Explaining Patients' Lived Experiences of Bedside Teaching: A Qualitative Study

Explaining Patients' Lived Experiences of Bedside Teaching: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Explaining Patients' Lived Experiences of Bedside Teaching: A Qualitative Study azizeh barry, azam shahbaz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4809439/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Jan, 2025 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Background appropriate clinical environment by providing learning opportunities, plays an important role in preparing students to apply the knowledge learned in the bedside. Since the lived experiences of patients in the clinical environment are effective on the quality of students' learning, the present study was conducted with the aim of explaining the lived experiences of patients regarding bedside teaching. Materials and methods The present qualitative study was conducted using content analysis approach in 2023 at the Imam Sajjad educational and therapeutic center affiliated to Tabriz Islamic Azad University of Medical Sciences.The studied samples were selected with purpose-based sampling among the patients hospitalized in Imam Sajjad educational and therapeutic center of Tabriz (18 people). In addition, semi-structured interviews were used to collect data and Graneheim and Lundman's approach for analysis of the data. Results From the analysis of participants' narratives, 3 subcategory and 17 primary concepts were obtained.The subcategory of the treatment dimension includes the 7 primary concepts, the subcategory of the moral-human dimension including the 5 primary concepts of and the next subcategory of education dimension including 5 primary concepts. Conclusion Considering that the formation of patients' lived experiences is one of the predictive factors in the realization of learning and facilitating the process of professionalization of students in clinical education, therefore, the attention of managers and administrators to clinical education is amomg vital components. Clinical education often emphasizes education and learning in the clinical environment, and usually along with this education, the patient, his conditions and problems are also discussed. Bedside teaching Patient Qualitative study Content analysis Introduction Bedside teaching is a general term that usually refers to any type of education and learning in the presence of a patient in a wide range of modern health and care environments in the presence of a bed [ 1 ]. This triple interaction of doctor-patient-student is done in bedside teaching (BST) with the dual purpose of patient care and medical student learning [ 2 ]. Because BST involves training in the presence of patients, it may also include human aspects of patient care that help students integrate theory and the clinical experiences [ 3 ]. Studies in the literature have shown that this approach improves the transfer of theoretical knowledge to practical application and also increases learner participation in medical education [ 4 – 6 ]. Bedside teaching may improve active learning in real situations, observing students' skills, increasing their motivation, professional thinking, clinical integration, communication skills, problem solving skills, decision making and ethical skills along with improving understanding of patients [ 7 , 8 ] and helps the doctor to see the patient as a real person and not just a summary of the disease [ 9 ]. That is why these characteristics cannot be developed effectively in classrooms [ 10 ]. Patients have always been involved in the education of medical students, but they have mainly been considered as passive teaching materials, as teaching resources [ 11 ]. Involving the patient in health care to maintain respect for autonomy and using him as a participant to discuss treatment and support self-care is essential for patient-centered professionalism. Benefits of this method for patients include empowerment, an opportunity to learn more about their condition, improved doctor-patient relationships, and increased recovery through improved self-esteem. Despite efforts to promote active patient participation through staff development programs, patients are still reported to believe that they are powerless, especially when faced with bedside teaching [ 12 ]. In most cases, the patients not only ignored during the clinical round and the purpose of what is happening during the teaching is not clear to him, but they start to worry about their illness when they hear unfamiliar scientific words [ 13 ]. In this situation, many people from different classes such as students, interns, residents and faculty members deal with the patient briefly, which cannot create a friendly relationship between the doctor and the patient. On the other hand, students have not yet acquired enough skill and precision in performing routine operations, so the potential physical harm to the patient is a concern [ 14 ]. A recent systematic review concluded that bedside teaching rounds have a positive effect on learner behavior and health care delivery [ 15 ]. Peters and Ten Cate report that 77–85% of patients enjoy being a part of clinical education [ 16 ]. According to the condition of the patient and the patient himself, which causes a group of mental problems and impatience for the patient, does establishing such rounds on the patient's bed, which sometimes lasts for a long time, cause the patient to be annoyed, or on the contrary, does it make the patient feel that sufficient attention is paid to him, and the explanation of the disease and the treatment process of the disease gives him relief and feeling Peace comes from self-hospitalization? [ 9 ]. Some studies have shown that if patients' rights are protected and they receive humane care, they will have a positive view of engaging in clinical rounds. The main reason for their enthusiasm is that they feel that they have participated in the students' learning. When patients see the care and concern of the medical team for themselves, they are happy that they have been noticed and had an opportunity to ask their questions. In addition, their information about their disease increases during the round and they know that their feelings and opinions affect the decisions made [17]. Today, due to the increase in the cost of care, the reduction of the length of hospitalization of the patient, the employment of senior doctors in managerial and administrative affairs and the change of attitudes and in some cases, the difficulty in facing the patient or teaching at the bedside, attention is paid to clinical education in discussion or conference rooms instead of The clinical round has increased [ 18 ]. The investigations conducted on the clinical professors who had 14 years of experience indicated that the time limit is the most important limiting factor in the implementation of the clinical teaching method [ 19 ]. The time spent on BST has decreased since 1978. As reported by Ahmad, the time spent for teaching using BST method has decreased from 75% (30 years ago) to 16% [ 20 ]. The most important reasons for the decrease in bedside teaching are the time limitation due to the effort to visit a large number of patients, the increase in the number of inpatients, the decrease in the length of hospitalization, and also the teacher's concern about the comfort of the patient. In addition, unfulfillable expectations of the faculties, lack of self-confidence or experience, lack of comfort in the role of the lecturer at the bedside are other reasons for this decrease [ 21 ]. But still teaching at the bedside is the most effective method for teaching clinical and communication skills, and the decrease in the use of this method is one of the factors. which causes a sharp decrease in the clinical skills of trainees. Currently, clinical skills are increasingly taught in preclinical courses by incorporating clinical scenarios [ 22 ]. Medical students believe that BST may stress and embarrass patients. Researchers have come to the conclusion that most patients benefit from BST, but some of them express concern, so it is recommended to obtain permission from the patients before starting the training and before any physical examination [ 23 ] and give them explain that they have the right not to accept this [ 3 ]. It is important to ensure that the BST communicates with the patient, and that the patient's privacy is maintained through the use of curtains and barriers and separate rooms [ 24 ]. In addition, it is essential to consider the patient's health status, especially if the patient's condition is very serious, and respect the patient's choice if he wishes to stop the session. Patient-related barriers that can affect BST include lack of cooperation, fear of acceptance, misinterpretation of discussion, and cultural issues. Solutions to overcome these obstacles require that the patient's role be transformed from an interesting case to an active participant who has the full right to discuss, interrupt and provide deep and extensive insight into his illness [ 25 ]. However, the comfort levels of different patients differed with medical students, for example, urogenital patients reported a higher level of comfort than male students. Obstetrics and Gynecology patients have reported a higher level of comfort with female students [ 26 , 27 ]. The level of preparation and level of patient comfort in attracting medical students in their care may be influenced by the students' own previous experiences, their understanding of the role and responsibility of the students, The nature of the medical problem and the gender of the student should be placed in this context. Therefore, due to the lack of examination of patients' inner feelings and perceptions in quantitative studies and the effects of these perceptions on their level of satisfaction and the cultural difference of people and the lack of qualitative studies in this field in Iran to better understand the patients' attitudes, this research aims to identify the lived experiences of patients in Clinical rounds were conducted in educational and medical centers. Therefore, through this research, it is possible to modify the process and schedule of clinical rounds. Materials and methods Type of study The present qualitative study was conducted using content analysis approach in 2023 at the Imam Sajjad educational and therapeutic center affiliated to 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. Data collecting Prior to 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 such that the researcher went to the patients' hospital room and communicated with them, and after obtaining oral consent to participate in the study, the time and place of the interview was determined by 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 was 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 30–45 minutes. 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 In order to ensure the accuracy and reliability of the data, the four main criteria of validity, reliability, confirmability and transferability of Lincoln and Goba 6 were used (18). In order to ensure the validity of the data, the method of confirmation of the participants and long-term involvement of the researcher was used. Also, the data was evaluated by an external researcher. In order to achieve verification, an audit method was used in such a way that all the stages of the research, especially the stages of data analysis, were recorded in detail along the way, so that if another researcher wants to continue the research in this field, he can do so. follow Also, the transferability of the findings was done by providing a rich description of the research report in this field. 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 Demographic characteristics of the samples Row Age Gender Marital status Education Duration of hospitalization Type of disease Hospitalization unit 1 51 female married diploma 5 days liver cyst Internal gynecological surgery 2 45 female married Bachelor 4 days mastectomy Internal gynecological surgery 3 57 male married diploma 5 days BPH Internal surgery for men 4 34 female Single Masters 3 days Cholecystectomy Internal gynecological surgery 5 42 female married Diploma 4 days uterine myoma Obstetrics and Gynecology 6 38 female married Diploma 7 days Cesarean section infection Obstetrics and Gynecology 7 54 female married Diploma 10 days Pneumonia Internal gynecological surgery 8 48 female married Bachelor 4 days hysterectomy Obstetrics and Gynecology 9 51 male divorced Diploma 8 days Nephrectomy Internal surgery for men 10 47 male married Diploma 5 days BPH Internal surgery for men 11 46 female Single Diploma 12 days colon cancer Internal gynecological surgery 12 39 female married Diploma 4 days lumbar disc Internal gynecological surgery 13 45 female married Diploma 4 days hysterectomy Obstetrics and Gynecology 14 52 female Single Bachelor 3 days lumbar disc Internal gynecological surgery 15 40 female divorced Bachelor 3 days Cholecystectomy Internal gynecological surgery 16 48 male married Diploma 4 days lumbar disc Internal surgery for men 17 36 male married Bachelor 8 days colon cancer Internal surgery for men 18 32 male Single Bachelor 6 days Gastritis Internal surgery for men 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 ). Table 2 Category and subcategories and primary concepts Main Category Subcategories Primary concepts Clinical education Treatment dimension - Increasing the number and duration of visits - Fear of wrongly performing procedures by students (feeling insecure about being treated by a non-physician) - Not knowing the person responsible for treatment and responding to different people - The feeling of prolonged hospitalization due to the training process - Fear and anxiety of the unknown and unfamiliar terms expressed in clinical rounds - Increasing the possibility 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 Moral-human dimension - Failure to maintain the patient's privacy and reporting the patient's condition in public and examination by people of the same sex - Lack of attention to the patient and his talk in clinical rounds and focus more on education - Not paying attention to the psychosocial issues of the patient and his hobbies and focusing more on his body - Violation of reliability - Mental and physical discomfort due to more tests and investigations Education dimension - Help to increase patient awareness and promote self-care behaviors - Increasing interest in learning about the disease (patient learning) - Encouraging students to learn more - Assisting in communication between patients and health care providers - Helping to educate students 1. Treatment dimension subcategory Narratives of the participants in the study showed that clinical training has therapeutic effects, such as : 1.1 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 ." 1.2 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 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 ." 1.3 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 ." 1.4 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 ". 1.5 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 ." 1.6 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 by them. Due to the fact that the patient is likely to be hospitalized for a longer period of time, 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 ." 1.7 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 . ” 2. The subcategory of the moral-human dimension The narratives of the participants in the study showed that clinical training creates a series of issues and problems for patients from a human and ethical point of view, which include the following : 2.1 Failure to maintain privacy: In clinical training, there is always the fear that the patient will resist and struggle against revealing their privacy. Patient number 10 states: "I don't like that when my doctor comes to visit me, several students are with him at the same time and everyone knows about my illness." I would like the doctor to come alone for a visit ." 2.2 Ignoring the patient and his words: In clinical rounds, one of the problems that arise is ignoring the patient and his words. Due to the fact that in some rounds there are many students and more time is spent to explain, the patient is inevitably placed on the sidelines. Patient number 18 states: "When the doctor enters my room, there are several students and assistants next to him, and they are mostly talking together and do not pay attention to my words ." 2.3 Lack of attention to psychosocial issues: Mental and psychological issues and the history of the patient are sometimes ignored during clinical training. Patient No. 6 states: "When the doctor was talking to the assistants, they mostly talked about the wounds on my body and didn't pay much attention to my mental state and how good or bad I was ." 2.4 Violation of reliability: Another important issue that is challenged in clinical education is reliability. As patient number 15 mentions: “I don't trust them and I can't tell them all my problems, because the professor tells the students and they talk about me in front of everyone, maybe one of them knows me . ” 2.5 Mental and physical discomfort: Among other therapeutic effects of clinical training, we can mention the increase of mental and physical discomfort due to more tests and examinations. Patient number 9 states: "I am a miserable person and I am ashamed to be on top of me and I lie down. I wish only the doctor would examine me ". And patient number 4 states: "Every time the students press my stomach, I start to feel pain, I don't allow them to do tests on my body ". 3. Education dimension subcategory : The narratives of the study participants showed that clinical education has the following effects in terms of teaching and learning : 3.1 Helping to increase the patient's awareness and promote self-care behaviors: Considering that the professor and student are busy talking and examining the patient at the patient's bedside, information and knowledge related to the disease and its treatment will be transferred to the patient whether they like it or not. Patient No. 1 states: "When the doctor and students talk about my illness above me, I try to listen carefully to their words in order to gain information about my illness and then be able to act properly to improve and treat it." do I gained useful information from their talks about my illness ." 3.2 Increasing interest in learning about the disease: Increasing interest and gaining knowledge about the disease by the patient is another educational effect of clinical education. Patient number 12 states: " Whenever the doctor talks to the student at my bedside, I am very interested to find out what is the cause of the disease and get information about it ." 3.3 Encouraging students to learn more: Bedside teaching encourages students to do better in learning. Patient number 2 says: "When I participate in their class, I am happy and sometimes I feel that I am also useful. I try to cooperate with them so that they can learn more. Their professors also ask them questions and the students ask for answers. They are studying, sometimes I feel that they are trying to study better in order not to be embarrassed in front of me . ” 3.4 Helping communication between patients and health care providers: The bedside teaching process helps to increase communication skills between patients and health care providers. Patient No. 5 states: " When the class starts, the professor enters the room with a pleasant face and first greets me and explains about the class to me, sometimes he even jokingly answers my questions," another patient says: “during these classes and the times when they are present above me, I can get to know them and talk to them, and I feel that I am getting closer to them ". 3.5 Helping to train students: Bedside training is one of the most important parts for training and improving the knowledge, attitude and performance of students. Patient No. 7 says: "Students see examinations closely and learn how to tie a splint from their teacher, they discuss my medications and tests, I think they can learn very well if they pay attention to the class ." Clinical education experts all agree that despite all the advances that have been made, none of them can replace the experience and pleasure of working with a real patient when the student can see the disease with his own eyes (for example, the sound of a trill). (Hear from the narrowness of the mitral valve) this matter has been imprinted in his mind for a long time. None of the delicate and sensitive skills are formed through virtual education in the classroom and it is necessary that they must be taught in real conditions . Discussions Clinical education often emphasizes education and learning in the clinical and bedside environment, and usually along with this education, the patient, his conditions and problems are also discussed. In this study, the obtained results were classified into three subcategories: treatment dimension, human and moral dimension, and educational dimension. Treatment dimension According to the people who participated in this study, repeated examinations and visits and crowded and long rounds in which information about a person's illness is explained to him in an incomprehensible way, causes dissatisfaction in patients because patients should not be just an educational tool. And they should be used to teach a disease or perform examinations. The results of the study by Adibi et al. in Isfahan are consistent with the findings of our study [ 28 ]. Among the other problems of patients with cancer in the study are the large number of questioners and examiners in the clinical rounds and the lack of clarity of the main treating physician, scattered and conflicting discussions on the patient's bedside, as well as the lack of providing sufficient and understandable explanations about the disease and treatment measures. To the patient, which increases the sense of insecurity in the patients and their lack of confidence in being treated by a person other than the main physician. To improve the condition of the clinical round, it is suggested to conduct a group visit of interns and interns and even assistants at the same time to decrease the number of visits in a clinical round. Moreover, on the patient's bedside, focus more on practical aspects of the specific points and discussed other theoretical issues in the conference halls, which were considered as a substitute for the clinical rounds. Also, by observing points such as introducing the responsible physician at the beginning of the round, being patient in answering the patient's questions, providing a brief explanation about the disease and therapeutic measures, and reassuring the patient, he added to the effectiveness of the clinical round. Refraining from performing some diagnostic or therapeutic actions by fellow interns or assistants, without creating a disturbance in the treatment process, and avoiding the use of complex medical words and terms or conducting miscellaneous topics at the patient's bedside [ 29 ]. Another problem and concern of the participants in the study was the increase in the possibility of infection due to the large number of students and examinations by them. The results of the study by Pritam and his colleagues showed that health concerns and stress led to the rejection of students in delivery rooms, and also the patients examined in the urology departments showed the highest percentage of examination rejection by students due to health concerns [ 30 ]. Another study conducted by Marwan et al. at Kuwait University showed that obstetrics and gynecology patients showed the greatest refusal of students to participate. Most of the patients preferred to allow the students to prescribe the drugs only under the supervision of the doctor, while the rest of the patients were against it mainly due to health concerns [ 31 ]. The results of these studies confirm the findings of our study. Moral-human dimension Clinical rounds are one of the important places and occasions for teaching human behavior and the correct way of dealing with patients and medical ethics. Not allowing the patient to discuss his mental issues and social conditions and not participating and asking for his opinion in medical discussions and decisions, along with the low level of emotional connection between the doctor and the patient, causes the feeling of neglecting human aspects, in While in related studies, indicators such as good communication with the patient, participation of the patient in decisions, paying attention to the patient's concerns, promptness in solving the patient's problems and answering his questions are among the parameters of the doctor's human behavior [ 32 , 33 ]. In some cases, the doctor who is responsible for treating the patient does not provide information to the patient with the misconception that providing information to the patient can cause him to take a stand on the subject and oppose the presence of the student. This causes confusion for the patient and his companions, and because of that, they have trouble getting information about the diagnosis of the disease and the treatment process, and they ask questions from every person who comes to the patient's bedside. Such a path can cause information to be obtained from people who are not completely knowledgeable about the patient's condition and provide information to the patient based on speculation, and in many cases this method of obtaining information can cause misunderstanding of the patient and create tension between become a patient and a doctor, and sometimes the patient accuses the doctor of incompetence. We should not forget that in order to establish a correct relationship between the doctor and the patient, telling the truth is necessary, which increases the patient's trust in the therapist. During the presence of a large number of students, the patient feels that his privacy is violated, and sometimes he refuses to provide some of the information needed to diagnose the disease due to the fear of revealing his confidential information. Perhaps the most effective solution to this problem is to specify the maximum number of students, by the medical education policy makers, so that this problem is less associated with the reaction of patients. It is also possible to solve the problem to some extent by giving sufficient explanations to the patient about the observance of the principle of confidentiality by all the present students [ 34 ]. The findings of Beigzadeh et al.'s study are in line with the findings of the present study and confirm it [ 35 ]. The findings of Pritam et al.'s study showed that male patients were more accepting of medical students than female patients. The most common reason for rejecting student participation in the above cases was confidentiality. Of the female patients who allowed students to perform breast exams, delivery room procedures, genital exams, digital rectal exams, and urinary catheterizations, about a quarter preferred that only female students be present [ 30 ]. The results of Aquilina et al.'s study also showed that, in most cases, health concerns and stress are issues that bother adults and older patients (over 60), while privacy and confidentiality are concerns of younger age groups [ 36 ]. In clinical rounds, with a little patience and openness, you can establish a proper emotional relationship with the patient and by paying attention to the mental concerns of the patient, make him understand that his personality as a human being is respected and his rights are respected. It is counted. The lack of effective communication between the patient and the doctor and inappropriate attention to professionalism may prevent the patient from cooperating with the learners and reduce his preparation as another teaching input in the clinical environment. This issue has been emphasized in other studies as well [ 37 , 38 ]. Educational dimension The main elements of bedside teaching are patients and their relatives. Most patients find clinical education useful because it helps to increase patient awareness and promote self-care behaviors, and it increases interest in learning about the disease and encourages students to learn more, and it helps communication between patients and health care providers. Students are also very effective. Doctors and students talking with less medical terms is especially useful for patients with lower education [ 39 ]. The interaction between patients and students has an important impact on the success of bedside training, so the selection of suitable patients is essential [ 40 ]. The findings of Pritam et al.'s study showed that most patients were comfortable with the involvement of medical students during their hospital stay. Two very interesting reasons for this, expressed by patients, were as follows: 1) patients understood their medical condition better by talking to students, and 2) they believed that bedside teaching was essential for medical students to learn and to empower doctors in the future [ 30 ]. By gaining medical knowledge alongside students, patients benefit from the benefits of clinical education by increasing transparency in diagnosis and treatment. At the same time, they provide valuable information to students and clinicians by providing essential information about the signs and symptoms of their disease [ 10 ]. The results of the Al-Swailmi study also showed that most patients enjoyed bedside teaching with a better understanding of their disease and problems [ 41 ]. Also, studies showed that clinical education involves the patient in self-care and It also improves mutual communication between doctor and patient [ 42 , 43 ]. Conclusion The present study was conducted with the aim of explaining the lived experiences of patients regarding bedside teaching. Considering that the formation of patients' lived experiences is one of the predictive factors in realizing learning and facilitating the professionalization process of students in clinical education, therefore the attention of officials and managers to clinical education is important. Clinical education often emphasizes education and learning in the clinical environment, and usually along with this education, the patient, his conditions and problems are also discussed. Serious attention to the patient and his condition by the doctor/professor will help a lot to increase the sense of responsibility of the students in the future in dealing with the patients. Teaching in the presence of the patient provides a good opportunity so that knowledge and skills are used together and be useful for both the student and the patient. A teacher can also play his role as a role model and teach students the necessary points that cannot be conveyed through words. This time is a good opportunity for training and then evaluating the level of clinical skills. Limitations This study was conducted in a teaching and therapeutic hospital, and considering the maximum diversity in the selection of the studied samples, there may be limitations in generalizing the results of the study to other hospitals. Declarations Acknowledgments Hereby, the authors would like to appreciate all the participants in the research as well as Research Deputy of Tabriz Islamic Azad University of Medical Sciences for funding this research. Author Contribution All authors read and approved the final manuscript. Study conception and design: A.Sh, A.B ; Data collection: A.Sh, A.B ; Data analysis and interpretation: : A.Sh, A.B ; Drafting of the article: A. Sh , A. B ; Critical revision of the article: A.Sh , A.B ; Funding acquisition: A.Sh, A.B ; Resources: A.Sh, A.B ; Supervision: A.Sh , A.B . Competing Interests The authors declare that they have no competing interests. Ethical Approval This study was approved by the ethics committee of Tabriz Islamic Azad University of Medical Sciences (ethics code: IR.IAU.TABRIZ.REC.1402.294) Funding This article is drawn from a research project supported by Tabriz Islamic Azad University of Medical Sciences. References Towle A, Godolphin W. 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Iran J Med Sci. 2011;36(1):1. Aliakbari F, Haghani F. Patient's bedside teaching: Advantages and disadvantages. Iran J Med Educ. 2011;10(5):1161–76. Lichstein PR, Atkinson HH. Patient-centered bedside rounds and the clinical examination. Med Clin. 2018;102(3):509–19. Narayanan V, Nair BR. The value of bedside teaching in undergraduate medical education: a literature review. Med Ed Publish. 2020;9(149):149. Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ open. 2020;10(7):e037217. Gordon M, Gupta S, Thornton D. Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review. BEME Guide 58 Med teacher. 2020;42(1):4–16. O'Connor AB. Clinical instruction & evaluation: A teaching resource. Jones & Bartlett; 2014. Adibi P, Enjavian M, Alizadeh R, Omid A. The effect of ward round teaching on patients: The health team and the patients’ perspectives. J Educ health promotion. 2013;2:35. Ratelle JT, Gallagher CN, Sawatsky AP. The effect of bedside rounds on learning outcomes in medical education: a systematic review. Acad Med. 2022;97(6):923. Ten Cate O, Candy AE, Anderson TJ. Bedside teaching in medical education: a literature review. Perspectives on medical education and Patient satisfaction with medical student participation in a longitudinal integrated clerkship: a controlled trial. Academic Medicine 2020; 95(3): 417–424. Chang BJ. Problem-based learning in medical school: A student's perspective. Annals Med Surg. 2016;12:88–9. Gonzalo JD, Heist BS, Duffy BL. Identifying and overcoming the barriers to bedside rounds: a multicenter qualitative study. Acad Med. 2014;89(2):326–34. Qureshi Z. Back to the bedside: the role of bedside teaching in the modern era. Perspect Med Educ. 2014;3:69–72. Franklyn-Miller A, Falvey E, McCrory P. Patient-based not problem-based learning: An Oslerian approach to clinical skills, looking back to move forward. J Postgrad Med. 2009;55(3):198. Carlos WG, Kritek PA, Clay AS. Teaching at the Bedside. Maximal Impact in Minimal Time. Annals Am Thorac Soc. 2016;13(4):545–8. Alawad A, Younis FH. Patients' attitude towards undergraduate medical students at university charity teaching hospital in Sudan. Int J Med (Dubai). 2014;2(1):28–31. Stickrath C, Aagaard E, Anderson M. MiPLAN: a learner-centered model for bedside teaching in today’s academic medical centers. Acad Med. 2013;88(3):322–7. Dent J, Harden RM, Hunt D. A practical guide for medical teachers 2017: Elsevier Health Sciences. Fortier AM, Hahn PM, Trueman J, Reid RL. The acceptance of medical students by women with gynaecology appointments. J Obstet Gynecol Can. 2006;28(6):526–30. Passaperuma K, Higgins J, Power S, Taylor T. Do patients’ comfort levels and attitudes regarding medical student involvement vary across specialties? Med Teach. 2008;30(1):48–54. Adibi P, Alizadeh R. The Effects of Clinical Rounds on Patients in Internal Wards of Hospitals Affiliated to Isfahan University of Medical Sciences: The Viewpoints of Clinical Care Team. Iran J Med Educ. 2007;7(1):15–22. McGee S. Bedside teaching rounds reconsidered. JAMA. 2014;311(19):1971–2. Shetty PA, Magazine R, Chogtu B. Patient outlook on bedside teaching in a medical school. J Taibah Univ Med Sci. 2021;16(1):50–6. Marwan Y, Al-Saddique M, Hassan A. Are medical students accepted by patients in teaching hospitals? Med Educ Online. 2012;17(1):17172. Gonzalo JD, Kuperman E, Lehman E, Haidet P. Bedside interprofessional rounds: perceptions of benefits and barriers by internal medicine nursing staff, attending physicians, and housestaff physicians. J Hosp Med. 2014;9(10):646–51. Burgess A, van Diggele C, Roberts C, Mellis C. Key tips for teaching in the clinical setting. BMC Med Educ. 2020;20(2):1–7. Aliakbari F, Haghani F. Patient's Bedside Teaching: Advantages and Disadvantages. Iran J Med Educ 2011; 10(5). Beigzadeh A, Bahaadinbeigy K, Adibi P, Yamani N. Identifying the challenges to good clinical rounds: A focus-group study of medical teachers. J Adv Med Educ Professionalism. 2019;7(2):62. Aquilina T, Thompson SM, Metcalfe KH. The involvement of older inpatients in medical student education. Eur Geriatr Med. 2018;9:77–82. Arabshahi KS, Haghani F, Bigdeli S. Challenges of the ward round teaching based on the experiences of medical clinical teachers. J Res Med sciences: official J Isfahan Univ Med Sci. 2015;20(3):273. Haghani F, Arabshahi SK, Bigdeli S. Medical academia clinical experiences of Ward Round Teaching curriculum. Adv Biomedical Res. 2014;3:50. Swanwick T. Understanding medical education. Understanding Medical Education: Evidence, Theory, and Practice 2018: 1–6. Ramackers W, Stupak JV, Marcheel IL. Regression analyses of questionnaires in bedside teaching. BMC Med Educ. 2020;20:1–9. Al-Swailmi FK, Khan IA, Mehmood Y. Students’ perspective of bedside teaching: A qualitative study. Pakistan J Med Sci. 2016;32(2):351. Garibaldi BT, Russell SW. Strategies to improve bedside clinical skills teaching. Chest. 2021;160(6):2187–95. Artandi M, Russell S. Telemedicine paradoxically deepened our connection with patients. AAMC. 2020. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Jan, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 30 Jul, 2024 Editor assigned by journal 30 Jul, 2024 Submission checks completed at journal 30 Jul, 2024 First submitted to journal 26 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4809439","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":333985088,"identity":"fb93344f-22aa-4280-bbb1-ae3afb21c715","order_by":0,"name":"azizeh barry","email":"","orcid":"","institution":"Islamic Azad University of Tabriz","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"azizeh","middleName":"","lastName":"barry","suffix":""},{"id":333985089,"identity":"ef6d902b-b362-4858-9479-c0390e38a5e2","order_by":1,"name":"azam shahbaz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYHACNgbGhgMMDOzNBx98qLBhYJAgWgvPsWTDGWfSSNEi4WMmzdt2mLAW/gb2Zw9+7rgjLz+DwUCCt+18Yv9soAsZamyicWmROMBjbth75plh4+yGBAOJc7cTZ9w5lmzAcCwttwGXngM8bEDDDzM2yxw4kGBQdjux4UaOmQRjw2GcWuQPsD+T/Nt22L5NIrHhQALbucT5hLQYHGAA+zqxRyIZGAptBxI3ENJieJjHTFq27VnyDJ5jzIwNZ5KNN95ISzZIwOMXuePtzyTftt2xnd/e//33nwo72Xk3koFxWmOD2/vMaHxHsMoEXMqxAXtSFI+CUTAKRsHIAABNnGaJOLBPrAAAAABJRU5ErkJggg==","orcid":"","institution":"Islamic Azad University of Tabriz","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"azam","middleName":"","lastName":"shahbaz","suffix":""}],"badges":[],"createdAt":"2024-07-26 16:40:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4809439/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4809439/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-06711-z","type":"published","date":"2025-01-30T15:58:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75352071,"identity":"486f76ac-4167-48d4-85fa-e39124b4e274","added_by":"auto","created_at":"2025-02-03 16:13:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1076453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4809439/v1/ac3d0ef7-e91d-4473-9172-34d3faabbec8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Explaining Patients' Lived Experiences of Bedside Teaching: A Qualitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBedside teaching is a general term that usually refers to any type of education and learning in the presence of a patient in a wide range of modern health and care environments in the presence of a bed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This triple interaction of doctor-patient-student is done in bedside teaching (BST) with the dual purpose of patient care and medical student learning [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Because BST involves training in the presence of patients, it may also include human aspects of patient care that help students integrate theory and the clinical experiences [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Studies in the literature have shown that this approach improves the transfer of theoretical knowledge to practical application and also increases learner participation in medical education [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBedside teaching may improve active learning in real situations, observing students' skills, increasing their motivation, professional thinking, clinical integration, communication skills, problem solving skills, decision making and ethical skills along with improving understanding of patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and helps the doctor to see the patient as a real person and not just a summary of the disease [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. That is why these characteristics cannot be developed effectively in classrooms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Patients have always been involved in the education of medical students, but they have mainly been considered as passive teaching materials, as teaching resources [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Involving the patient in health care to maintain respect for autonomy and using him as a participant to discuss treatment and support self-care is essential for patient-centered professionalism. Benefits of this method for patients include empowerment, an opportunity to learn more about their condition, improved doctor-patient relationships, and increased recovery through improved self-esteem.\u003c/p\u003e \u003cp\u003eDespite efforts to promote active patient participation through staff development programs, patients are still reported to believe that they are powerless, especially when faced with bedside teaching [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In most cases, the patients not only ignored during the clinical round and the purpose of what is happening during the teaching is not clear to him, but they start to worry about their illness when they hear unfamiliar scientific words [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this situation, many people from different classes such as students, interns, residents and faculty members deal with the patient briefly, which cannot create a friendly relationship between the doctor and the patient. On the other hand, students have not yet acquired enough skill and precision in performing routine operations, so the potential physical harm to the patient is a concern [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A recent systematic review concluded that bedside teaching rounds have a positive effect on learner behavior and health care delivery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Peters and Ten Cate report that 77\u0026ndash;85% of patients enjoy being a part of clinical education [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the condition of the patient and the patient himself, which causes a group of mental problems and impatience for the patient, does establishing such rounds on the patient's bed, which sometimes lasts for a long time, cause the patient to be annoyed, or on the contrary, does it make the patient feel that sufficient attention is paid to him, and the explanation of the disease and the treatment process of the disease gives him relief and feeling Peace comes from self-hospitalization? [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Some studies have shown that if patients' rights are protected and they receive humane care, they will have a positive view of engaging in clinical rounds. The main reason for their enthusiasm is that they feel that they have participated in the students' learning. When patients see the care and concern of the medical team for themselves, they are happy that they have been noticed and had an opportunity to ask their questions. In addition, their information about their disease increases during the round and they know that their feelings and opinions affect the decisions made [17].\u003c/p\u003e \u003cp\u003eToday, due to the increase in the cost of care, the reduction of the length of hospitalization of the patient, the employment of senior doctors in managerial and administrative affairs and the change of attitudes and in some cases, the difficulty in facing the patient or teaching at the bedside, attention is paid to clinical education in discussion or conference rooms instead of The clinical round has increased [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The investigations conducted on the clinical professors who had 14 years of experience indicated that the time limit is the most important limiting factor in the implementation of the clinical teaching method [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The time spent on BST has decreased since 1978. As reported by Ahmad, the time spent for teaching using BST method has decreased from 75% (30 years ago) to 16% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most important reasons for the decrease in bedside teaching are the time limitation due to the effort to visit a large number of patients, the increase in the number of inpatients, the decrease in the length of hospitalization, and also the teacher's concern about the comfort of the patient. In addition, unfulfillable expectations of the faculties, lack of self-confidence or experience, lack of comfort in the role of the lecturer at the bedside are other reasons for this decrease [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. But still teaching at the bedside is the most effective method for teaching clinical and communication skills, and the decrease in the use of this method is one of the factors. which causes a sharp decrease in the clinical skills of trainees. Currently, clinical skills are increasingly taught in preclinical courses by incorporating clinical scenarios [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Medical students believe that BST may stress and embarrass patients. Researchers have come to the conclusion that most patients benefit from BST, but some of them express concern, so it is recommended to obtain permission from the patients before starting the training and before any physical examination [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and give them explain that they have the right not to accept this [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is important to ensure that the BST communicates with the patient, and that the patient's privacy is maintained through the use of curtains and barriers and separate rooms [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, it is essential to consider the patient's health status, especially if the patient's condition is very serious, and respect the patient's choice if he wishes to stop the session. Patient-related barriers that can affect BST include lack of cooperation, fear of acceptance, misinterpretation of discussion, and cultural issues. Solutions to overcome these obstacles require that the patient's role be transformed from an interesting case to an active participant who has the full right to discuss, interrupt and provide deep and extensive insight into his illness [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, the comfort levels of different patients differed with medical students, for example, urogenital patients reported a higher level of comfort than male students. Obstetrics and Gynecology patients have reported a higher level of comfort with female students [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The level of preparation and level of patient comfort in attracting medical students in their care may be influenced by the students' own previous experiences, their understanding of the role and responsibility of the students, The nature of the medical problem and the gender of the student should be placed in this context. Therefore, due to the lack of examination of patients' inner feelings and perceptions in quantitative studies and the effects of these perceptions on their level of satisfaction and the cultural difference of people and the lack of qualitative studies in this field in Iran to better understand the patients' attitudes, this research aims to identify the lived experiences of patients in Clinical rounds were conducted in educational and medical centers. Therefore, through this research, it is possible to modify the process and schedule of clinical rounds.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eType of study\u003c/h2\u003e \u003cp\u003eThe present qualitative study was conducted using content analysis approach in 2023 at the Imam Sajjad educational and therapeutic center affiliated to Tabriz Islamic Azad University of Medical Sciences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSampling method\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collecting\u003c/h2\u003e \u003cp\u003e Prior to 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 such that the researcher went to the patients' hospital room and communicated with them, and after obtaining oral consent to participate in the study, the time and place of the interview was determined by 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 was 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\u0026ndash;45 minutes. 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eTo 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy rigor\u003c/h2\u003e \u003cp\u003eIn order to ensure the accuracy and reliability of the data, the four main criteria of validity, reliability, confirmability and transferability of Lincoln and Goba 6 were used (18). In order to ensure the validity of the data, the method of confirmation of the participants and long-term involvement of the researcher was used. Also, the data was evaluated by an external researcher. In order to achieve verification, an audit method was used in such a way that all the stages of the research, especially the stages of data analysis, were recorded in detail along the way, so that if another researcher wants to continue the research in this field, he can do so. follow Also, the transferability of the findings was done by providing a rich description of the research report in this field.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eDemographic 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\u0026thinsp;\u0026minus;\u0026thinsp;3 days.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the samples\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration of hospitalization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eType of disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHospitalization unit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ediploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eliver cyst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003emastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ediploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal surgery for men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003euterine myoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eObstetrics and Gynecology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCesarean section infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eObstetrics and Gynecology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ehysterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eObstetrics and Gynecology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal surgery for men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal surgery for men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecolon cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elumbar disc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ehysterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eObstetrics and Gynecology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elumbar disc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elumbar disc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal surgery for men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecolon cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal surgery for men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGastritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInternal surgery for men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFrom 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\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCategory and subcategories and primary concepts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubcategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimary concepts\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClinical education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment dimension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Increasing the number and duration of visits\u003c/p\u003e \u003cp\u003e- Fear of wrongly performing procedures by students (feeling insecure about being treated by a non-physician)\u003c/p\u003e \u003cp\u003e- Not knowing the person responsible for treatment and responding to different people\u003c/p\u003e \u003cp\u003e- The feeling of prolonged hospitalization due to the training process\u003c/p\u003e \u003cp\u003e- Fear and anxiety of the unknown and unfamiliar terms expressed in clinical rounds\u003c/p\u003e \u003cp\u003e- Increasing the possibility of infection due to the large number of students and examination by them\u003c/p\u003e \u003cp\u003e- Less access to the relevant doctor due to being busy with education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoral-human dimension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Failure to maintain the patient's privacy and reporting the patient's condition in public and examination by people of the same sex\u003c/p\u003e \u003cp\u003e- Lack of attention to the patient and his talk in clinical rounds and focus more on education\u003c/p\u003e \u003cp\u003e- Not paying attention to the psychosocial issues of the patient and his hobbies and focusing more on his body\u003c/p\u003e \u003cp\u003e- Violation of reliability\u003c/p\u003e \u003cp\u003e- Mental and physical discomfort due to more tests and investigations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation dimension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Help to increase patient awareness and promote self-care behaviors\u003c/p\u003e \u003cp\u003e- Increasing interest in learning about the disease (patient learning)\u003c/p\u003e \u003cp\u003e- Encouraging students to learn more\u003c/p\u003e \u003cp\u003e- Assisting in communication between patients and health care providers\u003c/p\u003e \u003cp\u003e- Helping to educate students\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cbr\u003e \u003cp\u003e\u003cstrong\u003e1. Treatment dimension subcategory\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNarratives of the participants in the study showed that clinical training has therapeutic effects, such as\u003cem\u003e\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIncrease in the number and duration of visits:\u003c/strong\u003e During the day, sometimes the number of visits and the duration of visits become long and tire the patient. Patient No. 1 states:\u0026nbsp;\u003cem\u003e\u0026quot;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\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eFear of wrongly performing procedures:\u003c/strong\u003e 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: \u003cem\u003e\u0026quot;I always like the doctor to come over me instead of the assistants and do my work. Honestly, I\u0026apos;m afraid that the assistants will make mistakes and my condition will get worse\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eUncertainty of the person responsible for treatment and responding to different people:\u003c/strong\u003e 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: \u0026quot;I don\u0026apos;t know exactly who to ask\u003cem\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 The feeling of prolonged hospitalization due to the training process:\u003c/strong\u003e 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:\u0026nbsp;\u003cem\u003e\u0026quot;I know because I was trained It\u0026apos;s possible that I won\u0026apos;t be released soon, I\u0026apos;m needed for their lessons, on the other hand, this is a teaching hospital, if he\u0026apos;s not sick, how do they want to teach\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e\u0026quot;.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Fear and anxiety of the unknown:\u003c/strong\u003e People are always stressed and anxious about the unknown and things that do not have enough or complete information. Patient number 11 says: \u003cem\u003e\u0026quot;I don\u0026apos;t know exactly why they come over me every day, maybe my disease is dangerous, I don\u0026apos;t understand much of what they say\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.6 Increase in the possibility of infection:\u003c/strong\u003e Another after-treatment effect is the increase in the possibility of infection due to the large number of students and examinations by them. Due to the fact that the patient is likely to be hospitalized for a longer period of time, his infection rate also increases. Patient number 8 says:\u0026nbsp;\u003cem\u003e\u0026quot;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\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.7 Less access to the relevant doctor due to being busy with education:\u003c/strong\u003e 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:\u0026nbsp;\u003cem\u003e\u0026quot;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\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. The subcategory of the moral-human dimension\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe narratives of the participants in the study showed that clinical training creates a series of issues and problems for patients from a human and ethical point of view, which include the following\u003cem\u003e\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Failure to maintain privacy:\u0026nbsp;\u003c/strong\u003eIn clinical training, there is always the fear that the patient will resist and struggle against revealing their privacy. Patient number 10 states:\u0026nbsp;\u003cem\u003e\u0026quot;I don\u0026apos;t like that when my doctor comes to visit me, several students are with him at the same time and everyone knows about my illness.\u0026quot; I would like the doctor to come alone for a visit\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIgnoring the patient and his words:\u0026nbsp;\u003c/strong\u003eIn clinical rounds, one of the problems that arise is ignoring the patient and his words. Due to the fact that in some rounds there are many students and more time is spent to explain, the patient is inevitably placed on the sidelines. Patient number 18 states: \u003cem\u003e\u0026quot;When the doctor enters my room, there are several students and assistants next to him, and they are mostly talking together and do not pay attention to my words\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eLack of attention to psychosocial issues:\u003c/strong\u003e Mental and psychological issues and the history of the patient are sometimes ignored during clinical training. Patient No. 6 states:\u0026nbsp;\u003cem\u003e\u0026quot;When the doctor was talking to the assistants, they mostly talked about the wounds on my body and didn\u0026apos;t pay much attention to my mental state and how good or bad I was\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eViolation of reliability:\u0026nbsp;\u003c/strong\u003eAnother important issue that is challenged in clinical education is reliability. As patient number 15 mentions:\u003cem\u003e\u0026nbsp;\u0026ldquo;I don\u0026apos;t trust them and I can\u0026apos;t tell them all my problems, because the professor tells the students and they talk about me in front of everyone, maybe one of them knows me\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eMental and physical discomfort:\u0026nbsp;\u003c/strong\u003eAmong other therapeutic effects of clinical training, we can mention the increase of mental and physical discomfort due to more tests and examinations. Patient number 9 states:\u0026nbsp;\u003cem\u003e\u0026quot;I am a miserable person and I am ashamed to be on top of me and I lie down. I wish only the doctor would examine me\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e\u0026quot;.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eAnd patient number 4 states:\u0026nbsp;\u003cem\u003e\u0026quot;Every time the students press my stomach, I start to feel pain, I don\u0026apos;t allow them to do tests on my body\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e\u0026quot;.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Education dimension subcategory\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe narratives of the study participants showed that clinical education has the following effects in terms of teaching and learning\u003cem\u003e\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003eHelping to increase the patient\u0026apos;s awareness and promote self-care behaviors:\u003c/strong\u003e Considering that the professor and student are busy talking and examining the patient at the patient\u0026apos;s bedside, information and knowledge related to the disease and its treatment will be transferred to the patient whether they like it or not. Patient No. 1 states: \u003cem\u003e\u0026quot;When the doctor and students talk about my illness above me, I try to listen carefully to their words in order to gain information about my illness and then be able to act properly to improve and treat it.\u0026quot; do I gained useful information from their talks about my illness\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003eIncreasing interest in learning about the disease:\u003c/strong\u003e Increasing interest and gaining knowledge about the disease by the patient is another educational effect of clinical education. Patient number 12 states: \u0026quot;\u003cem\u003eWhenever the doctor talks to the student at my bedside, I am very interested to find out what is the cause of the disease and get information about it\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Encouraging students to learn more:\u003c/strong\u003e Bedside teaching encourages students to do better in learning. Patient number 2 says: \u003cem\u003e\u0026quot;When I participate in their class, I am happy and sometimes I feel that I am also useful. I try to cooperate with them so that they can learn more. Their professors also ask them questions and the students ask for answers. They are studying, sometimes I feel that they are trying to study better in order not to be embarrassed in front of me\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eHelping communication between patients and health care providers:\u003c/strong\u003e The bedside teaching process helps to increase communication skills between patients and health care providers. Patient No. 5 states: \u0026quot;\u003cem\u003eWhen the class starts, the professor enters the room with a pleasant face and first greets me and explains about the class to me, sometimes he even jokingly answers my questions,\u0026quot;\u003c/em\u003e another patient says:\u0026nbsp;\u003cem\u003e\u0026ldquo;during these classes and the times when they are present above me, I can get to know them and talk to them, and I feel that I am getting closer to them\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e\u0026quot;.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eHelping to train students:\u003c/strong\u003e Bedside training is one of the most important parts for training and improving the knowledge, attitude and performance of students. Patient No. 7 says:\u0026nbsp;\u003cem\u003e\u0026quot;Students see examinations closely and learn how to tie a splint from their teacher, they discuss my medications and tests, I think they can learn very well if they pay attention to the class\u003c/em\u003e\u003cspan dir=\"RTL\"\u003e.\u0026quot;\u003c/span\u003e\u003cem\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eClinical education experts all agree that despite all the advances that have been made, none of them can replace the experience and pleasure of working with a real patient when the student can see the disease with his own eyes (for example, the sound of a trill). (Hear from the narrowness of the mitral valve) this matter has been imprinted in his mind for a long time. None of the delicate and sensitive skills are formed through virtual education in the classroom and it is necessary that they must be taught in real conditions\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eClinical education often emphasizes education and learning in the clinical and bedside environment, and usually along with this education, the patient, his conditions and problems are also discussed. In this study, the obtained results were classified into three subcategories: treatment dimension, human and moral dimension, and educational dimension.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTreatment dimension\u003c/h2\u003e \u003cp\u003eAccording to the people who participated in this study, repeated examinations and visits and crowded and long rounds in which information about a person's illness is explained to him in an incomprehensible way, causes dissatisfaction in patients because patients should not be just an educational tool. And they should be used to teach a disease or perform examinations. The results of the study by Adibi et al. in Isfahan are consistent with the findings of our study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the other problems of patients with cancer in the study are the large number of questioners and examiners in the clinical rounds and the lack of clarity of the main treating physician, scattered and conflicting discussions on the patient's bedside, as well as the lack of providing sufficient and understandable explanations about the disease and treatment measures. To the patient, which increases the sense of insecurity in the patients and their lack of confidence in being treated by a person other than the main physician. To improve the condition of the clinical round, it is suggested to conduct a group visit of interns and interns and even assistants at the same time to decrease the number of visits in a clinical round. Moreover, on the patient's bedside, focus more on practical aspects of the specific points and discussed other theoretical issues in the conference halls, which were considered as a substitute for the clinical rounds. Also, by observing points such as introducing the responsible physician at the beginning of the round, being patient in answering the patient's questions, providing a brief explanation about the disease and therapeutic measures, and reassuring the patient, he added to the effectiveness of the clinical round. Refraining from performing some diagnostic or therapeutic actions by fellow interns or assistants, without creating a disturbance in the treatment process, and avoiding the use of complex medical words and terms or conducting miscellaneous topics at the patient's bedside [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother problem and concern of the participants in the study was the increase in the possibility of infection due to the large number of students and examinations by them. The results of the study by Pritam and his colleagues showed that health concerns and stress led to the rejection of students in delivery rooms, and also the patients examined in the urology departments showed the highest percentage of examination rejection by students due to health concerns [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Another study conducted by Marwan et al. at Kuwait University showed that obstetrics and gynecology patients showed the greatest refusal of students to participate. Most of the patients preferred to allow the students to prescribe the drugs only under the supervision of the doctor, while the rest of the patients were against it mainly due to health concerns [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The results of these studies confirm the findings of our study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMoral-human dimension\u003c/h2\u003e \u003cp\u003eClinical rounds are one of the important places and occasions for teaching human behavior and the correct way of dealing with patients and medical ethics. Not allowing the patient to discuss his mental issues and social conditions and not participating and asking for his opinion in medical discussions and decisions, along with the low level of emotional connection between the doctor and the patient, causes the feeling of neglecting human aspects, in While in related studies, indicators such as good communication with the patient, participation of the patient in decisions, paying attention to the patient's concerns, promptness in solving the patient's problems and answering his questions are among the parameters of the doctor's human behavior [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn some cases, the doctor who is responsible for treating the patient does not provide information to the patient with the misconception that providing information to the patient can cause him to take a stand on the subject and oppose the presence of the student. This causes confusion for the patient and his companions, and because of that, they have trouble getting information about the diagnosis of the disease and the treatment process, and they ask questions from every person who comes to the patient's bedside. Such a path can cause information to be obtained from people who are not completely knowledgeable about the patient's condition and provide information to the patient based on speculation, and in many cases this method of obtaining information can cause misunderstanding of the patient and create tension between become a patient and a doctor, and sometimes the patient accuses the doctor of incompetence. We should not forget that in order to establish a correct relationship between the doctor and the patient, telling the truth is necessary, which increases the patient's trust in the therapist. During the presence of a large number of students, the patient feels that his privacy is violated, and sometimes he refuses to provide some of the information needed to diagnose the disease due to the fear of revealing his confidential information. Perhaps the most effective solution to this problem is to specify the maximum number of students, by the medical education policy makers, so that this problem is less associated with the reaction of patients. It is also possible to solve the problem to some extent by giving sufficient explanations to the patient about the observance of the principle of confidentiality by all the present students [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The findings of Beigzadeh et al.'s study are in line with the findings of the present study and confirm it [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of Pritam et al.'s study showed that male patients were more accepting of medical students than female patients. The most common reason for rejecting student participation in the above cases was confidentiality. Of the female patients who allowed students to perform breast exams, delivery room procedures, genital exams, digital rectal exams, and urinary catheterizations, about a quarter preferred that only female students be present [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The results of Aquilina et al.'s study also showed that, in most cases, health concerns and stress are issues that bother adults and older patients (over 60), while privacy and confidentiality are concerns of younger age groups [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In clinical rounds, with a little patience and openness, you can establish a proper emotional relationship with the patient and by paying attention to the mental concerns of the patient, make him understand that his personality as a human being is respected and his rights are respected. It is counted. The lack of effective communication between the patient and the doctor and inappropriate attention to professionalism may prevent the patient from cooperating with the learners and reduce his preparation as another teaching input in the clinical environment. This issue has been emphasized in other studies as well [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEducational dimension\u003c/h2\u003e \u003cp\u003eThe main elements of bedside teaching are patients and their relatives. Most patients find clinical education useful because it helps to increase patient awareness and promote self-care behaviors, and it increases interest in learning about the disease and encourages students to learn more, and it helps communication between patients and health care providers. Students are also very effective. Doctors and students talking with less medical terms is especially useful for patients with lower education [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The interaction between patients and students has an important impact on the success of bedside training, so the selection of suitable patients is essential [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The findings of Pritam et al.'s study showed that most patients were comfortable with the involvement of medical students during their hospital stay. Two very interesting reasons for this, expressed by patients, were as follows: 1) patients understood their medical condition better by talking to students, and 2) they believed that bedside teaching was essential for medical students to learn and to empower doctors in the future [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy gaining medical knowledge alongside students, patients benefit from the benefits of clinical education by increasing transparency in diagnosis and treatment. At the same time, they provide valuable information to students and clinicians by providing essential information about the signs and symptoms of their disease [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The results of the Al-Swailmi study also showed that most patients enjoyed bedside teaching with a better understanding of their disease and problems [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Also, studies showed that clinical education involves the patient in self-care and It also improves mutual communication between doctor and patient [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study was conducted with the aim of explaining the lived experiences of patients regarding bedside teaching. Considering that the formation of patients' lived experiences is one of the predictive factors in realizing learning and facilitating the professionalization process of students in clinical education, therefore the attention of officials and managers to clinical education is important. Clinical education often emphasizes education and learning in the clinical environment, and usually along with this education, the patient, his conditions and problems are also discussed. Serious attention to the patient and his condition by the doctor/professor will help a lot to increase the sense of responsibility of the students in the future in dealing with the patients.\u003c/p\u003e \u003cp\u003eTeaching in the presence of the patient provides a good opportunity so that knowledge and skills are used together and be useful for both the student and the patient. A teacher can also play his role as a role model and teach students the necessary points that cannot be conveyed through words. This time is a good opportunity for training and then evaluating the level of clinical skills.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was conducted in a teaching and therapeutic hospital, and considering the maximum diversity in the selection of the studied samples, there may be limitations in generalizing the results of the study to other hospitals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHereby, the authors would like to appreciate all the participants in the research as well as Research Deputy of Tabriz Islamic Azad University of Medical Sciences for funding this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript. Study conception and design: A.Sh, A.B ; Data collection: A.Sh,\u0026nbsp;A.B\u0026nbsp;;\u0026nbsp;Data analysis and interpretation: : A.Sh,\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eA.B ; Drafting of the article: A. Sh ,\u0026nbsp;A. B ; Critical revision of the article: A.Sh , A.B ; Funding acquisition: A.Sh,\u0026nbsp;A.B ; Resources: A.Sh, A.B ; Supervision: A.Sh , A.B\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of Tabriz Islamic Azad University of Medical Sciences (ethics code: IR.IAU.TABRIZ.REC.1402.294)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is drawn from a research project supported by Tabriz Islamic Azad\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eUniversity of Medical Sciences.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTowle A, Godolphin W. 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Med Educ. 2017;51(6):585\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLaughlin JE, Roth MT, Glatt DM. The flipped classroom: a course redesign to foster learning and engagement in a health professions school. Acad Med. 2014;89(2):236\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalam A, Siraj HH, Mohamad N, Das S, Rabeya Y. Bedside teaching in undergraduate medical education: issues, strategies, and new models for better preparation of new generation doctors. Iran J Med Sci. 2011;36(1):1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAliakbari F, Haghani F. Patient's bedside teaching: Advantages and disadvantages. Iran J Med Educ. 2011;10(5):1161\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLichstein PR, Atkinson HH. Patient-centered bedside rounds and the clinical examination. 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The effect of ward round teaching on patients: The health team and the patients\u0026rsquo; perspectives. J Educ health promotion. 2013;2:35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRatelle JT, Gallagher CN, Sawatsky AP. The effect of bedside rounds on learning outcomes in medical education: a systematic review. Acad Med. 2022;97(6):923.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTen Cate O, Candy AE, Anderson TJ. Bedside teaching in medical education: a literature review. Perspectives on medical education and Patient satisfaction with medical student participation in a longitudinal integrated clerkship: a controlled trial. Academic Medicine 2020; 95(3): 417\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang BJ. Problem-based learning in medical school: A student's perspective. Annals Med Surg. 2016;12:88\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonzalo JD, Heist BS, Duffy BL. Identifying and overcoming the barriers to bedside rounds: a multicenter qualitative study. Acad Med. 2014;89(2):326\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQureshi Z. Back to the bedside: the role of bedside teaching in the modern era. Perspect Med Educ. 2014;3:69\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranklyn-Miller A, Falvey E, McCrory P. Patient-based not problem-based learning: An Oslerian approach to clinical skills, looking back to move forward. J Postgrad Med. 2009;55(3):198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlos WG, Kritek PA, Clay AS. Teaching at the Bedside. Maximal Impact in Minimal Time. Annals Am Thorac Soc. 2016;13(4):545\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlawad A, Younis FH. Patients' attitude towards undergraduate medical students at university charity teaching hospital in Sudan. Int J Med (Dubai). 2014;2(1):28\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStickrath C, Aagaard E, Anderson M. MiPLAN: a learner-centered model for bedside teaching in today\u0026rsquo;s academic medical centers. Acad Med. 2013;88(3):322\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent J, Harden RM, Hunt D. A practical guide for medical teachers 2017: Elsevier Health Sciences.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFortier AM, Hahn PM, Trueman J, Reid RL. The acceptance of medical students by women with gynaecology appointments. J Obstet Gynecol Can. 2006;28(6):526\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePassaperuma K, Higgins J, Power S, Taylor T. Do patients\u0026rsquo; comfort levels and attitudes regarding medical student involvement vary across specialties? Med Teach. 2008;30(1):48\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdibi P, Alizadeh R. The Effects of Clinical Rounds on Patients in Internal Wards of Hospitals Affiliated to Isfahan University of Medical Sciences: The Viewpoints of Clinical Care Team. Iran J Med Educ. 2007;7(1):15\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGee S. Bedside teaching rounds reconsidered. JAMA. 2014;311(19):1971\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShetty PA, Magazine R, Chogtu B. Patient outlook on bedside teaching in a medical school. J Taibah Univ Med Sci. 2021;16(1):50\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarwan Y, Al-Saddique M, Hassan A. Are medical students accepted by patients in teaching hospitals? Med Educ Online. 2012;17(1):17172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonzalo JD, Kuperman E, Lehman E, Haidet P. Bedside interprofessional rounds: perceptions of benefits and barriers by internal medicine nursing staff, attending physicians, and housestaff physicians. J Hosp Med. 2014;9(10):646\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurgess A, van Diggele C, Roberts C, Mellis C. Key tips for teaching in the clinical setting. BMC Med Educ. 2020;20(2):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAliakbari F, Haghani F. Patient's Bedside Teaching: Advantages and Disadvantages. Iran J Med Educ 2011; 10(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeigzadeh A, Bahaadinbeigy K, Adibi P, Yamani N. Identifying the challenges to good clinical rounds: A focus-group study of medical teachers. J Adv Med Educ Professionalism. 2019;7(2):62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAquilina T, Thompson SM, Metcalfe KH. The involvement of older inpatients in medical student education. Eur Geriatr Med. 2018;9:77\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArabshahi KS, Haghani F, Bigdeli S. Challenges of the ward round teaching based on the experiences of medical clinical teachers. J Res Med sciences: official J Isfahan Univ Med Sci. 2015;20(3):273.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaghani F, Arabshahi SK, Bigdeli S. Medical academia clinical experiences of Ward Round Teaching curriculum. Adv Biomedical Res. 2014;3:50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSwanwick T. Understanding medical education. Understanding Medical Education: Evidence, Theory, and Practice 2018: 1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamackers W, Stupak JV, Marcheel IL. Regression analyses of questionnaires in bedside teaching. BMC Med Educ. 2020;20:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Swailmi FK, Khan IA, Mehmood Y. Students\u0026rsquo; perspective of bedside teaching: A qualitative study. Pakistan J Med Sci. 2016;32(2):351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaribaldi BT, Russell SW. Strategies to improve bedside clinical skills teaching. Chest. 2021;160(6):2187\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArtandi M, Russell S. Telemedicine paradoxically deepened our connection with patients. AAMC. 2020.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bedside teaching, Patient, Qualitative study, Content analysis","lastPublishedDoi":"10.21203/rs.3.rs-4809439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4809439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eappropriate clinical environment by providing learning opportunities, plays an important role in preparing students to apply the knowledge learned in the bedside. Since the lived experiences of patients in the clinical environment are effective on the quality of students' learning, the present study was conducted with the aim of explaining the lived experiences of patients regarding bedside teaching.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eThe present qualitative study was conducted using content analysis approach in 2023 at the Imam Sajjad educational and therapeutic center affiliated to Tabriz Islamic Azad University of Medical Sciences.The studied samples were selected with purpose-based sampling among the patients hospitalized in Imam Sajjad educational and therapeutic center of Tabriz (18 people). In addition, semi-structured interviews were used to collect data and Graneheim and Lundman's approach for analysis of the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom the analysis of participants' narratives, 3 subcategory and 17 primary concepts were obtained.The subcategory of the treatment dimension includes the 7 primary concepts, the subcategory of the moral-human dimension including the 5 primary concepts of and the next subcategory of education dimension including 5 primary concepts.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eConsidering that the formation of patients' lived experiences is one of the predictive factors in the realization of learning and facilitating the process of professionalization of students in clinical education, therefore, the attention of managers and administrators to clinical education is amomg vital components. Clinical education often emphasizes education and learning in the clinical environment, and usually along with this education, the patient, his conditions and problems are also discussed.\u003c/p\u003e","manuscriptTitle":"Explaining Patients' Lived Experiences of Bedside Teaching: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 05:52:40","doi":"10.21203/rs.3.rs-4809439/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-31T02:18:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-30T11:31:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-30T11:31:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-07-26T16:38:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e259ec8f-ab35-4469-a06f-39a3c4f0e900","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T16:10:40+00:00","versionOfRecord":{"articleIdentity":"rs-4809439","link":"https://doi.org/10.1186/s12909-025-06711-z","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-01-30 15:58:15","publishedOnDateReadable":"January 30th, 2025"},"versionCreatedAt":"2024-08-26 05:52:40","video":"","vorDoi":"10.1186/s12909-025-06711-z","vorDoiUrl":"https://doi.org/10.1186/s12909-025-06711-z","workflowStages":[]},"version":"v1","identity":"rs-4809439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4809439","identity":"rs-4809439","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}