Internal medicine program directors' perceptions of resident work rounds

Work rounds have received little attention in the medical education literature. At the outset of the second post graduate year, medical residents are expected to function, without much guidance, as both team leaders and teacher. New York State health code regulation 405 restrict house staff work hours and may influence the manner and content of work rounds. The goals of work rounds were identified through a literature review and our own experiences. A 36-item questionnaire utilizing the identified goals was used in this cross-sectional descriptive study. The participants were the Program Directors of New York State Internal Medicine residency programs. Each of the fourteen goals identified reflects one of three resident behaviors: patient care, teaching, and evaluation. The goals that received the highest importance scores were patient management and updating team leader of events. Ninety percent (90%) or more of the participants indicated that patient management, teaching clinical reasoning and problem solving, verifying important chart data, and verifying physical examination should be performed "often" or "almost always." Most programs employed verbal instructions but only few held conference or provided literature on the expectations and conduct of work rounds. New York State Internal Medicine program directors perceive work rounds as primarily a patient care task, and many rely on verbal instructions to convey the objectives to the house staff. While previous research has demonstrated that work rounds are an important setting for house staff education, this study reveals that in most New York State programs this opportunity may be missed.