ArticleBMC medical education2025
Time-at-bedside and competency acquisition: a secondary analysis of GM-ITE domain scores in Japanese resident physicians.
Article in BMC medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDirect bedside learning is recognized as essential for clinical skill development, yet its domain-specific effects on competency acquisition have not been fully elucidated. We examined how self-reported time-at-bedside was associated with performance across four GM-ITE competency domains.
methodsWe performed a nationwide multicenter, cross-sectional study of Japanese first- and second-year postgraduate resident physicians who took the General Medicine In-Training Examination (GM-ITE) in late 2022. Time-at-bedside was defined as the average self-reported time per day a resident spent providing direct care at the patients' bedside and was stratified into six categories: C1 (10-20 min/day), C2 (30-50 min/day), C3 (60-80 min/day), C4 (90-110 min/day), C5 (120-140 min/day), and C6 (≥ 150 min/day). Data on time-at-bedside were collected through an electronic survey conducted immediately after the GM-ITE. A linear mixed-effects model was employed to examine the association between time-at-bedside and four GM-ITE competency-specific scores-medical interview and professionalism (MP), symptomatology and clinical reasoning (CR), physical examination and clinical procedures (PP), and disease knowledge (DK).
resultsOf 5,344 residents analyzed, more time-at-bedside showed only weak associations with MP and CR scores. In contrast, PP and DK scores increased in a dose-response pattern. Compared to C1, PP adjusted score differences were 0.3 (95% confidence interval [95% CI]: 0.07 to 0.48) in C2, 0.5 (95% CI: 0.27 to 0.73) in C3, 0.6 (95% CI: 0.13 to 1.01) in C5. Similarly, DK adjusted score differences were 0.6 (95% CI: 0.23 to 0.94) in C2, 0.5 (95% CI: 0.18 to 0.96) in C3, and 0.6 (95% CI: 0.16 to 1.66) in C5.
conclusionIn Japanese clinical residency, more time-at-bedside was associated with the acquisition of physical examination skills, clinical procedure skills, and disease knowledge. Future prospective longitudinal cohort studies are warranted to determine whether more time-at-bedside can accelerate these competencies.
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