How team clinical reasoning occurs on ward rounds: Implications for learning

Area of Science:

• Medical Education
• Clinical Reasoning
• Team-Based Learning

Background:

• Ward rounds are crucial for medical education and team clinical reasoning.
• Understanding team clinical reasoning processes is key to improving teaching methods.

Purpose of the Study:

• To assess how team clinical reasoning occurs during ward rounds.
• To inform strategies for enhancing the teaching of clinical reasoning in a clinical setting.

Main Methods:

• Focused ethnography was used to observe five different hospital ward teams over six weeks.
• Field notes from 41 new patient presentations were analyzed using content analysis.

Main Results:

• Ward rounds dedicated more time to information sharing than to differential diagnosis discussions (46% of cases lacked differential diagnosis).
• Hierarchy influenced participation, with junior learners (medical students, interns) contributing less frequently to clinical reasoning discussions.

Conclusions:

• Current ward round practices may limit junior learners' engagement in clinical reasoning.
• Strategies are needed to actively involve medical students and interns in team-based clinical reasoning to optimize learning.