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Identifying and Overcoming the Barriers to Bedside Rounds: A Multicenter Qualitative Study

Gonzalo, Jed D. MD, MSc; Heist, Brian S. MD, MSc; Duffy, Briar L. MD, MSc; Dyrbye, Liselotte MD; Fagan, Mark J. MD; Ferenchick, Gary MD; Harrell, Heather MD; Hemmer, Paul A. MD, MPH; Kernan, Walter N. MD; Kogan, Jennifer R. MD; Rafferty, Colleen MD, MPH; Wong, Raymond MD; Elnicki, D. Michael MD

doi: 10.1097/ACM.0000000000000100
Research Reports

Purpose The use of bedside rounds in teaching hospitals has declined, despite recommendations from educational leaders to promote this effective teaching strategy. The authors sought to identify reasons for the decrease in bedside rounds, actual barriers to bedside rounds, methods to overcome trainee apprehensions, and proposed strategies to educate faculty.

Method A qualitative inductive thematic analysis using transcripts from audio-recorded, semistructured telephone interviews with a purposive sampling of 34 inpatient attending physicians from 10 academic U.S. institutions who met specific inclusion criteria for “bedside rounds” was performed in 2010. Main outcomes were themes pertaining to barriers, methods to overcome trainee apprehensions, and strategies to educate faculty. Quotations highlighting themes are reported.

Results Half of respondents (50%) were associate or full professors, averaging 14 years in academic medicine. Primary reasons for the perceived decline in bedside rounds were physician- and systems related, although actual barriers encountered related to systems, time, and physician-specific issues. To address resident apprehensions, six themes were identified: build partnerships, create safe learning environments, overcome with experience, make bedside rounds educationally worthwhile, respect trainee time, and highlight positive impact on patient care. Potential strategies for educating faculty were identified, most commonly faculty development initiatives, divisional/departmental culture change, and one-on-one shadowing opportunities.

Conclusions Bedside teachers encountered primarily systems- and time-related barriers and overcame resident apprehensions by creating a learner-oriented environment. Strategies used by experienced bedside teachers can be used for faculty development aimed at promoting bedside rounds.

Dr. Gonzalo is assistant professor of medicine and public health sciences and assistant dean for health systems education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. At the time of this research, he was general internal medicine medical education fellow and clinical fellow in medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Dr. Heist is assistant professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. At the time of this research, he was general internal medicine medical education fellow and clinical fellow in medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Dr. Duffy is assistant professor of medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.

Dr. Dyrbye is associate professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.

Dr. Fagan is professor of medicine, Alpert Medical School of Brown University, Providence, Rhode Island.

Dr. Ferenchick is professor of medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan.

Dr. Harrell is associate professor of medicine, University of Florida College of Medicine, Gainesville, Florida.

Dr. Hemmer is professor of medicine and vice chairman for educational programs, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Kernan is professor of medicine, Yale University School of Medicine, New Haven, Connecticut.

Dr. Kogan is associate professor of medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Rafferty is assistant professor of medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.

Dr. Wong is associate professor of medicine, Loma Linda University School of Medicine, Loma Linda, California.

Dr. Elnicki is professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Funding/Support: The Shadyside Hospital Foundation’s Thomas H. Nimick, Jr. Research Fund.

Other disclosures: None reported.

Ethical approval: Ethical approval has been granted or waived at each of the participating institutions.

Disclaimer: The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Uniformed Services University, the United States Air Force, the Department of Defense, or other federal agencies.

Correspondence should be addressed to Dr. Gonzalo, Division of General Internal Medicine, Penn State Hershey Medical Center–HO34, 500 University Dr., Hershey, PA 17033; telephone: (717) 531-8161; fax (717) 531-7726; e-mail: jgonzalo@hmc.psu.edu.

© 2014 by the Association of American Medical Colleges