EDUCATION N ENSEIGNEMENT Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfaction Tara N. Cassidy-Smith, MD*; J. Hope Kilgannon, MD*; Andrew L. Nyce, MD*; Michael E. Chansky, MD*; Brigitte M. Baumann, MD, MSCE* ABSTRACT improvements with the timeliness of patient dispositions, faculty bedside teaching, and attending physician availability. Objectives: To determine if a dedicated teaching attending for Conclusions: The addition of select teaching attending medical student education improves medical student, attend- physician shifts had the greatest effect on medical student ing physician, and resident perceptions and satisfaction. and faculty perceptions and satisfaction, with some improve- Methods: Two dedicated teaching attending physician shifts ments for residents. were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to RE´SUME´ 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physi- Objectifs : De´ terminer si un enseignement spe´ cialise´ destine´ cian). Attending physician and resident perceptions and aux e´ tudiants en me´ decine ame´ liore les perceptions et la satisfaction with the teaching attending physician shifts satisfaction des e´ tudiants en me´ decine, des me´decins using a 5-point Likert-type scale (1 5 poor to 5 5 excellent) traitants et des re´ sidents en me´ decine. were also assessed. Me´ thodes : Deux quarts de me´ decins traitants enseignants Results: Eighty-nine (100%) medical students participated, spe´ cialise´ s ont e´te´ ajoute´s a` l’horaire de travail clinique with 63 preteaching attending physician and 26 teaching chaque semaine. Un essai de type « avant et apre` s » a permis attending physician rotation evaluations. The addition of de comparer les e´ valuations des e´ tudiants en me´ decine entre teaching attending physician shifts improved mean medical 2000 et 2004 (me´ decin traitant avant sa certification) aux student satisfaction with bedside teaching (4.1 to 4.5), lecture e´ valuations des e´ tudiants en me´ decine entre 2005 et 2006 satisfaction (4.2 to 4.8), preceptor scores (4.3 to 4.8), and (me´ decin traitant enseignant). On a e´ galement compare´ les perceived usefulness of the rotation (4.5 to 5.0) (all p , 0.05). perceptions et la satisfaction des me´ decins traitants et des Thirteen attending physicians (93%) participated in the cross- re´ sidents en me´ decine aux quarts de me´ decins traitants sectional questionnaire. The addition of teaching attending enseignants a` l’aide d’une e´ chelle de type Likert en 5 points physician shifts improved faculty ratings of their medical (1 5 me´ diocre a`55 excellent). student interactions by $ 1.5 points for all items (p # 0.001). Re´ sultats : Quatre vingt-neuf (100 %) e´ tudiants en me´ decine Faculty perceptions of their resident interactions improved for ont participe´a` l’e´ tude, et les e´ valuations des rotations ont quality of bedside teaching (3.1 to 4.0), their availability to hear porte´ sur 63 me´ decins traitants avant leur certification et 26 resident presentations (3.4 to 4.2), and their supervision of me´ decins traitants enseignants. L’addition des quarts de residents (3.4 to 4.1) (p # 0.01). Residents (n 5 35) noted minor me´ decins traitants enseignants a ame´ liore´ la satisfaction Department of Emergency Medicine, Cooper University Hospital and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, Camden, NJ. Correspondence to: Dr. Brigitte M. Baumann, Department of Emergency Medicine, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103; [email protected]. Submitted May 8, 2010; Revised NA; Accepted June 23, 2010. Preliminary findings of a subset of this data were presented in two parts: as a poster presentation at the Society for Academic Emergency Medicine annual meeting, San Francisco, CA, May 2006, and as a poster presentation at the American College of Emergency Physicians annual meeting, New Orleans, LA, October 2006. This article has been peer reviewed. ß Canadian Association of Emergency PhysiciansCJEM 2011;13(4):259-266 DOI 10.2310/8000.2011.110289 CJEM N JCMU 2011;13(4) 259 Downloaded from https://www.cambridge.org/core. IP address: 170.106.35.229, on 02 Oct 2021 at 17:14:23, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.2310/8000.2011.110289 Cassidy-Smith et al moyenne des e´tudiants en me´decine quant a` l’enseignement 4,1) (p # 0,01). Les re´sidents en me´decine(n 5 35) ont observe´ au chevet des malades (4,1 a`4,5),a` la satisfaction des cours (4,2 des ame´liorations mineures quant a` la ponctualite´desdisposi- a` 4,8), aux scores des pre´cepteurs (4,3 a`4,8),eta` l’utilite´perc¸ue tions des patients, a` l’enseignement au chevet des malades par de la rotation (4,5 a` 5,0) (toutes les valeurs p , 0,05). Treize la faculte´eta` la disponibilite´desme´decins traitants. me´ decins traitants (93 %) ont participe´ au questionnaire Conclusions : L’addition de certains quarts de me´ decins transversal. L’addition des quarts de me´decins traitants traitants enseignants a eu un effet maximal sur les percep- enseignants a ame´ liore´ le classement par la faculte´deses tions et la satisfaction des e´ tudiants en me´ decine et de la interactions avec les e´tudiants en me´decinede$ 1,5 point pour faculte´ , et apporte´ certaines ame´ liorations pour les re´ sidents tous les items (p # 0,001). Les perceptions par la faculte´deses en me´ decine. interactions avec les re´ sidents se sont ame´liore´es quant a`la qualite´ de l’enseignement au chevet des malades (3,1 a` 4,0), a` leur disponibilite´a` entendre les pre´sentations des re´sidents en Keywords: clinical clerkship, education, emergency medi- me´decine(3,4a`4,2),eta` leur supervision des re´sidents (3,4 a` cine, internship and residency, teaching methods Bedside teaching has been an integral part of medical adversely affected our residency program. Attending education, yet over the past century, the classic bedside physicians expressed frustration with balancing patient model refined by Sir William Osler has suffered. care and maintaining student satisfaction. Students’ cases Increasing medical school class sizes and educators’ required additional faculty time, documentation, and needs to impart vast quantities of information within a supervision, and these responsibilities were interfering limited time period have led educational efforts away with patient care and throughput efforts.13 After careful from the bedside and into the lecture hall. This trend deliberation, faculty members agreed to increase their has reversed somewhat over the past 20 years owing to teaching efforts and pilot a potential solution. Thus, a concerns about the increasing depersonalization of limited number of dedicated ‘‘medical student teaching medicine.1,2 With a renewed emphasis on small-group attending physician shifts’’ were added to our ED’s clinical interactions, a core element in current educa- clinical faculty schedule, and this study hypothesized that tion of aspiring physicians includes real-time feedback the addition of teaching attending physician shifts would on their history and physical examination skills at the improve medical student satisfaction with the rotation as bedside from seasoned clinicians.3–5 well as faculty and resident perceptions of their clinical Emergency departments (EDs) offer many opportu- experiences. nities for bedside teaching owing to high volumes of acutely ill patients and the need for procedural interven- METHODS tions. In spite of these opportunities, bedside teaching in the ED has become increasingly challenging. Patient Design and objectives encounters must be brief, patient acuity may interfere with teaching moments, and, most recently, ED crowd- This study followed a cross-sectional before-after ing may limit the number of educational opportunities survey design. The primary objective was to determine owing to privacy and space issues as well as limited faculty if teaching attending physician shifts would improve availability for dedicated medical student instruction.3,6–10 medical students’ satisfaction with their ED elective. These challenges have led to increasing undergraduate The secondary objectives were to determine if there and graduate trainee dissatisfaction with their clinical was any improvement in emergency medicine resident emergency medicine didactic experiences.3,11,12 and attending physician perception and satisfaction As with other institutions, our ED has experienced a scores with the initiation of teaching attending dramatic increase in annual patient volume and acuity physician shifts. over the past decade. Accompanying these increases, there was a steep decline in fourth-year medical student Participants and setting rotation satisfaction, particularly regarding the paucity of attending physician–initiated bedside teaching. Accom- Responses from a standardized anonymous question- panying the poor clerkship reviews, there was also a naire that had been collected from all fourth-year decline in applications to emergency medicine residency medical students prior to the initiation of teach- programs from medical students at our institution, which ing attending physician shifts served as baseline data 260 2011;13(4) CJEM N JCMU Downloaded from https://www.cambridge.org/core. IP address: 170.106.35.229, on 02 Oct 2021 at 17:14:23, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.2310/8000.2011.110289 Teaching attending physician perceptions and satisfaction (July–September 2000–2004). Completion of these The teaching attending physician program was limited questionnaires was mandatory for all students who to July to September because the majority of subinterns completed the emergency medicine elective. The rotated in the ED during these months. Teaching emergency medicine rotation was an elective offered attending physician shifts were 8 hours in duration.