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What the Literature Says

Bedside teaching is "the way things used to be," the old way, the "when I was in medical school" way of educating medical learners. It is the tradition which medical educators from the middle part of this century would shudder to find waning today. At the bedside, generations of students have observed science meet the art of medicine, have been indoctrinated in the demeanor and approach of a physician as he/she examines a patient, and have been challenged to be prepared and observant.

However, while rounding with residents at the bedside and leading workshops for attendings on bedside teaching, certain comments invariably arise:

• "I think bedside teaching rounds make patients feels exposed and uncomfortable."
• "I had an attending once who wanted to do bedside teaching rounds; they were a horrible example of how physicians should teach patients. I determined at that time I would never do bedside teaching rounds."
• "Bedside teaching rounds are inefficient and take too much time."

What does the literature say?

Educators have studied physician and patient views on bedside teaching, and have also looked at outcome measures. Kurt Kroenke, et al¹. surveyed physicians involved with teaching in order to find out their attitudes toward attending rounds.

• Ninety-six percent of residents and 88% of attendings preferred that cases NOT be presented at the patient’s bedside.
• Respondents believed that only 30% of an attending's rounding time should be spent at the bedside.

A study at the Medical College of Wisconsin² demonstrated that only 2% of housestaff and 4% of students felt comfortable presenting cases at the bedside.

• Forty-seven percent of attending physicians who had practiced medicine less than 10 years favored presenting and teaching away from the bedside.
• However, 85% of patients preferred to be present when their cases were presented.
• An indication that this move away from the bedside has been a relatively recent phenomenon is demonstrated by the fact that only 18% of those attending physicians in practice 10 years or longer preferred presentations and teaching away from the bedside.

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Survey studies such as these prompted a more vigorous controlled clinical trial by Lehmann and Brancati at Johns Hopkins in 1997³. They randomized resident attending teams to make case presentations during morning rounds either at the patient’s bedside or in a conference room for one week. They used a patient perception questionnaire that was administered within 24 hours in order to determine the patient’s perceived quality of care.

There was no significant statistical difference in the patient’s perceptions of whether

• Their problems were explained adequately
• Tests and drugs were explained adequately
• Patients were treated with respect
• The rounds caused them worry
• The quality of their care suffered

Nair⁴ asked a group of 100 patients about their impressions of bedside teaching after they had had their case presented and discussed at the bedside.

• Sixty-eight percent found that it increased their understanding of their medical problems, 77% said they enjoyed it (only 17% did not), 83% said it did not make them anxious, 85% said they do not think that bedside teaching breaches confidentiality, and 84% said they would recommend bedside teaching to other patients.
• In this same study, 100% of the students, interns and residents (N=136) believed bedside teaching was valuable and, once they experienced it, over half said they did not receive enough of it.

So, in the literature we see that physicians have echoed some of our same initial reactions to bedside teaching. And yet, when bedside teaching is actually studied, patients and learners appreciate it and find it effective . It is time we stopped blaming patients and students for our own insecurities at the bedside.

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Community-Based Teaching Benefits - Strategies for Teaching in a Busy Practice
The Precepting Microskills - Observation and Feedback - Bedside Teaching
What is Evidence-Based Medicine? - Teaching Evidence-Based Medicine
The Ten-Minute Talk - Strategies Home Page

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