Elsevier

Ambulatory Pediatrics

Volume 7, Issue 5, September 2007, Pages 354-359
Ambulatory Pediatrics

Pediatric Education
Exam Room Presentations and Teaching in Outpatient Pediatrics: Effects on Visit Duration and Parent, Attending Physician, and Resident Perceptions

https://doi.org/10.1016/j.ambp.2007.05.006Get rights and content

Objective

To examine the effects of exam room presentations and teaching (ERPT) in a busy outpatient pediatric setting on visit duration and on parent, preceptor, and resident perceptions.

Methods

This 8-week, 2-method crossover study compared first-year pediatric resident patient presentations and attending physician teaching and discussion in the exam room (ERPT) with conference area presentation and teaching (CAPT). Outcome measures included visit duration, parent satisfaction, and resident/attending physician perceptions. Differences were analyzed using χ2 (parent surveys), t tests (visit duration), and signed rank tests (Attending Physician and Resident Surveys).

Results

Three hundred forty patient encounters were studied (151 ERPT vs 189 CAPT) that involved 15 first-year pediatric residents and 15 attending physicians. Visit durations were equivalent. Parent satisfaction was high in both methods. Attending physicians favored ERPT for adding opportunities to evaluate resident competencies, provide informed feedback, and role model. Attending physicians felt that ERPT decreased resident comfort level when discussing sensitive topics. Residents were less comfortable with ERPT for discussing sensitive topics and felt somewhat embarrassed when they did not know the answer to attending physicians' questions. Residents reported that ERPT presentations permitted attending physicians to demonstrate more physical exam skills and to observe interactions, enabling more informed feedback.

Conclusions

ERPT and CAPT require similar time and result in high parent satisfaction. Although residents are a little less comfortable with ERPT, attending physicians are better able to observe, evaluate, and give feedback on resident skills and to role model and teach physical diagnosis.

Section snippets

Study Setting and Population

The Pediatric Primary Care Center (PPCC) at the Cincinnati Children's Hospital Medical Center is a large, hospital-based pediatric primary care provider to a diverse socioeconomic and ethnic population. The PPCC is the continuity site for 50 pediatric residents (about one third of the pediatric residents from the residency training program) and also serves as a training site for residents on their primary care, outpatient rotation (60 per year) and for medical students (50 per year).

Results

All eligible first-year residents (n = 15, 9 female and 6 male) and all eligible attending physicians (n = 15, 9 female and 6 male) consented to participate and completed the surveys. Attending physicians had an average of 10 years experience (range, 2–30 years) postresidency training.

Three hundred seventy-four PPCC visits were eligible (272 well-child visits and 102 ill-child visits). However, the research assistant was unable to approach all of these patients because sometimes more than 1

Discussion

To our knowledge, this is the first study of ERPT in a pediatric outpatient setting. This builds on the work of Orsetti and Williams,6 Smith et al,7 Anderson et al,8 and Rogers et al,9 who studied this method in other outpatient settings. We found that location of presentation and discussion of patient information does not affect visit duration or parent satisfaction and comfort level with the resident-patient relationship. Resident and attending physician ratings favored the exam room location

Conclusions

Exam room presentations and discussions add value in the outpatient pediatric setting. With increasing emphasis on family-centered care and involvement of families in decision making, bedside teaching appears to be an appropriate approach in both the inpatient and outpatient arena. Although this does create some discomfort in residents, especially early in their training, this should diminish with experience as suggested in the adult literature. Advantages to parents are involvement in decision

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    Presented at the 2006 Pediatric Academic Societies Annual Meeting, San Francisco, Calif, May 2006.

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