Table 2 Themes of the barriers and suggestions to improve the teaching of physical examinations at the bedside
Main Themes | Categories | Barriers | Suggestions for improvement |
|---|---|---|---|
The culture of teaching physical examination at the bedside | Hospital | ● Lack of standard/motivation ● Inadequate appreciation, award, and salary support | ● Need to set standard ● Increase appreciation, award, and salary support |
Attending physicians | ● Lack of enthusiasm ● Lack of physician confidence ● Impact of prior education and exposure ● Different knowledge, attitudes and skills among physicians ● Lack of accountability | ● Need to work on the impact of prior education (Increasing need to train residents as teachers) ● Improve teachers selection and preparation ● Create faculty development programs | |
Residents | ● Lack of enthusiasm and motivation ● High anxiety/stress level ● Poor insight in their own skills | ||
Technology | ● Over reliance on technology | ||
The hospital environment makes bedside teaching difficult | Time pressure | ● Conflicting responsibility ● Too many admitted patients | ● Prioritization of teaching (too many teaching rounds) ● Delegation of task |
Hospital Environment | ● Rooms are too small ● Lack of basic equipment ● Too noisy ● Need for nurse education regarding paging and protected time | ● Purchase of basic equipment for examination ● Utility of dedicated room for teaching ● Need for nurse education regarding paging and protected time ● Need for geographic location for each team | |
Patients | ● Not available ● Fear of discomfort ● Family disruption | ● Importance of proper patient selection | |
Structured physical examination curricula create missed opportunities | Content | ● Missed opportunity by following curriculum (restrictive) ● Teachers not following the curriculum / schedule ● Inability to find patient with findings | ● Importance of proper patient selection ● Incorporation of ultrasound, media, video, photos into rounds |
Organization | ● Lack of schedule dissemination ● Need for formal structure of the rounds, debrief session | ● Need to give topic ahead of time for residents to prepare | |
Assessment | ● Lack of assessment tools | ● Implement mini-CEX or encounters cards to promote formative feedback |