The challenges and opportunities clinical education in the context of psychological, educational and therapeutic dimensions in teaching hospital | BMC Medical Education

Type of study

The present qualitative study was conducted using a content analysis approach in 2023 at the Imam Sajjad educational and therapeutic center affiliated with Tabriz Islamic Azad University of Medical Sciences.

Sampling method

The studied samples were among the patients admitted to the Imam Sajjad Educational and Medical Center of Tabriz, and it was carried out with purpose-based sampling. In this type of sampling, people were selected because of their experiences and information about bedside teaching. The selection criteria for participants included: Being at least 18 years old, able to communicate, having consent to participate in the study and be hospitalized, and having a history of bedside clinical training. Exclusion criteria included: Unwillingness to participate in the study, inability to communicate, being under 18 years of age, and having no history of bedside clinical training.

Data collecting

Before sampling, ethical permission to conduct the study was obtained from the regional ethics committee in Tabriz Islamic Azad University of Medical Sciences. The data of this study were collected through open, semi-structured interviews with 18 patients admitted to Imam Sajjad Hospital in Tabriz who had a history of attending or observing bedside teaching. The process of conducting the interview was that first, the interview guide, whose file is uploaded as an attachment, was provided to the patients. The researcher went to the hospital room and communicated with them, and after obtaining verbal consent to participate in the study, the time and place of the interview were determined with the opinion of the participants. At the beginning of the interview, the purpose of the study was explained to the participants and they were assured that the information obtained from the interview would be completely confidential and anonymous. After obtaining written consent to participate in the study, the interview started. The main question of the interview included this item: “What is your experience regarding the bedside teaching of medical, nursing, and midwifery students?” Then, according to the participants’ answers, some exploratory questions were asked such as “What context or categories affect your experience of the phenomenon?” and “What do you think about it?“. The duration of the interview was variable and each interview lasted between 30 and 45 min. All the interviews were recorded and then the manuscripts were read word by word, line by line, coded, and classified, and then the topics were extracted simultaneously with the continuation of the interviews. Data collection continued until data saturation was reached, and then it was terminated when new codes did not appear.

Data analysis

To analyze the data, the 6-step conventional content analysis method of Granheim and Lundman was used. In this way, in the first stage, after immersing in the data and repeatedly reading the text of the interviews, initial ideas emerged. In the next stage, the primary concepts were created. In the third stage, categories were identified. Relations between categories and subcategories were formed in the fourth stage. In the fifth stage, the categories and subcategories were named, and in the last stage, the final results of the research were reported. In this study, data collection and analysis were done simultaneously.

Study rigor

To ensure the validity and accuracy of the data, the four criteria of dependability, transferability, credibility, and confirmability proposed by Lincoln and Guba were utilized (18). To enhance the credibility of the data, the researcher engaged in long-term interaction and continuous and in-depth observations within the environment. To increase the dependability of the data, all stages of the study were described step by step to ensure proper judgment in external auditing. In order to achieve confirmability, the recorded interviews and their transcripts, along with the coding process, were shared with other colleagues who were knowledgeable in qualitative research methods, and the accuracy of the coding was confirmed. To enhance transferability, participants were selected with maximum diversity (in terms of age, gender, education, work experience, and workplace). Furthermore, participants’ opinions were used to examine the alignment between the findings and their experiences. In this regard, after coding, the interview text was returned to the participants to ensure the accuracy of the codes and interpretations.

Findings

Demographic characteristics: The study participants were 18 patients from the inpatient departments of Imam Sajjad Hospital in Tabriz. 8 patients were hospitalized in the internal department of women’s surgery, 6 patients in the internal department of male surgery, and 4 patients in the obstetrics and gynecology department. 10 participants were women and 8 were men. The age of the participants was between 32 and 57 years old and the duration of their hospitalization was between 12 − 3 days (Table 1).

From the analysis of participants’ narratives, 3 subcategories and 17 primary concepts were obtained. The subcategory of the treatment dimension includes the primary concepts of “increasing the number and duration of visits, fear of wrongly performing procedures by students, not knowing the person responsible for the treatment and responding to different people, the feeling of prolonged hospitalization due to the education process, fear and anxiety of unknowns and unfamiliar terms expressed in clinical rounds, increasing the probability of infection due to the large number of students and examination by them, less access to the relevant doctor due to being busy with education”, the subcategory of the ethical human dimension including the primary concepts of “lack of keeping the patient’s privacy and reporting the patient’s condition in public and examination by people of the same sex, not paying attention to the patient and his talk in clinical rounds and focusing more on education, not paying attention to the patient’s psychosocial issues and his hobbies and focusing more on his body, violation of trustworthiness, mental and physical discomfort due to more tests and examinations” and the next subcategory of education includes primary concepts “helping to increase the patient’s awareness and promoting self-care behaviors, increasing the patient’s interest in learning about the disease, Encouraging students to learn more, helping communication between patients and health care providers, helping to educate students (Table 2).

Treatment dimension subcategory

Narratives of the participants in the study showed that clinical training has therapeutic effects, such as:

Increase in the number and duration of visits

During the day, sometimes the number of visits and the duration of visits become long and tire the patient. Patient No. 1 states: “Some days, first thing in the morning, doctors and students come to my room several times and talk to the patients for a long time, and I like them to leave the room early because it gets boring.”

Fear of wrongly performing procedures

Fear of wrongly performing procedures by students and creating a feeling of insecurity from treatment by non-physicians is another disadvantage of clinical education. Patient number 13 says: “I always like the doctor to come over to me instead of the assistants and do my work. Honestly, I’m afraid that the assistants will make mistakes and my condition will get worse.”

Uncertainty of the person responsible for treatment and responding to different people

Another therapeutic effect of clinical training is the lack of clarity of a person responsible and accountable to the patient. Sometimes, due to overcrowding in the wards, the patient gets confused and does not know who is the person responsible for answering him. Patient number 14 states: “I don’t know exactly who to ask.”

The feeling of prolonged hospitalization due to the training process

one of the effects of clinical training is the unfavorable feeling about the length of hospitalization that is created in the patient, as mentioned by patient number 17: “I know because I was trained It’s possible that I won’t be released soon, I’m needed for their lessons, on the other hand, this is a teaching hospital, if he’s not sick, how do they want to teach”.

Fear and anxiety of the unknown

People are always stressed and anxious about the unknown and things that do not have enough or complete information. Patient number 11 says: “I don’t know exactly why they come over me every day, maybe my disease is dangerous, I don’t understand much of what they say.”

Increase in the possibility of infection

Another after-treatment effect is the increase in the possibility of infection due to the large number of students and examinations. Due to the fact that the patient is likely to be hospitalized for a longer period, his infection rate also increases. Patient number 8 says: “I have to wear a mask, the space in the room is closed and I am afraid that other patients will transfer the infection to me, my body is weak.”

Less access to the relevant doctor due to being busy with education

Considering the overcrowding of departments in government hospitals and the importance of student education, it is often not possible for patients to have easy access to the relevant doctor due to involvement in the education process. Patient number 15 states: “My doctor has classes with students for a few hours, once when my wife wanted to talk to Dr. M about transferring me to another hospital, she had to wait for a few hours until their class was over and after the class she hurriedly He went to the operating room.”