Blog | Tuesday, November 19, 2013

Ward rounds ... does style matter?

Over the past few weeks I have had several discussions about the style of ward attending rounds. Medical educators who I respect greatly have argued strongly that they have the best way to do rounds. The more variations that they report, the more I am convinced that we have many ways to skin that cat.

When we started our ward attending round research over 10 years ago, we wanted to discover something about the style of rounds. We discovered a great deal, but nothing about the style of rounds. We learned the characteristics and domains of successful rounds.

Quoting from our recent letter to the editor of JAMA: “We learned that successful attending rounds required a multidimensional skill set comprised of 5 distinct domains: learning atmosphere, clinical teaching, teaching style, communicating expectations, and team management. As Wachter and Verghese explained, current work hour restrictions and hospital expectations create a demand for team management skills, one of our domains. This domain includes timeliness, efficiency, and accommodating absences required for administrative demands.”

“While team management is an important domain, it did not outweigh clinical teaching, learning atmosphere, teaching style, or communicating expectations. Trainees valued teaching. They rated ‘sharing of attending’s thought processes’ as the top attribute for successful rounds. They also valued bedside teaching and role modeling. These less precise attributes of clinical wisdom trumped the teaching of evidence-based literature. Students and residents felt they could read books and medical literature, but they wanted and needed attending physicians to demonstrate clinical reasoning, patient communication, physical examination skills, and professional physician behavior.”

There are many successful styles of attending rounds. We should not debate the proper structure of rounds. We should understand that our personalities influence how we like to run rounds. Learners care less about structure than they do about sharing ones thought processes, having some bedside teaching and role-modeling.

I encourage all ward attending physicians to develop their own structure and style for making rounds. Structure and style are less important than content. Our job is to use rounds to insure superb care for our patients and give our learners the opportunity to gain expertise. We should understand that our learners need us to provide role-modeling, not just through words, but also through observation. How we interact with patients matters. That we make certain that patients understand what is happening in the seemingly hostile atmosphere of a hospital matters. That we share our thought processes matters. And these activities trump style and structure.

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.