ABSTRACT
Introduction Reportedly, teaching at the bedside is declining over time. This purported decline has not been quantified. Quantifying bedside teaching is challenging, and we found only one study quantifying bedside teaching on a hospitalist service. We conducted a study to understand the prevalence of bedside teaching in our medical intensive care unit. Methods We conducted a single-center single-unit study in the medical intensive care unit of an academic tertiary care institution. We utilized a survey tool to assess perceived time spent on bedside teaching, quality of teaching, and total rounding time. In parallel, independent observers objectively measured time spent on rounds and on bedside teaching. Residents were asked to complete the survey once a week. Independent observers collected data daily and weekly averages were obtained. Results A total of 43 responses were collected over a 4-month period. Most respondents (73%) reported a total rounding time of either 90-120 min or greater than 120 min. Median reported bedside teaching time was 16-20 min with 16 respondents (37%) reporting less than 15 min and 27 respondents (63%) reporting 16 min or more. The amount of time spent on bedside teaching was reported as adequate or more than adequate by 77% (33) of respondents with 58% (25) reporting that bedside teaching was very or extremely effective in helping them learn. The mean census reported by the independent observers was 12.75 patients per team. Bedside teaching represented an average of 12% of total rounding time, 16.85 minutes per day. There was no correlation between the team census and the amount of bedside teaching. While total rounding time increased with increasing census, there was no decline in bedside teaching time. Discussion/Conclusion Medical education has evolved over time and has gradually incorporated informal teaching sessions, simulations, and mini lectures in addition to traditional bedside teaching. Despite the evolution in medical education, bedside teaching remains an integral component of post graduate medical education. Even though bedside teaching represented only 12% of total rounding time, medical residents perceived the time and quality of bedside teaching to be adequate. Strengths: Bedside teaching time was corroborated by independent observers and not limited to subjective perception of trainees. Limitations: This study was limited to one medical intensive care unit in an academic tertiary care hospital. This study was conducted during the COVID-19 pandemic which may have affected results. A small number of surveys were collected over a 4-month period. (Figure Presented).
ABSTRACT
In March 2020, at the onset of the SARS-CoV-2 pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. Members include physicians and ECMO coordinators from the six medical centers in the county that offer ECMO. The goal was to formulate guidelines that ensure ECMO is delivered equitably in a clinically and resource effective manner during the pandemic. SARS-CoV2 ECMO patient selection criteria were established in accordance with Extracorporeal Life Support Organization (ELSO) recommendations. The purpose of these criteria was to reduce variation of ECMO criteria among different providers/hospital systems. The guidelines were reviewed and approved by an expert biomedical ethicist to ensure that community benefit was maximized given that ECMO is a limited resource, and could require allocation decisions be made. The California Department of Health and County of San Diego further incorporated the guidelines into their allocation of scarce resources plans. The consortium meets weekly via video conference to 1) foster collaborative multidisciplinary discussions and refine clinical practices 2) review countywide ECMO census and staffing abilities, and 3) share these data with the Department of Health and hospital system leadership. Benefits of the consortium include the ability to exchange equipment, collaborative assessments of referrals from other counties, and the ability to transfer multiple patients who were initiated on ECMO at one hospital system to another to balance ECMO burden among centers to increase capacity. As a result, our community has offered ECMO to a total of 42 patients with COVID-19.