Why teaching bedside skills to hospitalists is in decline

Only 17% of hospitalist teaching time is spent at the patient’s bedside, according to a new study “Quantification of Bedside Teaching by an Academic Hospitalist Group,” published in the May/June 2009 issue of the Journal of Hospital Medicine.

Conducted at the Brigham and Women’s Hospitalist Service in Boston, the study asked residents and interns how much time hospitalist attending physicians spend at the bedside and how much they teach physical examination skills. The academic hospital found that hospitalists spend an average of 17 minutes inside patient rooms during rounds, which translates to only 17% of their teaching time spent at the bedside.

The decline in teaching bedside skills is a far departure from the emphasis on such training decades earlier. In the 1960s, bedside teaching accounted for 75% of clinical curriculums. By 1978, that estimate dropped to only 16%, according to the study. Today, with the 17% rate, both residents (53%) and hospitalist attending physicians (50%) said the resident curriculum should further emphasize bedside teaching.

Most respondents cited time constraints as the culprit for the lack of bedside teaching.

“Time is an increasingly precious commodity for hospitalists; though many commentators echo the sentiments of the respondents in this study that more time at the bedside is needed, the amount of time that should be optimally spent at the bedside remains unclear,” according to the study.