Does the structure of inpatient rounds affect medical student education?

Abstract

ObjectivesTo assess whether the organization and structure of inpatient team rounds affects medical student perception of the overall quantity and quality of teaching on an inpatient general medicine service.MethodsA pilot project to improve inpatient care was launched at the Department of Veterans Affairs Ann Arbor Healthcare System (VAAAHS). General medicine attending physicians involved in the pilot followed a “non-traditional” rounding structure (accentuating senior resident-run “work rounds” while time for “attending rounds” focused on critical issues and teaching). The remainder kept the “traditional” rounding structure (entire team rounds on patients one-by-one). In a cross-sectional design, third- and fourth-year medical students at the University of Michigan were surveyed after their rotation about their experience. Students were asked to rate their educational experience in 21 domains. Responses were evaluated by rounding structure.ResultsA total of 90 students (59%) responded. Across every domain surveyed, students rated the quantity and quality of teaching higher after experiencing “non-traditional” rounds. Statistically significant increases were seen in ratings for “teaching during rounds from senior resident”, “teaching during rounds from attending”, “sit-down teaching from attending”, “overall amount/quality of teaching”, and “overall improvement in internal medicine knowledge”, among others.ConclusionsThe organization and structure of inpatient rounds can significantly impact medical student education. Teaching physicians and medical school clerkship directors should consider this when organizing inpatient team workflow.

An academic hospitalist model to improve healthcare worker communication and learner education: Results from a quasi‐experimental study at a veterans affairs medical center

“…Our finding that third‐year medical students on the Gold team performed significantly better than University of Michigan third‐year medical students on other teams is an intriguing finding that warrants confirmation. On the other hand, this finding is consistent with a previous report evaluating learner satisfaction in which Bodnar et al found improved ratings of quantity and quality of teaching on teams with a nontraditional structure (Gold team) . Moreover, despite relatively few studies, the reason underlying the educational benefit of hospitalists should surprise few.…”

“…To assess the educational interventions, we used learner evaluations of attendings, by both residents and medical students, and standardized internal medicine National Board of Medical Examiners Subject Examination (or “shelf”) scores for third‐year medical students. A separate evaluation of medical student perceptions of the rounding structure introduced on the Gold team using survey design has already been published …”

“…A separate evaluation of medical student perceptions of the rounding structure introduced on the Gold team using survey design has already been published. 21…”

“…On the other hand, this finding is consistent with a previous report evaluating learner satisfaction in which Bodnar et al found improved ratings of quantity and quality of teaching on teams with a nontraditional structure (Gold team). 21 Moreover, despite relatively few studies, the reason underlying the educational benefit of hospitalists should surprise few. The hospitalist model ensures that learners are supervised by physicians who are experts in the care of hospitalized patients.…”

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

“…The surgical team should be limited to only essential providers, and the number of times that members of the surgical team enter the room of a COVID-19 patient while still maintaining the standard of care should also be limited. Furthermore, ''pre-rounding'' to prepare for rounds must be restricted [14]. Functional work rounds may provide excellent patient care coupled with focused education [15] all while reducing the number of required room entries.…”