Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study

Area of Science:

• Medical Education
• Health Services Research
• Cognitive Science

Background:

• Ward rounds are a long-standing, essential component of hospital care, evolving from training to clinical practice.
• Despite their importance, ward rounds remain under-researched and poorly understood.
• This study addresses the need for research into the human reasoning processes within medical teams during ward rounds.

Purpose of the Study:

• To enhance understanding of collaborative group reasoning mechanisms in hospital ward rounds.
• To develop a program theory explaining the reasoning processes involved in ward rounds.
• To identify factors influencing ward round reasoning for practice improvement.

Main Methods:

• A critical realist case study approach was employed in two Victorian hospitals.
• Data collection involved direct observation of ward rounds.
• Interviews with medical practitioners and focus group discussions were conducted.

Main Results:

• Nine distinct group reasoning mechanisms were identified across information accumulation, sense-making, and decision-making.
• These mechanisms collectively form a program theory of ward round reasoning.
• Identified themes include criteria use, mechanism tensions, time constraints, and medical hierarchies.

Conclusions:

• The study provides a novel representation of ward round reasoning, enhancing comprehension of group dynamics.
• Findings support theory-based evaluations, practice redesign, and improved training for medical teams.
• This research contributes valuable insights into the complex reasoning processes during clinical rounds.