gms | German Medical Science

Bedside teaching (BST) has a long tradition and a firm place in medical education. In light of the often-described decrease in bedside teaching, there are now efforts to use the remaining time as efficiently as possible. However, there is little research on tangible quality characteristics of good BST. The aim of this study is to investigate the influence of various teacher and structural characteristics on the perceived quality (in the dimensions of preparation, clinical teaching and learning climate) and to represent it in a model.

To investigate this question, we filmed 36 BSTs (80 hours) and distributed questionnaires to 24 lecturers and 259 students. Using a theory based categorical scheme, two raters independently coded the video material with high interrater reliability. On this basis, we analyse various structural characteristics of the recorded BSTs: the number of students, number of patients, overall duration, and the proportion of clinical examination. The physicians’ questionnaires provide insight into the teaching experience and the intrinsic motivation of the physicians, and the students evaluate the quality of the BSTs. To identify relationships, we use Pearson’s correlation coefficient. In order to best represent the complex teaching situation, we use a linear mixed model (LMM) with nested random effects.

The physicians’ intrinsic motivation showed a strong correlation with the quality of preparation (r=.678) and clinical teaching (r=.617) and a moderately strong correlation with the learning climate (r=.462). Experience showed no significant correlation with any perceived dimension of quality. The number of patients showed a correlation with the quality of clinical teaching (r=.461); this correlation was also significant in the LMM (p=.027). The number of students showed a negative correlation with the quality of preparation (r=-.468) and clinical teaching (r=-.414) as perceived by students. Overall duration had a medium relationship with the quality of clinical teaching (r=.381) and learning climate (r=.396). The proportion of clinical examination has a strong correlation with the quality of clinical teaching (r=.552), and this relationship was also significant in the LMM (p=.007).

Based on our results, some conclusions for how to design BST can be drawn: The strongest indicators for higher student satisfaction with BST courses were more patients being included in BST and more opportunities for clinical examination being offered. Moreover, based on our results, reducing the number of students in BST courses is recommendable. Regarding lecturers, intrinsic motivation and good preparation showed to be more important than experience. We argue that the present study amends the literature in that it provides a comprehensive insight into which personnel and structural characteristics have an influence on which dimension of quality of BST.