Background: Resident work rounds (RWR) serve as the venue for team-based patient interaction, subsequent patient care planning, and education through didactics and observation. However, the expectations of RWR are unclear; do residents continue to see patients and is teaching still expected? If not, what barriers exist? Few studies examining RWR structure have been done however they are typically limited to a single institution or a limited region. This study seeks to characterize the structure and functionality of work rounds at internal medicine residency programs across the United States.
Methods: A survey was distributed to program directors and associate program directors at all internal medicine residency programs in the United States via the Association of Program Directors in Internal Medicine (APDIM) electronic listserv. RWR were defined as the time prior to attending rounds in which an upper level resident led the team of interns and medical students in seeing patients and discussing care plans. The survey collected data on program characteristics, amount of time allotted for RWR, clinical and educational expectations during RWR, presence of geographical organization of the team census, and the presence of an observation/feedback mechanism. The survey was opened for a 4-week period and reminders were sent every week. Frequencies were calculated for individual responses. The association between the requirement of patients being seen and the above listed variables were separately tested using chi-squared statistics.
Results: One hundred and sixty-four responses were collected from 410 programs (40.0%). The majority of responses were from programs of < 50 residents (50%), and community-based university-affiliated programs (41.3%). One hundred and eleven of the 164 responses (67.8%) reported their programs scheduling time for RWR with university-based programs being the least likely to do so (p = 0.03). Ninety-two of the 111 responses (82.8%) indicated that patients were expected to be seen and most of these respondents (67.4%) reported that patients were consistently seen. Patients were more likely to be seen at programs allotting greater than one hour for RWR (p = 0.01). Geographical organization of the team census did not affect the expectation of patients being seen on RWR (p = 0.43). Programs expecting patients to be seen during RWR also were more likely to expect teaching (p < 0.01). No differences were observed between the expectation to see patients and the use of formal feedback (p = 0.30).
Conclusions: Patients were seen and residents were able to teach more consistently when more time was allocated for RWR. The relatively lower presence of RWR at university-based programs may reflect increased patient care volume combined with limited time allocation. In addition to programs increasing the time allotted for RWR, role-modeling of efficient rounding practices by more experienced physicians may contribute to their success.