# 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.

## Key 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.