Interruptions to Attending Physician Rounds and Their Effect on Resident Education

Armendariz, Julia; Tamayo, Carla; Slade, Justin J.; Belitskaya-Lévy, Ilana; Gray, Caroline; Allaudeen, Nazima

doi:10.4300/jgme-d-20-00698.1

Cited by 8 publications

(11 citation statements)

References 33 publications

(42 reference statements)

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“…With the known importance of optimal sleep hygiene in physicians (Ferguson et al, 2019), future work could examine the interaction of P-Flow with sleep. Academic physicians experience various disruptions that hinder important non-patient care responsibilities such as instructing/training residents during rounds (Armendariz et al, 2021). Skaugset et al (2016) studied task-switching in EM, providing recommendations to counter flow deterrents: decrease external interruptions, recognize the impact of these interruptions, use appropriate technology to help achieve task completion, and implement sufficient work flow methodologies.…”

Section: Discussionmentioning

confidence: 99%

Physician Flow at Work: Examining Work Absorption, Clinical Flow, Work Fulfillment, and Flow Thieves

Shreffler

Huecker

2022

Workplace Health Saf

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Background: The experience of “flow” at work correlates with positive job outputs and work-related attitudes. Very little current literature describes flow at work in physicians, who experience significant barriers to optimal work outputs, also known as flow thieves (e.g., case interruptions, documenting care). This study aimed to develop a measurement for physician flow (P-Flow) at work and examine the association of P-Flow with physician burnout, job satisfaction, and well-being. Methods: A pilot instrument was tested with items measuring P-Flow at work. After the pilot administration, a 14-item physician flow (P-Flow-14) scale was administered to physicians. In addition to the P-Flow-14 scale, physician respondents completed items measuring burnout, job satisfaction, and well-being. Results: This study specifies initial psychometric evidence of P-Flow-14 and 7-item P-Flow instruments for researchers interested in studying flow at work in physicians. For each P-Flow instrument, higher levels of the flow experience correlated with superior levels of well-being ( p < .01) and job satisfaction ( p < .01), and less burnout ( p < .001). Results showed initial psychometric evidence of derived subscales (work absorption, clinical flow, flow thieves, work fulfillment) for application in future research. Results showed associations between flow experience by age group and physician specialty. Conclusions/Application to Practice: To enhance well-being and job satisfaction, physicians should aim for concentration and immersion in clinical duties while reducing unnecessary distractions. These findings can be applied by employers and can guide further research on work interruptions and patient safety. Future research can validate the P-Flow scales and subscales to assess interventions aimed to improve the physician work environment.

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Section: Discussionmentioning

confidence: 99%

Physician Flow at Work: Examining Work Absorption, Clinical Flow, Work Fulfillment, and Flow Thieves

Shreffler

Huecker

2022

Workplace Health Saf

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“…In rural family medicine, many patients experience multiple changes in their clinical courses, and nurses need to discuss these changes with physicians. The interruption of bedside teaching by discussions with nurses could impinge on the participants’ learning [ 27 , 28 ]. One of the medical teachers noted that “ Nurses’ questions interrupting bedside teaching hindered effectiveness.…”

Section: Resultsmentioning

confidence: 99%

Bedside Teaching in Rural Family Medicine Education in Japan

Ohta¹,

Sano

2022

IJERPH

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Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.

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“…The themes pertaining to education in ward rounds were identified (Table 3). [22], 2018 ✓ Goodrich et al [23], 2020 ✓ Levine et al [24], 2020 ✓ Spence et al [25], 2020 ✓ Gray et al [26], 2020 ✓ Armendariz et al [27], 2021 ✓ ✓ ✓ Khan et al [28], 2021 ✓ ✓ ✓ ✓ Modak and Gray [29], 2020 ✓ Solomon et al [30], 2021 a ✓: indicates the studies incorporated the relevant theme(s) mentioned in the header.…”

Section: Search Resultsmentioning

confidence: 99%

“…Although ward rounds are recognized as educational opportunities, teaching during rounds may increase the time needed to conduct rounds. Moreover, interruptions [ 11 , 27 ] have been noted as another common barrier to effective ward rounds. The potential educational aspect of ward rounds is why they are beneficial to trainees; however, it has been noted multiple times that the service-oriented nature of rounds [ 5 , 11 , 28 ] diminishes this educational element.…”

Section: Resultsmentioning

confidence: 99%

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Education During Ward Rounds: Systematic Review

Khalaf

Khan

2022

Interact J Med Res

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Background Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds. Objective This systematic review examines perceptions of education in ward rounds, educational activities in ward rounds, barriers to learning, and perceptions of simulation-based ward rounds. Methods The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MEDLINE (EBSCO), Cochrane, and Scopus were searched on May 29, 2022, for studies assessing learning during ward rounds. The search terms included “ward rounds,” “education,” and “trainees.” Then, the selected articles were reference searched. In total, 354 articles were retrieved. The articles were assessed for eligibility by 2 independent reviewers who screened titles, abstracts, and full-length texts. Articles addressing trainees’ education in all ward rounds were included. Articles were excluded if they were specific to certain disciplines, were reviews, were not published in scholarly journals, were published before 2015, were published in languages other than English, or did not concern human participants. Following the removal of 63 duplicates, a total of 268 articles were excluded. The risk of bias within the selected articles was also assessed via the Critical Appraisal Skills Programme checklist for qualitative research. Qualitative data were used to describe results in a narrative synthesis and in tables. Results A total of 23 articles were included. Perceptions of teaching in rounds were addressed by 6 studies, of which 3 showed negative perceptions among participants, 2 reported ambivalent perceptions, and 1 showed positive perceptions. Perceived barriers to teaching during rounds were assessed by 7 studies. The reported barriers included time constraints, workloads, schedules, interruptions, the service-oriented nature of rounds, the lack of feedback, hierarchies, the lack of opportunities to ask questions and be engaged in patient management, and divergent learner needs. Further, 8 studies identified types of educational activities, including observation, patient-specific teaching, and discussion. Perceptions of learning through simulated ward rounds were assessed by 8 studies, and a consensus of satisfaction was noted among learners. The interventions that were explored to improve education included using teaching frameworks, involving clinical librarians, and changing the setting of ward rounds. Conclusions The main limitations of this review are the predominant use of qualitative data in the included articles and the lack of standardization for the educational compositions of ward rounds among articles, which made the articles hard to compare. In conclusion, learning opportunities in ward rounds are often missed, and trainees perceive rounds to have low educational value. It is important to recognize the barriers to education during ward rounds and address them to maximize the benefits of ward rounds. Finally, there is a need to develop plans that incorporate teaching regularly during ward rounds in the inpatient setting. Trial Registration PROSPERO CRD42022337736; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337736

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Interruptions to Attending Physician Rounds and Their Effect on Resident Education

Cited by 8 publications

References 33 publications

Physician Flow at Work: Examining Work Absorption, Clinical Flow, Work Fulfillment, and Flow Thieves

Physician Flow at Work: Examining Work Absorption, Clinical Flow, Work Fulfillment, and Flow Thieves

Bedside Teaching in Rural Family Medicine Education in Japan

Education During Ward Rounds: Systematic Review

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