A Randomized Controlled Study Comparing Educational Outcomes of Examination Room Versus Conference Room Staffing

Abstract

Background: This prospective randomized controlled study examined outpatient clinical teaching in the presence of the patient. Methods: In 2006, patients in ambulatory internal medicine clinics at the University of Iowa were randomized to have faculty-learner presentations either in their presence or in the conference room. Staffing encounters were timed and faculty, learners and patients completed postencounter surveys. Results: Participation included 254 patients and 12 faculty. Comparison of patient encounters randomized to exam room ( n = 120) or conference room ( n = 134) staffing demonstrated increased time spent with the patient in exam room staffing (91% vs. 54% of total staffing time; p < .0001) but no significant differences in mean total staffing time. Patients, learners, and faculty preferred exam room staffing. Conclusions: Concerns about time efficiency and patient and learner satisfaction during exam room staffing were not supported. This approach may allow attending physicians to maximize billing levels while increasing learner/patient involvement.

Acknowledgments

This study was supported by Educational Development Grant from the Office of Consultation and Research in Medical Education at the University of Iowa Carver College of Medicine.

Notes

^a n = 120.

^b n = 134.

^c Conference room patients were asked whether listening to their concerns discussed with another doctor “would have made them uncomfortable/embarrassed.”

^a Patient, faculty, learner encounter as unit of measure.

^b n = 120.

^c n = 134.

^a Patient, faculty, learner encounter as unit of measure.

^b n = 120.

^c n = 134.

^a n = 10.

^b n = 28. ^c Likert scale: 1 (never), 2 (almost never), 3 (sometimes), 4 (almost always), 5 (always).

^a n = 120.

^b n = 134.

^c Total time faculty and learner were together for presentation and discussion of the patient.

^d Lower mean time for fellow conference room staffing is attributable to one clinic where the attending finished the encounter alone rather than re-entering the patient room with the fellow to confirm history and physical exam findings if they had been randomized to conference room staffing. For these encounters, total staffing time included only time spent with fellow.