Asking a Variety of Questions on Walk Rounds: a Pilot Study

Morning walk rounds have lost some of their engagement while remaining a useful and valued practice.

We created a pilot study to evaluate the impact on rounds of learning to asking a variety of different questions.

One-hour intervention sessions were voluntarily offered to members of the Department of Medicine and taught by an expert in the question, listen, and respond method.

Participants included attendings and residents in Internal Medicine on medical teams.

Questionnaires were collected on six pre-intervention and six post-intervention days. Nine months later, an anonymous online survey was sent to participants asking about their use of a wider variety of questions.

Two hundred eight physicians (residents 175 (45.5%), attending physicians 25 (27.7%)) filled out pre-intervention surveys. One hundred eighty-one physicians (residents 155 (40.3%), attending physicians 18 (20%)) filled out post-intervention surveys. When survey responses from the attendings and residents on the medical teams were combined, post-intervention rounds were perceived as more worthwhile (1.99 pre-intervention and 1.55 post-intervention, [95% confidence interval 1.831-2.143]) (p < 0.001) and more engaging (1.68 pre-intervention and 1.30 post-intervention, [95% confidence interval 1.407-1.688]) (p < 0.001).Non-medical teams' survey responses did not change. Patient census data indicated no significant difference in the hospital's census on the pre- and post-intervention dates. Spontaneous suggestions for improving rounds came largely from the residents and included teaching points, clinical pearls, patient focus, more interactive, increased dedicated time for teaching, inclusive/multidisciplinary, questions, and evidence-based teaching. Of the participants who answered the online survey 9 months later, 75% (6/8) reported that they "actually asked a wider variety of types of questions."

This pilot study indicates that the 1-h intervention of learning to ask a variety of different questions is associated with rounds that are rated as more worthwhile and engaging by the medical teams.