Background: Teaching during rounds is a key component of medical education. While peer observation studies have examined bedside teaching from the attending perspective, limited literature exists on resident viewpoints. Family-centered rounds (FCR) studies have identified attending behaviors as a key factor in resident satisfaction, yet the specific ways in which attendings impact trainee education in real-time during rounds remains understudied. Two factors that may shape perceptions of bedside teaching are resident comfort in engaging in patient care discussions and attending support of resident autonomy. Because these elements may be experienced differently by trainees who are observing versus actively participating, comparing both perspectives can provide insight into attending behaviors that foster an effective learning environment. This study explores trainee perceptions of bedside teaching and the learning environment during rounds and compares the perspectives of observing trainees with those of residents actively participating in rounds to identify attending-specific factors that influence educational experiences.
Methods: This prospective cohort study was conducted at a tertiary children’s hospital from April to August 2025. Twenty inpatient rounds led by 16 hospitalists with 59 participating residents were observed. Typical rounding teams included a senior resident (PGY-2 or PGY-3) and 2-3 interns (PGY-1). Each rounds session was observed by a hospital medicine fellow and one of four senior residents on the study team. Participating residents completed post-rounds surveys assessing resident comfort engaging in discussion, level of resident autonomy, and attending teaching style. Likert-scale items (1= strongly disagree, 5= strongly agree) were summarized descriptively. Free-text responses underwent thematic analysis with independent inductive coding and consensus reconciliation.
Results: A total of 39 observation forms were completed by observers. Forty-four post-rounds surveys were completed by participating residents (PGY-1: 61%, PGY-2: 16%, PGY-3: 23%). On a 5-point scale, participating residents reported a mean score of 4.49 for comfort engaging in questions, compared with 4.63 from observing residents and 4.95 from the fellow (p = 0.07, between observers). For attending support of autonomy, participating residents reported 4.49, compared with 4.68 and 4.95, from observing residents and the fellow, respectively (p = 0.03, between observers). Thematic analysis revealed six themes: communication, learning environment, autonomy, teaching methods/ techniques, barriers to education, and time management. Each theme included multiple sub-themes; for the learning environment theme, for instance, sub-themes included attending personality traits, attending behaviors, and learner factors (Table 1).
Conclusions: Attending physician behaviors and demeanor strongly influence the bedside learning environment. Observers perceived greater comfort and autonomy than participating residents, suggesting that clinical experience and observer versus participant role may affect perceptions of teaching. Clear communication, structured teaching, and protected time enhanced learning, while competing demands and variable autonomy hindered it. These findings highlight opportunities to strengthen resident engagement and maximize educational value during bedside rounds.
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