What’s the Purpose of Rounds? A Qualitative Study Examining the Perceptions of Faculty and Students
BACKGROUND: Rounds are a critical activity on any inpatient service, but there is little literature describing the purpose of rounds from the perspective of faculty and trainees in teaching hospitals.
OBJECTIVE: To evaluate and compare the perceptions of pediatric and internal medicine attendings and medical students regarding the purpose of inpatient attending rounds.
METHODS: The authors conducted 10 semistructured focus groups with attendings and medical students in the spring of 2014 at 4 teaching hospitals. The protocol was approved by the institutional review boards at all institutions. The authors employed a grounded theory approach to data collection and analysis, and data were analyzed by using the constant-comparative method. Two transcripts were read and coded independently by 2 authors to generate themes.
RESULTS: Forty-eight attendings and 31 medical students participated in the focus groups. We categorized 218 comments into 4 themes comprised of 16 codes representing what attendings and medical students believed to be the purpose of rounds. These themes included communication, medical education, patient care, and assessment.
CONCLUSIONS: Our results highlight that rounds serve 4 purposes, including communication, medical education, patient care, and assessment. Importantly, both attendings and students agree on what they perceive to be the many purposes of rounds. Despite this, a disconnect appears to exist between what people believe are the purposes of rounds and what is happening during rounds.
© 2017 Society of Hospital Medicine
For more than a century, medical rounds have been a cornerstone of patient care and medical education in teaching hospitals. They remain critical activities for exposing generations of trainees to clinical decision making, coordination of care, and patient communication.1
Despite this established importance within medical education and patient care, there is a relative paucity of research addressing the purpose of medical rounds in the 21st century. Medicine has evolved significantly since Osler’s day, and it is unclear whether the purpose of rounds has evolved along with it. Rounds, to Osler, were an important opportunity for future physicians to learn at the bedside from an attending physician. Increased duty hour restrictions, mandatory adoption of electronic medical records, and increasingly complex care have changed how rounds are performed, making it more difficult to achieve Osler’s ideals.2,3 While several studies have aimed to quantify the changes to rounds and have demonstrated a significant decline in bedside teaching,4-6 few studies have explored the purpose of rounds from the perspective of pertinent stakeholders, students, residents, and faculty. The authors have published the results of focus groups of resident stakeholders recently.7 We made the decision to combine the student/faculty data and describe it separately from the resident data to allow the most accurate and relevant discussion as it pertained to each group.
The aim of this study was to explore the perceptions of faculty and students of general inpatient rounds on internal medicine and pediatric rotations, and to identify any notable differences between these key stakeholders.
METHODS
Between April 2014 and June 2014, we conducted 10 semistructured focus groups at 4 teaching hospitals: The University of Chicago Medical Center, Children’s National Health System, Georgetown University Medical Center, and the University of California, San Francisco Medical Center. A sample of eligible 3rd-year medical students and residents on pediatrics and internal medicine hospitalist services as well as hospitalist attendings in pediatrics and internal medicine were invited by e-mail to participate voluntarily without compensation. Identical semistructured focus groups were also conducted with pediatric and internal medicine interns (postgraduate year [PGY1]) and senior residents (PGY2 and PGY3), and those data have been published previously.7
Data Collection
Most focus groups had 6 to 8 participants, with 2 groups of 3 and 4. The groups were interviewed separately by training and specialty: 3rd-year medical students who had completed internal medicine and/or pediatrics rotations, hospitalist attendings in pediatrics, and hospitalist attendings in internal medicine. Attendings with training in medicine-pediatrics were included in the department in which they worked most frequently. The focus group script was informed by a literature review and expert input, and we used open-ended questions to explore perspectives on current and ideal purposes of rounds. Interviews were digitally recorded, transcribed, and names of speakers or references to specific patients were removed to preserve confidentiality and anonymity. The focus groups lasted between 30 and 60 minutes. The author (OH) conducted focus groups at 1 site, and trained facilitators conducted focus groups at the remaining 3 sites. The protocol was determined to be exempt by the institutional review boards at all participating sites. Prior to the focus groups, the definition of family-centered rounds was read aloud; after which, participants were asked to fill out a demographic survey.
Data Analysis
The authors employed a grounded theory approach to data collection and analysis,8 and data were analyzed by using the constant-comparative method.9 There was no a priori hypothesis. Four transcripts were independently reviewed by 2 authors (OH and RR) by using sentences and phrases as the units of data, which were coded with an identifier. The authors discussed initial codes and resolved discrepancies through deliberation and consensus to create codebooks. Themes, made up of multiple codes, were identified inductively and iteratively and were refined to reflect the evolving dataset. One author (OH) independently coded the remaining transcripts by using a revised codebook as a guide. A faculty author (JF) assessed the interrater reliability of the final codebook by reviewing 2 previously coded, randomly selected transcripts with no new codes emerging in the process, with a kappa coefficient of >0.8 indicating significant agreement.
