Background: For most of the past century, clinical medicine was taught almost exclusively at the bedside. Currently, learners participate in a variety of activities that may or may not include bedside teaching. Balancing quality patient care and teaching a diverse group of learners is often a challenge. Electronic health records (EHR) with an ever-growing amount of data competes for time with teaching. In addition, placing orders and updating notes create a complex learning/teaching environment in a fast-paced setting. The objective of this study is to examine the perceptions of learners and faculty toward what’s considered valuable and to compare rounding styles.
Methods: We developed a 47-item questionnaire addressing team dynamics, learning environment, rounding style and team organization. Two resources were used to develop these themes. First a focused group of learners and faculty, second is a study by Castiglini et.al. Respondents were asked to compare three rounding styles, bedside (BR) hallway (HWR), and table rounds (TR). Learners and faculty from a large academic medical center were recruited via email to complete an anonymous questionnaire. All analyses were conducted using SPSS.
Results: Among 152 electronic questionnaires sent, 65 responded (response rate of 42.7%) including 9 students, 23 residents and 24 faculty members. Most of the participants, 73.8% were between 30-49 years of age. There were 32 males (57%) and 24 females (43%). 64% reported daily census of 11-15 patients, 61% reported spending 2-3 hours rounding. There was overall agreement between learners and faculty on most aspects of teaching rounds, finishing rounds on time, resident’s autonomy, attending approachability and enthusiasm, and accessing EHR while rounding were highly valued. Only 21% of all participants believe “rounding with the entire team on all patients” is valuable to their learning experience. There was a gap in perception between the groups; only 15.7% of learners perceive “faculty re-taking history” as valuable to their learning in contrast to 62.5% of faculty. Further, only 28.1% of learners perceive “Performing a physical exam with the entire team” as very valuable compare to 58% of faculty. When comparing the styles of rounds, learners and faculty agree that TR being the preferred setting (compared to BR and HWR) for teaching clinical reasoning, high-value care, placing orders and discharging patients. Both agree that BR is best for teaching patient-centered activities.
Conclusions: In general, learners and faculty agreed on most aspects of teaching rounds. Differences were noted in perceiving the value of retaking history and performing physical exam. Table rounds were preferred for most teaching activities except patient centered care. Based on our findings, further attention to examine these various styles of rounds in the ear of modern medicine might help bridge some gaps between learners and faculty and enhance the value of clinical teaching.