Is bedside teaching necessary or acceptable in paediatrics?

To the Editor: Bedside teaching is an important tool in medical education, highly regarded by students and supported by patients in adult medicine.1,2 Given the resource and practical constraints facing bedside teaching,3 it is important to justify and inform this method in the paediatric setting. No previous Australian study has explored bedside teaching in paediatrics.

We conducted two cross-sectional surveys, adapted from an earlier study,2 to separately assess student and parent perspectives on bedside teaching in paediatrics. Between 1 May 2012 and 31 July 2012, 100 final year medical students from Monash University and 107 parents of acutely unwell children admitted to Monash Medical Centre Clayton were approached at random in lecture theatres and on the wards, respectively. All of the students and 100 parents (93%) agreed to complete their respective surveys. Paediatric patients were aged 4 weeks to 16 years; 73% were medical patients, and 27% were surgical patients. Their length of stay varied from 1 day to 90 days. Seven parents declined to participate because of lack of time or limitations with English. The study received approval from the Southern Health Human Research Ethics Low Risk Review Panel.

The students identified history-taking, examination, communication and case presentation as key areas that benefited from bedside teaching, consistent with findings in adult medicine.2,4 Many of the medical students felt that they needed more bedside teaching in paediatrics than was provided to them at the time of the survey (Box).

The parents reported that the bedside teaching was important for students (98%), improved care of others (87%) and that they would recommend participating in bedside teaching to other parents (88%). Over half of surveyed parents (54%) would be comfortable with their child seeing students unsupervised.

Negative aspects of bedside teaching were the concerns about breach of confidentiality (9%), discomfort (19%) or anxiety (15%) of the child that could arise from participation. However, of the 52 respondents who had had previous experience with bedside teaching, only 6% were dissatisfied with a bedside discussion.

This preliminary study shows that bedside teaching is viewed positively in paediatric wards. Additional research exploring teacher perspectives and attitudes in different patient subgroups (eg, groups of patients by cultural background or type of illness) will help further inform the use of bedside teaching in undergraduate paediatric training.