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Background <p>Direct 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.</p> Methods <p>We 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&#xa0;min/day), C2 (30–50&#xa0;min/day), C3 (60–80&#xa0;min/day), C4 (90–110&#xa0;min/day), C5 (120–140&#xa0;min/day), and C6 (≥ 150&#xa0;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).</p> Results <p>Of 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.</p> Conclusion <p>In 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.</p>

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Time-at-bedside and competency acquisition: a secondary analysis of GM-ITE domain scores in Japanese resident physicians

  • 期刊论文

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  • 发表日期：

    2025年11月3日

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  • Kohta Katayama,
  • Toshihiko Takada,
  • Yuji Nishizaki,
  • Kazuya Nagasaki,
  • Taro Shimizu,
  • Yu Yamamoto,
  • Takashi Watari,
  • Yasuharu Tokuda,
  • Vineet Chopra,
  • Yoshiyuki Ohira

摘要

Background

Direct 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.

Methods

We 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).

Results

Of 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.

Conclusion

In 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.