Patterns of interaction during rounds: implications for work-based learning

Area of Science:

• Medical Education
• Clinical Practice
• Health Professions Education

Background:

• In-patient rounds are a cornerstone of medical education and patient care in teaching hospitals.
• Understanding team dynamics and participant perceptions is crucial for optimizing this learning environment.

Purpose of the Study:

• To explore team interactions during in-patient rounds.
• To assess medical student and resident perceptions of the educational utility of these rounds.

Main Methods:

• Utilized a novel personal digital assistant (PDA)-based system for non-participant observation of rounds.
• Collected survey data from medical students and residents on the utility of rounds.
• Employed social network analysis to quantify interaction patterns.

Main Results:

• Observed rounds averaged 106 minutes, discussing 22.1 patients.
• Attending physicians dominated discussions; many trainees spoke infrequently.
• Teacher-centered, factual teaching predominated, with earlier discussed patients receiving more attention.
• Attending physician-dominated sessions were perceived as more educationally valuable than interactive ones.

Conclusions:

• In-patient rounds represent a significant work-based learning opportunity.
• Current rounds may not consistently achieve their educational objectives.
• Enhancements include strategic patient discussion order, active engagement of all team members, and explicit learning objectives.