This is the first study to investigate the learning objectives of medical students in BST. The results indicate that themes of learning objectives most often are clinical reasoning, physical examination, history taking and knowledge. It was not a surprise that the focus for students was often on clinical reasoning. Clinical reasoning is the process from collecting information from the patient, understanding the problem or situation and plan and implement interventions. Our 5th year medical students have built their knowledge over the years and gained experience in patient care. They are now learning to apply their knowledge, one of their last steps in becoming a physician. The written down learning objectives were sometimes specific for obstetric patients, but always had the same themes. Therefore, results can also be applied to other internships.
Our second aim was to investigate if the students meet their learning objective. In most education, teachers set the learning objectives. BST is a form of education where multiple objectives can be addressed in one session. It is a suitable moment for students to set their own objective, based on their knowledge or skill gaps. This probably will enhance their motivation and participation. The only difference between our groups is setting an objective with or without information about topic and/or patient. Setting a learning objective matching the patient and/or topic, in other words an achievable objective, gives clearly better results regarding satisfaction and knowledge gain.
While physical examination was one of the prominent learning objectives, students indicated that that they’ve learned the least on it. We expect that is be due to the gynecological/obstetric population. If a patient gave permission, abdominal, lung, heart and neurological examination was performed. Gynecological examination, such as speculum examination, vaginal toucher and vaginal ultrasound, was not performed because of the burdensome impact. There was a discussion about the indication and the implication of the results of these physical examinations during the BST.
Almost all students (88,9%) have had BST in a previous internship. Since we have no information about the frequency and amount of previous BST, we cannot compare this with the numbers of the literature mentioned in the introduction.
Students in the second group experienced more sufficient feedback. The teacher did not differ her teaching and feedback strategy. We cannot explain this result with our data, a limitation of this study.
A possible influence on the results can be the seniority of the teacher. The teacher for the BST sessions was a junior doctor with 3+ years of experience in gynaecology and obstetrics. Literature shows that students judge junior doctors as capable as senior doctors in bedside teaching. 12, 13 Students are more comfortable being taught by a junior doctor, as they are more approachable and they are perceived to better understand the student’s perspective. Senior doctors made the sessions more challenging with inconsistency in teaching and discussion of topics that are not part of the curriculum.14
Furthermore, based on our findings we can concluded that during BST a safe learning environment can be created. A teacher creates this environment to show respect to the students and their level of knowledge. If students feel safe, they are more likely to ask questions and stretch their limitations. A safe environment enhances the motivation and learning of the students.15