Breaking the monotony and making rounds a productive opportunity for learning!
How can we make rounds more well-rounded?
This topic is a little different from our didactic-focused interventions. However, for those of us who participate in rounds or any experiential education in patient care, I think it is an important question. When I think about rounds, I think about how beneficial it can be for all participants. The process encourages attendings or faculty to teach, residents to both teach and learn as part of practice, and students to learn. However, I have also seen a less enthusiastic approach to rounds. Sometimes, it is just getting through the morning to move on to discharges, clinic follow up, etc. So, I started thinking-how can we make rounds a more well-rounded experience?
Bedside rounds, or family-centered rounds in pediatrics, can be defined as conducting attending rounds, including patient presentations and discussions, in the patient’s room with nursing and family present. If you look around an ICU team(asan example) and consider the amount of salaries standing in a circle(physicians,residents, nurses, pharmacists, case managers, social workers, dieticians, PT/OT, and more)-it would behoove us to make the best use of each professional’s time.
Areas of education in rounds include skills such as bedside physical examination teaching, effective communication, and encouragement of trainee independence. A first step to improving the educational experience on rounds is to have a specific plan/road map. Preparation instills confidence in both the teacher and the learner and facilitates the learning process. It allows you to maximize the learning outcomes rather than just repeating the same process day after day.
Defining each person’s role on the team has multiple benefits to improving education on rounds. This ensures that each person is involved, breaks down barriers between educator and learner, engages the team, maintains interest, ensures efficient rounds, validates the learner’s input, and allows equal opportunities between learners.
Devise a plan beforehand on what can be taught to act as a guide but still be flexible to improvise. No two days of rounds will be the same. Having a plan also allows for good time management and prioritizes educational opportunities to focus on the learner’s needs.
I have seen this be successful in a variety of ways. For example, presentations and team goals can be set at the beginning of the week. Each presentation is then planned and topics are decided on, therefore providing clear expectations. Some attendings will choose to review a certain article in the main journal of their expertise. It becomes a group discussion facilitated by the attending and allowing the attending to provide his/her expertise. Some residents have created quizzes based on topics discussed during the week. Other residents may opt to review an OB strip each week or an EKG each week just to provide exposure to the team. If you are able to collaborate with another department, maybe your team visits radiology once weekly, pathology once weekly, or microbiology once weekly. One resident I worked with had a focus on physician wellness and started each day of rounds with“GratitudeRounds” where each team member said something that they were grateful for. Setting an intentional focus to rounds each day and each week improves the amount of education provided to learners.
All of our students need to focus on deliberate practice before they become practitioners. On rounds, maybe there is a certain focus selected for each patient. This focus could be medical history taking, clinical examination, communication with the patient or family members, or breaking bad news. As faculty, we can role model these behaviors and teach by observation. Role modeling often takes place with either communication or clinical examination skills. In addition to techniques, faculty can model positive attitudes such as teamwork, effective and empathetic communication together with the professionalism that comes with experience.
Finally, an essential piece of education on rounds is feedback. We are the coaches for our learners. The following steps are recommended when providing feedback on rounds: give feedback promptly, allow time for discussion, allow the learner to review his/her performance first, encourage reflection and self-appraisal, start with positives, teacher comments after learner, clarify criteria for desired performance, use specific examples, limit to a few items at a time, use constructive criticism, end with a plan of action and set learning objectives for independent study.
I hope that the tips I mentioned are helpful in both an abstract and practical way. I hope you have a wonderful day of rounds and thank you for tuning in to Two Pills Podcast!