Stage

❑Create a safe and welcoming environment

❑ Email welcome before you come on service

❑Set clear expectations from day one

❑Identify your learners strengths/interests

❑Use icebreakers

❑Draw a mental image your time together

The “Mini” Orientation

❑Review the core service expectations on DAY 1 (10 minutes)

❑Set specific goals for each day on rounds (everyday is different)

❑Consider a pre-round huddle with your intern/medical student to map out the morning

❑Specify bedside goals and recognize that these may change

Be Specific:

✓ The order of presentations

✓ Presentation style (SOAP)

✓ Mini teaching topics and look ups

✓ Lightning presentations

✓ Safety Checklist

How do you position your team for bedside rounds?

Remember your Staging

ATTENDING/ RESIDENT

THE PERFECT TIME TO ASSESS MILESTONE METRICS FOR BOTH RESIDENTS AND MEDICAL STUDENTS

STEP 3: Teaching Skills

Pre Rounding

“By failing to prepare, you are preparing to fail”

- Ben Franklin

Avoid Common Pitfalls

❑ Avoid asking ‘read my mind’ types of questions

❑ Gentle corrections can be made when needed

❑ Actively discourage one-upmanship among the learners

❑ Avoid asking questions of junior learners when a senior learner has missed the question

❑ Keep all learners engaged to avoid boredom

❑ Avoid lengthy didactic discussions

Prepare to Succeed

What do you do to prepare before you meet your team/trainee for rounds?

Preparation Toolkit

❑ Chart check the night before and get in early on your first day

❑ “Stealth Round” virtually on your new admissions (EMR efficiency)

❑ Pick 1 or 2 topics that you want to tackle that day

❑ Plan and map out your teaching session:

-Organization/Timing

-How will you engage the learner

-Take home points

-Homework assignments

-Is there room for technology

Recall

– What are the 5 criteria for TTP?

The Art of Asking a Question

Analysis/Synthesis – What led you to that diagnosis?

Application – How will you treat this patient’s pain?

Self Assessment

– What would you do differently?

Waiting for an Answer

During Rounds and While at the Bedside Role Modeling is a Constant!

During the presentation…..

❑ Let them speak

❑ Break Points should be limited to 1 or 2

❑ Take notes

❑ Watch patient’s interactions with the presenter and the team

❑ Start thinking about feedback

During the Presentation… More Role Modeling

❑Teaching by Example: Power of Role Modeling

An exam Skill

An interaction with a patient

Self Directed Learning

The

Power of “I don’t know”

Think and Reason Aloud

❑Show learners your reasoning process

❑Show learners how to think

❑Open brainstorming

❑Lean on your team leads

Quality and Technology

Quality and technology are integral in engaging learners and enhancing the rounding experience!

A clinical picture is worth a thousand words

There is a valuable and abundant amount of quality and safety education at the bedside:

❑ Catheters, drains and lines

❑ Bed rails

❑ Fall precautions

❑ Diet

❑ Fluids

❑ Oxygen

❑ Smell

Leveraging Technology

Use media to engage

Make it patient centered Teaching arsenal

Closure is Critical

Know…

Perceived barriers to teaching can be overcome.

Do…

Set expectations and foster a warm and welcoming environment.

Feel…

While preparation is half the battle, you are always teaching.

“Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.”

-William Osler