Don’t Interrupt!? An Observational Study to Inform Faculty Development on Bedside Rounding and Teaching

Internal medicine bedside rounds should be efficient and educational. We previously piloted literature-based faculty development workshops emphasizing attending leadership in team preparation for rounds and the importance of not interrupting learners. Participants raised three key questions: (1) Do interruptions actually adversely affect the efficiency or educational value of rounds? (2) Do learners believe that attendings effectively prepare the team for bedside rounding? (3) After rounding together, do learners and attendings have the same perception of efficiency and educational value? We sought to answer these questions to improve our faculty development sessions and ultimately optimize bedside rounding.

We conducted a prospective observational study at an academic medical center. A convenience sample of ward attendings and learners were invited to participate. An observer tracked the number of interruptions (stopping the presenter from speaking with a question or comment).  After rounds, all participants were surveyed on their perception of the attendings’ efficacy in preparing the team for rounds, and the efficiency and educational value of each rounding session. Responses to statements were on a 5 point Likert scale where 1 = completely disagree, 5 = completely agree. We estimated means, standard deviations (SD), and correlation coefficients (CC). P-values were generated for comparisons.

Over 4 months, 16 ward attendings and 47 students and housestaff participated. On average, there were 12.9 interruptions per rounds (±6.9); the attending was responsible for an average of 5.4 (±5.1). There was no correlation between number of interruptions and the length of rounds (CC=0.28, p=0.12), perception of rounds efficiency by learners (CC=0.40, p=0.12) or attendings (CC=-0.04, p=0.88); or perception of educational value by learners (CC=0.31, p=0.24) or attendings (CC=-0.05, p=0.86). Learners (L) attributed greater efficacy to attendings (A) for team preparation than attendings did themselves. Examples: “… attending had established that a plan of care will be established before leaving the patient room,” (mean±SD; L=4.4±0.7 vs. A=3.25±1.3, p<0.05); “…attending had established expectation for format of the bedside presentation,” (L=3.89±0.13 vs. A=3.13±0.30, p=0.02). Learners perceived rounds to be more educational (L=4.4±0.9 vs. A=3.3±1.1, p<0.05) and efficient (L=4.3±0.13 vs. A=3.1±0.24, p<0.01) than attendings.

Interruptions don’t affect rounds efficiency or education. Learners attribute greater efficacy to attendings for rounds preparation than attendings do themselves. Learners may be picking up on cues unbeknownst to the attending. Since learners feel that the same rounds are more educational and efficient than attendings, it may be beneficial to use specific metrics so that teams can share a sense of whether rounding goals were met. Future faculty development will be informed by these findings.