(教学查房 OR 临床教学) AND 患者隐私

随着社会的快速发展以及人们思维理念的不断变化，医学伦理学问题变得更加突出和尖锐，许多医学问题也亟待解决。而对于临床实习生来说，由于面对伦理问题时经验不足、认识不够，往往处理方式欠妥、导致医患矛盾加剧，容易引起医患纠纷。笔者对内科临床实习过程中经常出现的伦理学问题进行了探讨，认为主要伦理学问题为患者的权力保障与现实的医疗环境的冲突，并提出了加强教育、完善规章制度等处理方法，供同行讨论和参考。

Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession, but its use is declining. A literature review was conducted to reveal its strengths, the causes of its decline and future perspectives, the evidence with regard to learning clinical skills and patient/student/teacher satisfaction. PubMed, Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching. Articles regarding the above-mentioned subjects were included. Bedside teaching has shown to improve certain clinical diagnostic skills in medical students and residents. Patients, students/residents and teachers all seem to favour bedside teaching, for varying reasons. Despite this, the practice of bedside teaching is declining. Reasons to explain this decline include the increased patient turnover in hospitals, the assumed violation of patients’ privacy and an increased reliance on technology in the diagnostic process. Solutions vary from increasingly using residents and interns as bedside teachers to actively educating staff members regarding the importance of bedside teaching and providing them with practical essentials. Impediments to bedside teaching need to be overcome if this teaching modality is to remain a valuable educational method for durable clinical skills.

Bedside teaching (BST), a time‐honoured tradition of clinical teaching which integrates theoretical knowledge and clinical practice, has declined steeply over the last decade. Moreover, many clinician teachers today are not specifically trained in and/or comfortable in delivering effective BST. Resucitating this valuable educational format may require a new approach to preparing teachers and setting the stage for effective BST. Framing BST as an entrustable professional activity (EPA) for teachers may be one strategy to enhance its application and quality.

… This paper describes a workshop on bedside teaching. The … a ‘Model of Best Bedside Teaching Practices’, which emerged … of patient discomfort Lack of privacy, confidentiality Patients …

… , bedside teaching is a vital method of clinical teaching. … as a potential barrier to bedside teaching, the present study … the bedside as an encroachment on their or their child's privacy. …

I have 3 comments on the interesting study by Kianmehr et al1 on the medical student and patient perspectives on bedside teaching. First, bedside teaching (BST) has long been considered the most effective method to teach clinical skills and communication skills. Kianmehr et al’s study1 supports that consideration by addressing in their study that most of the medical students believed that BST is an effective way for learning the principles of history taking, physical examination, practical skills, data registry, communicating skills, evidence-based medicine, and interpretation of para-clinical findings. However, BST is thought to be underutilized as many barriers confront its successful application: lack of respect for the patient; time constraints; learner autonomy; faculty attitude, knowledge, and skill, and over-reliance on modern technology.2,3 A variety of strategies were suggested to mitigate these barriers: orienting and including the patient; addressing time constraints through flexibility, selectivity, and integration with work; providing learners with reassurance, reinforcing their autonomy, and incorporating them into the teaching process; faculty development; and advocating evidence-based physical diagnosis.3 Second, Kianmehr et al1 showed that 60% of the studied adult patients were comfortable with BST. Actually, parents of sick children do share that comfort with BST as it was found that bedside rounds have a positive impact on parents’ attitudes toward physicians, that they do not dilute the child’s sense of relationship with the primary attending physician, and that they contribute to certain aspects of resident education.4 Third, BST with evidence-based practice elements, supported by e-learning activities, could play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation, and interactivity.5

Objective: To assess the student’s and patients’ perspectives about bedside teaching and to identify possible barriers that delay effective bedside teaching. Methods: This cross-sectional study was conducted at two teaching hospitals in Peshawar with 153 participants through non-probability serial sampling from December 2017 to March 2018. Interview-based validated questionnaires were used and pilot tested as well. Ethical approval was taken with the participant’s consent. Data were analyzed using SPSS version 19.0 using descriptive statistics. Results: Among the total 79 students, all of them completed the questionnaires with a 100% response rate. However, from the 76 patients only 74 responded with a response rate of 97%. The majority of the patients (n=58; 78%) were satisfied with bedside teaching with no problems faced. During the bedside teaching only (n= 13; 18.2%) felt anxious while others, enjoyed (n= 59; 80.5%) with satisfaction and only 13% (n= 10) thought their privacy was breached. The satisfied students with the time spent on bedside teaching were (n= 52; 65.5%) while (n= 30; 38.7%) thought thirty minutes time was not enough. The hurdles faced were lack of practice (37.3%), fear of embarrassment in front of peers (21.3%), and lack of confidence to approach the patient (16%). Conclusion: The patients showed positive attitude and enjoyed bedside teaching. The students preferred it as a valuable tool for clinical experience. However, time constraints, lack of practice, lack of confidence, confidentiality, and anxiety must be overcome to make bedside teaching a useful method. Effective teaching still requires good teaching methodologies with confidence and competency.

… bedside teaching and the humanistic dimensions of bedside interactions that make it imperative to shift clinical teaching back to the bedside. … explore teacher and learner opinions. Four …

… Bed-side teaching (BST) is considered in this report to be teaching when the patient is present… , shorter length of stay in hospital, emphasis on community care, lack of privacy in crowded …

Academic physicians encounter many demands on their time including patient care, quality and performance requirements, research, and education. In an era when patient volume is prioritized and competition for research funding is intense, there is a risk that medical education will become marginalized. Bedside teaching, a responsibility of academic physicians regardless of professional track, is challenged in particular out of concern that it generates inefficiency, and distractions from direct patient care, and can distort physician–patient relationships. At the same time, the bedside is a powerful location for teaching as learners more easily engage with educational content when they can directly see its practical relevance for patient care. Also, bedside teaching enables patients and family members to engage directly in the educational process. Successful bedside teaching can be aided by consideration of four factors: climate, attention, reasoning, and evaluation. Creating a safe environment for learning and patient care is essential. We recommend that educators set expectations about use of medical jargon and engagement of the patient and family before they enter the patient room with trainees. Keep learners focused by asking relevant questions of all members of the team and by maintaining a collective leadership style. Assess and model clinical reasoning through a hypothesis-driven approach that explores the rationale for clinical decisions. Focused, specific, real-time feedback is essential for the learner to modify behaviors for future patient encounters. Together, these strategies may alleviate challenges associated with bedside teaching and ensure it remains a part of physician practice in academic medicine.

RATIONALE, AIMS AND OBJECTIVES Sharing aspects of the traditional medical record with patients has been successful in primary and antenatal care, but has not been investigated in the UK inpatient setting. Our aim was to evaluate the impact on patient and clinician experience of providing patients with a written lay summary of their care-plan in the acute care setting. METHOD We carried out a qualitative interview study on two acute medicine wards in an NHS University Teaching Hospital for a 4-week period in 2019. A summary record, designed in response to suggestions from doctors and patients from a previous study, was distributed to patients on the first ward round after admission. Eligible participants included all doctors and nurses working on and all patients and their families attending the acute medical units; patients were excluded if they lacked capacity to consent or were under 18. We interviewed 20 patients, 10 relatives, 10 doctors and 7 nurses. RESULTS Patients felt that the summary improved their ability to remember details about their care so they could more accurately and easily update their relatives. They did not feel that the summary induced anxiety. Patient-doctor communication was improved: patients felt empowered to ask more questions and doctors felt that it solidified their plan and encouraged them to avoid medical jargon. Most patients felt the summary included the 'right' amount of information. Healthcare professionals were more concerned about the risk of breaching confidentiality than patients. Doctors felt that providing summaries was time-consuming; there were differing opinions about whether this was a worthwhile investment of time. Clinicians recognized that the traditional medical record has many roles. CONCLUSIONS A summary record could empower patients and improve patient-doctor communication but would require additional clinician and administrative time.

Aims 1. To improve ward round efficacy and efficiency. 2. To make ward rounds more patient informed and create an updated ward round patient “preparation sheet”. 3. To improve collaboration and communication between the multidisciplinary team (MDT). 4. To review and modify ward round/Care Programme Approach (CPA) proformas. Methods 1. Quality Improvement training was delivered to the MDT. 2. An anonymous Likert scale survey was completed by the MDT (n=10), to gather views on ward round experience and documentation. 3. Patients: 2 interactive, breakout sessions (n=4) were facilitated to: • Explore their experience of ward rounds through discussion and Likert scale questionnaires (n=4). • Review the existing patient preparation sheet and coproduce a revised version. 4. MDT: 4 interactive, breakout sessions were facilitated with staff (n=10) to create a: • Process map of ward rounds. • Fish bone diagram of the challenges within ward rounds. • Reverse fish bone diagram, to consider solutions. • Revised ward round and nursing proformas. 5. A driver diagram was developed to generate change ideas. 6. A scoping exercise was completed, comparing ward round proformas within the rehab division, to consider areas of best practice. 7. A Plan Do Study Act (PDSA) cycle was initiated. Results 1. Patient discussion and questionnaire feedback re: ward round experience was positive. Patients felt “respected”, “supported,” “understood team roles” and “plans” within ward rounds. 2. Patients mostly agreed with the current format of the patient preparation sheet, however wanted a visual prompt, for their recovery areas. A diagram, “My recovery wheel”, was designed, to include diet, hobbies, mood, exercise, substances etc. 3. Staff felt “respected”, and “listened to” and “understood their roles” in the staff survey; MDT proformas and time keeping were highlighted as requiring improvement. 4. The fishbone diagram identified challenges within: staffing, procedural factors, time, resources/equipment, training and education, communication, proformas and patient engagement. 5. New, succinct, MDT ward round proformas were designed, with focus on rehab goals, in order to facilitate the patient journey and discharge pathway. 6. A ward round prompt sheet for the chair was created. Conclusion 1. Both MDT and patients feel largely positive re: ward round experience. 2. The improved patient preparation sheet is more patient centred, after being co-produced with patients. 3. The MDT highlighted multifactorial challenges pertaining to ward rounds running in an efficacious and efficient manner. 4. The next cycle of the project will focus on testing the new forms and change ideas.

… or outcomes’ of ward rounds. The Department of Clinical Psychology at Birmingham … the group of doctors arrive on the wards; and Patient’s confidentiality is respected during the SGR’. …

… with many clinical decisions based on this information. The central role of ward rounds is not … Seemingly small gestures appeared to appease patient’s concerns over confidentiality in …

Introduction: Holding bedside round teaching and involving patients in the teaching of the students might lead to patients’ dissatisfaction. This study was carried out in order to find the viewpoints of the patients and the medical team about the effect of clinical round on patients hospitalized in Isfahan University of Medical Sciences. Materials and Methods: This study is of cross-sectional descriptive type which is carried out in Isfahan University of Medical Sciences using researcher-made tools. The statistical population included the hospitalized patients, interns, residents, and nurses of the internal wards of educational hospitals. In this study, 110 patients and 150 health team staff are participated. The analysis of the data was done through software Statistical Package for Social Science (SPSS) 11.5 and descriptive and inferential statistics were applied. Statistical analysis of the variance did not show any significant difference among the interns’, nurses’, and residents’ perception of patient's satisfaction. Results: Generally, the patients had a positive viewpoint toward things happening during a round, whereas the medical team's viewpoint was negative. In both groups, the highest satisfaction average pertained to the number of times and the duration of visits, but both groups believed that lack of a definite responsible medical doctor, feeling of insecurity during the incongruous and unclear discussions, and the level of respect for the patient were the causes of dissatisfaction with the clinical round process. Conclusion: The current method of clinical rounds can result in patients’ dissatisfaction. On the other hand, proper relationship with them leads to the development of a more positive attitude in them. Therefore, revision and correction of the current clinical round procedures and teaching the communication skills to the medical team could help improve this process.

Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Results: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.

Objective: To discover parental preferences about visiting during ward rounds. Design: Survey using a short structured interview Setting and participants: Families of babies cared for in a regional neonatal intensive care unit. Results: Eighty six respondents, no refusals. Sixty three had visited during a ward round, and 13 had come in especially for the round. About half had overheard conversations about other babies or thought discussions about their baby had been overheard. Concerns about these experiences were only expressed by respondents who had actually experienced overhearing. Parents and families had little information about the ward round, held diverse views, and expressed different priorities. They described a mixture of concerns about communication, practicalities, and issues of ethics and principle. Confidentiality was a matter of concern for some, but many parents expected some sharing of information between families on the unit. Conclusions: Units should consider: the information they have for parents about ward rounds; the possibility that consultations may be overheard; the opportunities for parents to communicate with the clinical team.

This survey investigates the attitudes of medical and nursing staff towards the daily otolaryngology ward rounds in a teaching hospital.Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Respondents indicated on a Likert scale the extent to which they agreed or disagreed with statements concerning their attitudes towards the ward round.Thirty-five members of staff were surveyed. The overall response rate was 74.3 per cent (n = 26). The majority of staff agreed that the ward round was a constructive use of their time and served to promote team spirit. It allowed for adequate communication between medical and nursing staff but there was uncertainty about the provision of adequate patient communication. The nursing staff agreed that the ward round provided a valuable learning experience. There was uncertainty about this among the medical staff. There was agreement in both groups that patients find the ward round to be reassuring. A significant majority of staff expressed concerns over maintenance of patient confidentiality.These findings could be used to inform changes in the departmental ward round structure. Specific attention should be directed to discussing sensitive issues in a more private setting and maximizing educational opportunities for junior medical staff.

Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members′ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation.Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

… approval, we evaluated our clinical ethics ward rounds using a … ward round and at the end of the fourth ward round. The pre-… student or staff confidentiality. It may be sensible to reassure …

… One lesson I took away from that teaching session is that those of us who teach medical ethics need to be mindful of mistakenly thinking that we have “walked the same road” as our …

Background Competence in ethical decision making and moral sensitivity are becoming increasingly important in nursing education. While teaching reforms have been conducted in nursing ethics, these reforms often fail to drive the adequate development of students’ critical thinking and ethical decision-making skills. To address this gap, in this study, a “nursing ethics–professional teaching” program is constructed on the basis of Rest’s ethical decision-making model, and its effects on enhancing the ethical decision-making ability and sensitivity of nursing interns are explored. Methods Limited by the prespecified monthly departmental rotation schedule and the need to avoid intergroup contamination, this nonrandomized controlled study used an imbalanced design to divide all 99 undergraduate nursing interns into an intervention group (n = 24) and a control group (n = 75). They received six months of “nursing ethics–professional teaching” training, in which ward rounds and routine ward-round teaching, respectively, were integrated. An investigation was conducted before and after the intervention, in which the Moral Sensitivity Questionnaire (MSQ) and the Judgments Regarding Nursing Decisions (JAND) were used to analyze the differences in the development and the correlation of the ethical sensitivity and decision-making ability between the two groups. Results After the intervention, both the MSQ and JAND scores were significantly higher for the intervention group than they were for the control group (t = 7.371 and 6.377, respectively; both P < 0.001). Subgroup comparisons conducted before and after the intervention revealed unexpected decreases in MSQ scores in the control group (t = 3.784, P < 0.01), which contrasted sharply with the significant increase that was revealed in MSQ scores in the intervention group (t=-5.925, P < 0.001) and those in the JAND scores across both groups (t=-23.115 and − 24.092, both P < 0.001). Both the intervention method and its interaction with the intervention duration significantly affected the MSQ (F = 25.642, P < 0.01) and JAND (F = 8.910, P < 0.01) scores. Overall, the total and dimensional MSQ and JAND scores were negatively correlated before the intervention (r=-0.300 to -0.237; all P < 0.05) but showed no correlation after the intervention. Conclusion The model-based integrated “nursing ethics–professional teaching” ward-round shows promising effects on intern nurses’ moral sensitivity and ethical decision-making—unlike conventional clinical internships, which enhance only the latter. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-026-01441-3.

Despite growing interest in ethical matters in psychiatry, little attention has been paid to means of teaching ethics to mental health professionals. In a monthly "ethics rounds" developed …

… Good evidence exists that many clinical ethics problems are frequently not recognized by … call “ethics rounds,” has been developed and utilized as an alternative. The term ethics rounds, …

… cornerstone of medical education, yet its ethical delivery depends on patients’ informed … patient understanding of BST and strengthen consent processes through a targeted educational …

BACKGROUND Bedside shift reports have been recently recommended to ensure handovers. However, no evidence summarising studies designed to determine the qualitative approaches capable of better understanding patient experience have been published to date. AIM The aim of this study was to acquire a deeper understanding of the experiences of patients regarding bedside shift reports. DATA SOURCES AND REVIEW METHODS A systematic review of qualitative studies followed by a meta-synthesis method based upon Sandelowski's and Barroso's guidelines was performed. Four databases were systematically explored (PubMed, CINAHL, Scopus and PsycINFO) without any limitation in time and up to the 31 August 2018. A total of 10 studies were included and evaluated in their methodological quality; then, a thematic synthesis was developed to synthetize the findings. RESULTS Three major themes reflect patients' experience regarding the bedside shift reports: (i) 'Being involved'; (ii) 'Being the centre of nursing care processes'; and (iii) 'Experiencing critical issues'. Patients are supportive of bedside shift reports as a right, as an opportunity to be involved, and of being in the centre of the nursing care process. By designing and implementing bedside shift reports, nurses also have an opportunity to increase patient safety and to provide concrete proof of the advancements achieved by the nursing profession in recent years. CONCLUSIONS The bedside shift reports experience has been little studied to date from the perspective of patients. According to the findings, implementation of the bedside shift reports should include providing education to nurses with regard to the preferences and expectations of patients, as well as the critical issues that they can experience during the bedside shift reports. Presenting the bedside shift reports method, asking patient consent, discussing potential critical issues and the degree of involvement preferred at hospital admission, is strongly recommended.

BACKGROUND Although bedside case presentation contributes to patient-centered care through active patient participation in medical discussions, the complexity of medical information and jargon-induced confusion may cause misunderstandings and patient discomfort. OBJECTIVE To compare bedside versus outside the room patient case presentation regarding patients' knowledge about their medical care. DESIGN Randomized, controlled, parallel-group trial. (ClinicalTrials.gov: NCT03210987). SETTING 3 Swiss teaching hospitals. PATIENTS Adult medical patients who were hospitalized. INTERVENTION Patients were randomly assigned to bedside or outside the room case presentation. MEASUREMENTS The primary endpoint was patients' average knowledge of 3 dimensions of their medical care (each rated on a visual analogue scale from 0 to 100): understanding their disease, the therapeutic approach being used, and further plans for care. RESULTS Compared with patients in the outside the room group (n = 443), those in the bedside presentation group (n = 476) reported similar knowledge about their medical care (mean, 79.5 points [SD, 21.6] vs. 79.4 points [SD, 19.8]; adjusted difference, 0.09 points [95% CI, -2.58 to 2.76 points]; P = 0.95). Also, an objective rating of patient knowledge by the study team was similar for the 2 groups, but the bedside presentation group had higher ratings of confusion about medical jargon and uncertainty caused by team discussions. Bedside ward rounds were more efficient (mean, 11.89 minutes per patient [SD, 4.92] vs. 14.14 minutes per patient [SD, 5.65]; adjusted difference, -2.31 minutes [CI, -2.98 to -1.63 minutes]; P < 0.001). LIMITATION Only Swiss hospitals and medical patients were included. CONCLUSION Compared with outside the room case presentation, bedside case presentation was shorter and resulted in similar patient knowledge, but sensitive topics were more often avoided and patient confusion was higher. Physicians presenting at the bedside need to be skilled in the use of medical language to avoid confusion and misunderstandings. PRIMARY FUNDING SOURCE Swiss National Foundation (10531C_ 182422).

… patients' perspectives toward the bedside handover practice undergo a comprehensive examination. This study aimed to explore patients' perceptions of bedside … written consent was …

… Educational approaches aligning patient and nurse evidence may heighten nurses’ enthusiasm for sharing information with patients during bedside … of gaining patient consent for …

… ; patient consent; educator conflict; and developing competency. The themes of clinical placement and patient consent … increasingly more realistic alternatives to learning at the bedside. …

… and was used to record patient consent or reason for not … of bedside procedures and housestaff education around … the bedside of awake patients for fear of heightening patient …

… Active and sensitively managed patient involvement in medical education is vital in the drive … MD1 began the BTE by securing patient consent for the teaching activity and research. He …

… Participation was voluntary and confidential, and verbal consent was obtained from all … We believe clinical education that incorporates substantial bedside teaching is an effective …

There are complex ethical dilemmas inherent to medicine teaching, particularly in clinical practice involving actual patients. Questions must be raised on fulfilling medical students’ training needs while still respecting patients’ fundamental rights to autonomy and privacy. We aimed to assess patients’ perspectives regarding medical students’ involvement in their medical care. An observational, cross-sectional study was developed, and a questionnaire was applied randomly to patients waiting for a consultation/admitted to three distinct departments: General Surgery, Obstetrics/Gynaecology, and Infectious Diseases. Of the 77% interviewed patients who reported previous experiences with medical students, only 59% stated that they were asked for consent for their participation, and 28% stated that students had adequately introduced themselves. Patients from Gynaecology/Obstetrics were the ones who reported lower rates of these practices and were also the ones who were most bothered by students’ presence, stating that they would be more comfortable without the presence of medical students. Male patients received more explanations than female patients regarding the same matters. Thirty-five percent of patients stated that they would feel more comfortable without the medical students’ presence. The study shows a need to pay closer attention to fulfilling patients’ fundamental rights.