Farewell frost!
October 30, 2024
The field of medicine is at a crossroads.
Artificial intelligence and advanced diagnostics are revolutionizing patient care. But research has found that physicians — spread thin from electronic health recordkeeping and managing alerts — spend only 13% of their time in direct contact with patients, which translates to just six minutes per patient per day in the hospital. This schedule often results in physician burnout and frustrated patients.
To combat this, Northwestern University Feinberg School of Medicine has launched a new Center for Bedside Medicine, which will aim to revitalize patient interactions by combining traditional elements of the bedside interaction — history taking, physical exams and more — with cutting-edge technology, such as artificial intelligence (AI) and devices like digital stethoscopes and handheld ultrasound machines.
“We've lost sight of the importance of some of the traditional skills that still have value, like talking to and building a rapport with patients, doing a targeted physical exam,” said the center’s inaugural director, Dr. Brian Garibaldi, a nationally recognized leader in innovative bedside teaching methods. “The most common error that's made in the physical exam is simply that the exam was never performed. Part of this is the false belief that if it's done through technology, it's somehow better than what we can see, hear, feel and smell.”
“We need to figure out how to layer on technology not to replace our time with patients but to make the most of the time we have with them,” said Garibaldi, also a professor of medicine in the division of pulmonary and critical care medicine at Feinberg and a Northwestern Medicine physician.
Garibaldi is a distinguished physician-scientist with expertise in clinical skills assessment, high-consequence pathogens, pandemic preparedness and COVID-19. He serves on the board of directors of, co-founded and was the inaugural co-president of the Society of Bedside Medicine.
The power of touch with real volunteer patients
Diagnostic errors are estimated to affect millions annually. They often stem from lapses in basic examination skills, which are hard to practice without hands-on patient contact.
“There are many times where patients will say, ‘No one’s ever examined me in that way before,’ and it may be simply taking down someone's gown and listening to their chest or their back on their bare skin with the stethoscope and not through their clothes,” Garibaldi said. “When you listen through clothes, you are more likely to miss something.”
In the U.S., graduating medical trainees have not participated in real-patient assessments since the 1970s, an anomaly when it comes to medical education in other countries, such as the United Kingdom, Garibaldi said. Instead, the U.S. medical system relies on multiple-choice examinations to test clinical knowledge. Medical schools assess physical exam skills by hiring actors who have been trained to mimic having a certain disease or set of symptoms, but there are limits to simulating a condition someone doesn’t really have. And after graduation from medical school, direct observation of clinical skills with real patients is a rare event.
To address this gap, the center is building up a volunteer-patient program called APECS (Assessment of Physical Examination and Communication Skills), which will fall under the center’s clinical teaching and assessment arm. The program will allow real patients to come to the center to take part in clinical exams with trainees and share authentic results.
“In my own career, I've never had a directly observed assessment of my clinical skills,” Garibaldi said. “If we want to improve our clinical skills and see how technology can augment them, we need to assess those skills. With APECS, we can evaluate trainees’ skills and give them real-time, hands-on feedback.”
