BACK TO THE BEDSIDE…OR NOT?

Background: Historical studies suggest that bedside (BS) rounding is optimal for learners. More recent studies report variable results with BS rounding viewed unfavorably among learners. Nonetheless, some academic institutions are moving toward widespread adoption of BS rounding as the preferred rounding style. On the Internal Medicine (IM) inpatient teaching services at the University of Kentucky Medical Center (UK), University of Michigan Medical Center (UM), and Wake Forest Baptist Medical Center (WF), supervising attending physicians utilize different rounding styles on teaching teams. Linking teaching evaluations from residents to attendings’ self-reported rounding and personality styles may identify important associations.

Methods: Attendings with ≥4 weeks of service on IM inpatient teaching services at UK, UM, or WF from July 2018-June 2019 were invited to participate. All institutions secured IRB approval. A 13-question survey was distributed via email with up to two reminders over a 6-week period. Attending survey responses were linked to their teaching evaluations from residents and de-identified by a neutral third-party. Evaluation scores were converted to a percentage of maximum score for each site. The data were dichotomized as predominately BS or “other” rounding, which included predominately hallway or conference room rounding. Aggregated scores for professionalism, autonomy, time management, and total composite teaching score were compared using student’s t-tests.

Results: 65 out of 105 attendings completed the survey (response rate of 62.0%). 26 (40%) attendings primarily use BS rounding and 39 (60%) primarily use “other” rounding style. Most (54%) of the BS rounding group identified themselves as extroverts, whereas most (62%) of the “other” rounding group identified themselves as introverts. The BS rounding group was also more likely to have a formal role in student or resident education (53.8% vs. 36.0% in the “other” rounding group) and report that their rounding style preference was “best for patients” (50.0% vs. 33.3% in the “other” rounding group). However, none of these differences were statistically significant. Total composite teaching scores and professionalism scores were higher for those who predominately used the BS rounding strategy, but these were not statistically significant. Furthermore, resident autonomy and time management scores were higher for the “other” rounding group, but again these were not statistically significant.

Conclusions: Attendings who predominantly use BS rounding are significantly more likely to consider themselves as extroverts and to report their preferred rounding style as being “best for patients.” Although this study was not able to measure acquired clinical skills or patient related outcomes of bedside rounding across 3 major academic institutions, these data demonstrate no clear difference between resident perceptions of educational effectiveness of attendings who predominantly use BS rounding versus those who use predominately “other” rounding styles. Therefore, resident perception of effectiveness should not be the prime motivator for widespread institution of BS rounding.