Background:

Effective hospital work rounds require attention to multiple components: physicians should be able to review patients’ course, test results, and treatment plan while attending to their comfort and answering questions. In general, it also provides the opportunity to enhance patient satisfaction. Poor execution of these tasks can lead to adverse patient outcomes and decreased patient satisfaction. Residents are the first line physicians at teaching hospitals and are expected to perform high–quality work rounds. Yet training for this difficult, multifaceted interaction is not consistently addressed in undergraduate or graduate medical education. Furthermore, it is not known which behaviors are performed well and which require increased attention. In previous work, we reported that standardized patient (SP) encounters improved resident confidence in performing high–quality work rounds. With a large and diverse sample of residents from the current year, we now report resident performance on specific behaviors in a SP work rounds scenario.

Methods:

A “work rounds” SP encounter involving a patient with a partial small bowel obstruction was created. The encounter scenario takes place on hospital Day 1, centering on pain management and patient education about their hospital stay. We created a checklist deconstructing the resident–SP interaction into discrete behaviors that were then grouped into six domains (Table 1). A score of 0, 1, or 2 was recorded for each component behavior for adequate, partial, and inadequate performance. A resident’s score in a behavior domain was the sum of individual component scores and thus an itemized measure of their performance. One–way ANOVA was performed to determine, if there were significant differences between the scores in behavior domains.

Results:

Performance data from 197 house staff from 17 programs at 10 hospitals were collected. Mean percentage of possible points for all examinees with standard deviation and percentage of examinees performing each component adequately are reported in Table 2. Strongest performance was in the verbal and nonverbal communication domains, while the weakest performance was in the anticipatory guidance domain with one–way ANOVA confirming that the differences in scores between domains were statistically significant (p < 0.001).

Conclusions:

Using standardized patients, we found significant deficits in resident ability to perform high–quality work rounds in multiple behavioral categories. Physicians and trainees can use this information to improve their practice. In addition, residency program directors and hospital quality officers can use this information to design educational interventions for quality improvement.

Table 1

Table 2Domain Performance