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.


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.


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).


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

Pain management
  Assessed pain severity
  Assessed efficacy of pain medications
  Explains what will be done to decrease patient’s pain.
  Empathy for the inadequate pain control
Patient education: disease
  Review results of X–ray without medical jargon
  Reviews clinical information supporting the diagnosis
  Explains how the tests planned will change management
  Explains why nasograstic tube helps the patient
  Assesses wheter the patient understands the information discussed (teach–back)
Patient education: anticipatory guidance
  Apologizes to patient for delay in testing and explains why it is occurring
  Sets expectations about timing of CT scan
  Sets expectations about length of stay in the hospital
  Summarizes information at end of encounter
Verbal communication skills
  Greets patient by name in a respectful manner
  Reintroduces self
  Uses open ended questions
  Avoids multiple linked questions
  Does not interrupt
  Avoids medical jargon
Nonverbal communication skills
  Makes an effort to appear unrushed
  Uses appropriate body language to enhance communication
Patient Satisfaction
  Acknowledges patient’s feelings, discomforts and concerns
  Clarifies team care approach
  Alerts the patient that other physicians other than the primary team will visit them
  Encourages additional questions or discussion

Table 2Domain Performance

Domain Mean Percentage Standard Deviation Percentage of Examinees Performing All Components Adequately
Pain management 43.1 26.9 2
Disease education 61.8 17.6 1
Anticipatory guidance 31.2 26.3 3
Verbal communication skills 85.3 10.5 13
Nonverbal communication skills 75.9 23.3 36
Patient satisfaction 43.6 21.9 3