Validation of a questionnaire exploring patient attitudes towards bedside teaching.

BACKGROUND: Bedside teaching (BST) facilitates medical education and has reduced in practice, often due to patient-related concerns. This study aimed to validate a questionnaire exploring patients attitudes towards BST. METHODS: International guidelines for questionnaire development were followed. Seven steps were included: literature review, patient interviews, development of clear and understandable items, expert validation, cognitive interviewing and pilot testing. Statistical analyses included exploratory factor analysis, internal consistency, investigation of demographic influences and discriminant validity across subscales. RESULTS: Following the literature review, 32 interviews were conducted. Potential items were developed, reviewed and adapted. Experts in medical education and statistics reviewed the draft questionnaire. Fifteen patients consented to cognitive testing and 401 consenting patients completed the final version. The median age of participants was 35 years of age (range: 18 to 70 years). Participants included women attending for antenatal (40%), postnatal (32%) and gynaecology issues (28%). Just under one third (29%) had taken part in medical student teaching previously. Statistical analyses found a two-factor solution, consisting of Educate medical professionals and Conditions for participation subscales with good internal consistency; responses did not vary by age or education. Participants who had opted-in for teaching in the ward and bedside endorsed higher levels of Educate medical professionals, suggesting discriminant validity. A majority of patients (> 92%) reported that they were happy to be involved in BST. Patients believed that they should not be asked to participate in BST should they feel stressed or unwell (68.2%). CONCLUSION: This study shows extensive patient support for BST, independent of age or education. The desire to educate is a strong motivating factor. This strong support by patients for BST is an area that medical schools and universities can potentially develop. Future versions of this questionnaire may include virtual bedside teaching, in the context of social distancing.

Cerebral autoregulation is temporarily disturbed in the early recovery phase after dynamic resistance exercise.

AIM: To determine cerebral blood-flow velocity (CBFV) and parameters of dynamic cerebral autoregulation (CA) during and after exhausting resistance exercise. METHODS: Strength endurance (23 repetitions) and maximal strength training (8 repetitions) in 16 female and 16 male athletes on a leg curler (m. quadriceps training; approx. 2 s contraction) in the upright position. Registration of ECG, blood pressure by Finapres, CBFV by transcranial Doppler (TCD), and breathing by a Zak breathing-belt. Additional repetitive ergospirometry (O2-uptake, CO2-elimination, ventilation) and blood gas analyses were performed in a subgroup of seven athletes. From BP and CBFV cerebrovascular resistance (CVR), pulsatility index (PI) as well as LF-power, gain and phase-angle (frequency analysis) were derived. RESULTS: All athletes showed significant (p<0.01) 15 % to 30 % increases in CBFV during both training sets without signs of flow depression due to Valsalva maneuvers. In the early recovery, when blood pressure rapidly decreased, CBFV amplitude significantly (p<0.01) increased for 60-80 seconds with mean flow (Vm) at the exercise level, while CVR and PI showed conflicting results, similar to a presyncopal reaction. Ergospirometry and blood gas analyses revealed no evidence of major changes in pCO2, but phase angle was reduced (p<0.001) after exercise, together with an LF power increase (p<0.001). CONCLUSION: An unexpected increase in CBFV amplitude and in Vm occurs directly after dynamic resistance exercise without increased pCO2, which is comparable to a maximum leg press with hypercapnia. CVR and PI results as well as data from frequency analysis show similarities to presyncopal reactions, on the one hand, and point towards a temporarily disturbed cerebral autoregulation, on the other.