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

TL;DR

This study finds that spending more time at the patient's bedside is linked to better skills in physical exams, procedures, and disease knowledge among Japanese resident physicians.

Contribution

The study provides evidence that time-at-bedside is associated with specific competency gains in clinical procedures and disease knowledge.

Findings

More time-at-bedside was weakly associated with medical interview and professionalism scores.

Physical examination and clinical procedures scores increased with more time-at-bedside in a dose-response pattern.

Disease knowledge scores also showed a dose-response increase with more time-at-bedside.

Abstract

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.

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).

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.

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.

The online version contains supplementary material available at 10.1186/s12909-025-08076-9.

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