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
RESULTS
What Do You Perceive the Purpose of Rounds to Be?
With respect to this prompt, we identified 4 themes, which represent 16 codes describing what attendings and medical students believed to be the purpose of rounds (Table 2). These themes are communication, medical education, patient care, and assessment.
Communication
Communication includes all comments addressing the role of rounds as it relates to communication between team members, patients, family members, and all those involved in patient care. There were 4 main codes, including coordination of patient care team, patient/family communication, establishing rapport with patients and/or family, and establishment of roles.
Coordination of patient care team identified rounds as a time “to make sure everyone is on the same page” and “to come together whenever possible,” so that everyone “had the same information of what was going on.” It also included comments related to interdisciplinary communication, with 1 participant describing rounds as “a time when your consulting team, or people with outside expertise, can weigh in on some medical issues.”
Medical Education
The theme of medical education is made up of 6 codes that encompass comments related to teaching and learning during rounds. These 6 codes include delivery of clinical education, exposure to clinical decision making, role modeling, student presentations, establishment of trainee autonomy, and providing a safe learning environment.
Delivery of clinical education included comments identifying rounds as a time for didactic teaching, teachable moments, “clinical pearls,” and bedside teaching of physical exam skills. Exposure to clinical decision making included comments by both medical students and attendings who described the purpose of rounds as a time for learning and teaching, specifically about how best to approach problems and decision making in a systematic manner, with 1 medical student explaining it as a time to “expose [trainees] to the way that people think about problems and how they decided to go about addressing them.”
Role modeling includes comments addressing rounds as a time for attendings to demonstrate appropriate behaviors and skills to trainees. One attending explained that “everybody learns from watching other people present and interact…so everybody has a chance to pick up things that they think, ‘Oh, this works well.’” Student presentations include comments, predominantly from students, that described rounds as an opportunity to practice presentations and receive feedback, with 1 student explaining it was a time “to learn how to present but also to be questioned and challenged.”
Establishing trainee autonomy is a code that identifies rounds as a time to encourage resident and student autonomy in order to achieve rounds that function with minimal input from the attending, with 1 attending describing how they “put resident leadership first as far as priorities… [and] fostering that because I usually let them decide what we’re going to do.”
Providing a safe learning environment identifies the purpose of rounds as being a space in which trainees can feel comfortable learning from their mistakes. One student described rounds as, “…a setting where it’s okay to be wrong and feel comfortable enough to know that it’s about a learning process.”
Assessment
Assessment is a theme composed of comments identifying the purpose of rounds as being related to observation, assessment, and feedback, and it includes 2 codes: attending observation, assessment, and feedback and establishment of expectations. Attending observation, assessment, and feedback includes comments from attendings and students alike who described rounds as a place for observation, evaluation, and provision of feedback regarding the skills and abilities of trainees. One attending explained that rounds gave him an “opportunity to observe trainees interacting with each other, with the patient, the patient’s family, and ancillary staff,” with another commenting it was time used “to assess how med students are gathering information, presenting information, and eventually their assessment and plan.” Establishment of expectations captures comments that describe rounds as a time for the establishment of expectations and goals of the team.
