Thursday, June 20, 2013
If rounding did not exist, would I create it?
@JoshHerigon asks (after an interesting back and forth on Twitter yesterday): I'm saying--if you never knew what "rounding" was, would you still develop a system for meded/pt care that looks like our rounds?
The answer is yes, but it deserves an explanation.
One cannot avoid rounds on inpatient rotations. Rounds are simply the process of seeing all the patients and making clinical decisions with those patients. If one is caring for patients in the hospital, then one must see all the patients. Rounds in that sense are a tautology.
But I do not think that is the question. The underlying question refers to medical education. Should attending physicians see the patients with the learners and teach during those visits? Again I say yes.
We have learned from this article: "The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement."
Clearly, one cannot learn medicine without patients. Osler famously said, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."
Seeing patients as a student or resident without having the attending physician discuss the findings, demonstrate the physical findings, and explicate the thought process almost nullifies the experience. We learn much at each level of training. Each year we become more sophisticated. Seeing patients directs our growth.
What is the best way for the attending to give feedback to students and residents? I (and many others) believe that rounding provides the ideal setting for practical teaching.
If I had to invent rounding, it would be for the combined benefit of the learners and the patients. I do believe that when well done, rounding represents the critical teaching activity for learners, and the most important exercise for patients.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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