Document Type: Review Article

Authors

1 Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Neurosciences Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

4 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

5 Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Objective: Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main factors in the clinical environment are not identified. Methods: A systematic review of English articles using Web of Science, PubMed, Embase, Scopus and Cochrane library were conducted. Relevant keywords and their synonyms were used for the domains “medical students/clinical teachers/barriers and clinical round”. Additional studies were identified by searching reference lists of retrieved articles. All searches for English language articles were conducted within a 10-day period from 25 May to 3 June 2017. No time limit was considered for article searching. We contacted Kerman University of Medical Sciences to locate some studies due to access limitation. In this systematic review, studies on the subject of barriers to clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 600 articles. After title and abstract review, 43 of these were obtained and finally 20 were included in the study. All data were abstracted from the included studies. Two authors independently screened the studies. We used inductive content analysis and categories of barriers were derived from the data. MAXQDA software version 10 was used for data analysis. Results: A total of 20 articles were included and analyzed in depth. Content analysis yielded identification of 320 codes concerning barriers to clinical rounds in six categories classified as system-, climate-, teacher-, student-, patient-, and personnel-related factors. Conclusion: Our investigation depicts primarily main barriers in teaching on rounds. In this regard, effective teaching in clinical rounds is not obtained unless barriers concerning the learning triad and its environment are explored and necessary actions are adopted accordingly

Keywords

Main Subjects

1. Ramani S, Leinster S. AMEE Guide no. 34: teaching in the clinical environment. Med Teach 2008; 30(4): 347-64. doi: 10.1080/01421590802061613.

2. Spencer J. Learning and teaching in the clinical environment. BMJ 2003; 326(7389): 591-4. doi: 10.1136/ bmj.326.7389.591.

3. Nair BR, Coughlan JL, Hensley MJ. Impediments to bed-side teaching. Med Educ 1998; 32(2): 159-62. doi: 10.1046/j.1365-2923.1998.00185.x.

4. Ramani S, Orlander JD, Strunin L, Barber TW. Whither bedside teaching? a focus-group study of clinical teachers. Acad Med 2003; 78(4): 384-90. doi: 10.1097/00001888- 200304000-00014.

5. Williams KN, Ramani S, Fraser B, Orlander JD. Improving bedside teaching: findings from a focus group study of learners. Acad Med 2008; 83(3): 257-64. doi: 10.1097/ ACM.0b013e3181637f3e.

6. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, et al. Identifying and overcoming the barriers to bedside rounds: a multicenter qualitative study. Acad Med 2014; 89(2): 326-34. doi: 10.1097/acm.0000000000000100.

7. Beigzadeh A, Yamani N, Bahaadinbeigy K, Adibi P. Challenges and problems of clinical medical education in Iran: a systematic review of the literature. Stride Dev Med Educ 2019; 16(1): e89897. doi: 10.5812/sdme.89897

8. Beigzadeh A, Adibi P, Bahaadinbeigy K, Yamani N. Strategies for teaching in clinical rounds: a systematic review of the literature. J Res Med Sci 2019; 24: 33. doi: 10.4103/jrms.JRMS_460_18.

9. Cole FL. Content analysis: process and application. Clin Nurse Spec 1988; 2(1): 53-7. doi: 10.1097/00002800- 198800210-00025.

10. Cavanagh S. Content analysis: concepts, methods and applications. Nurse Res 1997; 4(3): 5-16. doi: 10.7748/ nr.4.3.5.s2.

11. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15(9): 1277-88. doi: 10.1177/1049732305276687.

12. Jones P, Rai BP. The status of bedside teaching in the United Kingdom: the student perspective. Adv Med Educ Pract 2015; 6: 421-9. doi: 10.2147/amep.s83407.

13. Indraratna PL, Greenup LC, Yang TX. Bedside teaching in Australian clinical schools: a national study. Journal of Biomedical Education 2013; 2013: 948651. doi: 10.1155/2013/948651.

14. Force J, Thomas I, Buckley F. Reviving post-take surgical ward round teaching. Clin Teach 2014; 11(2): 109-15. doi: 10.1111/tct.12071.

15. Gonzalo JD, Masters PA, Simons RJ, Chuang CH. Attending rounds and bedside case presentations: medical student and medicine resident experiences and attitudes. Teach Learn Med 2009; 21(2): 105-10. doi: 10.1080/10401330902791156.

16. Celenza A, Rogers IR. Qualitative evaluation of a formal bedside clinical teaching programme in an emergency department. Emerg Med J 2006; 23(10): 769-73. doi: 10.1136/emj.2006.037796.

17. Shehab A. Clinical teachers’ opinions about bedside-based clinical teaching. Sultan Qaboos Univ Med J 2013; 13(1): 121-6. doi: 10.12816/0003205.

18. Holla R, Shrisha M, Unnikrishnan B, Sharma N, Janani S, Thapar R, et al. Facilitators and barriers for bedside teaching in the teaching hospitals of coastal south India. Asian J Pharm Clin Res 2015; 8(2): 271-3.

19. Dybowski C, Harendza S. Bedside teaching: general and discipline-specific teacher characteristics, criteria for patient selection and difficulties. GMS Z Med Ausbild 2013; 30(2): Doc23. doi: 10.3205/zma000866.

20. Al-Swailmi FK, Khan IA, Mehmood Y, Al-Enazi SA, Alrowaili M, Al-Enazi MM. Students’ perspective of bedside teaching: a qualitative study. Pak J Med Sci 2016; 32(2): 351-5. doi: 10.12669/pjms.322.9194.

21. Dewhurst G. Time for change: teaching and learning on busy post-take ward rounds. Clin Med (Lond) 2010; 10(3): 231-4. doi: 10.7861/clinmedicine.10-3-231.

22. Janicik RW, Fletcher KE. Teaching at the bedside: a new model. Med Teach 2003; 25(2): 127-30. doi: 10.1080/0142159031000092490.

23. Soltani Arabshahi K, Haghani F, Bigdeli S, Omid A, Adibi P. Challenges of the ward round teaching based on the experiences of medical clinical teachers. J Res Med Sci 2015; 20(3): 273-80.

24. Jaye C, Egan T, Smith-Han K, Thompson-Fawcett M. Teaching and learning in the hospital ward. N Z Med J 2009; 122(1304): 13-22.

25. Castiglioni A, Shewchuk RM, Willett LL, Heudebert GR, Centor RM. A pilot study using nominal group technique to assess residents’ perceptions of successful attending rounds. J Gen Intern Med 2008; 23(7): 1060-5. doi: 10.1007/ s11606-008-0668-z.

26. Khan IA. Bedside teaching-making it an effective instructional tool. J Ayub Med Coll Abbottabad 2014; 26(3): 286-9.

27. Claridge A. What is the educational value of ward rounds? a learner and teacher perspective. Clin Med (Lond) 2011; 11(6): 558-62. doi: 10.7861/clinmedicine.11-6-558.

28. Najafi N, Monash B, Mourad M, Ding Y, Glass M, Burrell GJ, et al. Improving attending rounds: qualitative reflections from multidisciplinary providers. Hosp Pract (1995) 2015; 43(3): 186-90. doi: 10.1080/21548331.2015.1043181.

29. O’Daniel M, Rosenstein AH. Professional communication and team collaboration. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US); 2008.

30. Joint Commission Resources. The Joint Commission Guide to Improving Staff Communication. Oakbrook Terrace, IL: Joint Commission Resources; 2005.

31. Montazeri H, Beigzadeh A, Shokoohi M, Bazrafshan A, Esmaili M. Perceptions of students and clinical instructors of academic learning environments at Yazd University of Medical Sciences. Res Dev Med Educ 2012; 1(2): 65-70. doi: 10.5681/rdme.2012.014.

32. Beigzadeh A, Bahaadinbeigy K, Adibi P, Yamani N. Identifying the challenges to good clinical rounds: a focusgroup study of medical teachers. J Adv Med Educ Prof 2019; 7(2): 62-73. doi: 10.30476/jamp.2019.44710.

33. Cox K. Planning bedside teaching--1. Overview. Med J Aust 1993; 158(4): 280-2.

34. Bahmanbijari B, Beigzadeh A, Etminan A, Rahmati Najarkolai A, Khodaei M, Seyed Askari SM. The perspective of medical students regarding the roles and characteristics of a clinical role model. Electron Physician 2017; 9(4): 4124-30. doi: 10.19082/4124.

35. Bahman Bijari B, Zare M, Haghdoost AA, Bazrafshan A, Beigzadeh A, Esmaili M. Factors associated with students’ perceptions of role modelling. Int J Med Educ 2016; 7: 333- 9. doi: 10.5116/ijme.57eb.cca2.

36. Beigzadeh A, Rahimi M, Lashkari M, Haghdoost A, Seyed Askari SM. A survey on the characteristics of an effective clinical teacher from the viewpoints of nursing students at Kerman University of Medical Sciences. Iran Journal of Nursing 2015; 28(95): 44-53. doi: 10.29252/ijn.28.95.44.

37. Esmaeili M, Haghdoost AA, Beigzadeh A, Bahman Bijari B, Bazrafshan A. Personal and scientific characteristics of positive and negative role models among medical educators from the viewpoint of dentistry and pharmacy students in Kerman University of Medical Sciences. Stride Dev Med Educ 2013; 10(3): 298-311. [[In Persian]].

38. Ende J. What if Osler were one of us? Inpatient teaching today. J Gen Intern Med 1997; 12(Suppl 2): S41-8. doi: 10.1046/j.1525-1497.12.s2.6.x.

39. LaCombe MA. On bedside teaching. Ann Intern Med 1997; 126(3): 217-20. doi: 10.7326/0003-4819-126-3-199702010- 00007.

40. Ramani S. Twelve tips to improve bedside teaching. Med Teach 2003; 25(2): 112-5. doi: 10.1080/0142159031000092463.

41. Kusurkar RA, Ten Cate TJ, van Asperen M, Croiset G. Motivation as an independent and a dependent variable in medical education: a review of the literature. Med Teach 2011; 33(5): e242-62. doi: 10.3109/0142159x.2011.558539.

42. Bahmanbijar B, Nazarieh M, Toufan N, Dehghani MR, Beigzadeh A. Identification of the reasons behind students’ lack of participation in classroom activities using a Delphi technique. Future of Medical Education Journal 2019; 9(2): 10-7. doi: 10.22038/fmej.2019.15154.1091.

43. Wang-Cheng RM, Barnas GP, Sigmann P, Riendl PA, Young MJ. Bedside case presentations. J Gen Intern Med 1989; 4(4): 284-7. doi: 10.1007/bf02597397.

44. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, et al. The art of bedside rounds: a multicenter qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med 2013; 28(3): 412-20. doi: 10.1007/s11606-012-2259-2.

45. Poorghaneh P, Hosseini MA. The role of nursing staff in nursing students’ learning in clinical settings. J Med Educ Dev 2010; 3(4): 7-11. [[In Persian]].

46. Yousefy A, Changiz T, Yamani N, Zahrai RH, Ehsanpour S. Developing a holistic accreditation system for medical universities of the Islamic Republic of Iran. East Mediterr Health J 2009; 15(3): 747-56.

47. Parsell G, Bligh J. Recent perspectives on clinical teaching. Med Educ 2001; 35(4): 409-14. doi: 10.1046/j.1365- 2923.2001.00900.x.

48. Yamani N, Moosavi SA, Alizadeh M, Khorvash F, Ghiasi M. A 360-degree performance evaluation of emergency medicine ward in Alzahra hospital. J Pak Med Assoc 2012; 62(3 Suppl 2): S13-7.