Article Text

  1. T. Wall,
  2. C. S. Ashworth
  1. University of Alabama at Birmingham, Birmingham, AL


Background General pediatric inpatient services serve as a major teaching site for both residents and students. Supervising faculty must accommodate the needs of learners at different levels in their training while providing appropriate medical care to patients and communications with families. Likewise, the struggle of balancing clinical and educational demands by residents has received increased attention, but little is known about inpatient educational experiences for pediatric trainees.

Objective To describe teaching activities on general inpatient pediatric services.

Methods This observational study examined teaching activities on the two major general pediatric inpatient teaching services at Children's Hospital of Alabama, the primary pediatric training site for UAB. Three premed students attended weekday rounds over an 8-week period (June-August 2005) and collected data at the patient level: type of patient (new or existing), presenter (student, intern, resident), time spent and topics discussed on each patient, type of faculty feedback, discussion level (teacher only, teacher and one learner, or involving the larger group), number of references made to the literature, and type of bedside teaching activities (demonstration and/or role modeling).

Results Three students observed 473 patient presentations (109 new, 364 existing) divided between the two teams (241, 232) and involving 7 attending physicians. Patients were usually presented on rounds by students (280, 61%), followed by interns (142, 31%) and residents (39, 8%). Presenters spent an average of 3.4 minutes per presentation (7.4 minutes new, 3.4 existing). Feedback on presentation and/or management was given on 33% of patient presentations: 17% instructional, 7% positive, 3% negative, and 7% neutral. Patient encounters prompted teaching points by the faculty in 26% and by the resident in 4%, with educational assignments given on 4% of patient encounters. When teaching discussions occurred, approximately 47% involved the group, 41% were one-way comments made by the attending, and 12% involved only two members of the team. References to the literature were made by faculty in 2.4% and by residents in 1.5% of patient encounters. Teams spent an average total of 11 minutes per patient, 10 minutes on existing patients vs 14 minutes on new patients. Bedside teaching consisted of faculty demonstrating physical findings on 30% of patients and role modeling professional behavior and communication with 95% of patients.

Conclusions Use of trained observers demonstrates key components of medical training but with important opportunities for improvement.

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