Attending rounds: What do the all-star teachers do?

Abstract

Aim: To examine differences in the types of teaching activities performed during rounds between the most effective and least effective inpatient teaching attendings.

Methods: Participants included 56 attending physicians supervising 279 trainees. Trained observers accompanied teams during rounds and recorded the frequencies of educational activities that occurred. Students and residents then rated their satisfaction with the teaching on rounds.

Results: Attending physicians with the highest learner satisfaction scores performed significantly more teaching activities per patient than attending physicians who were rated as average or less-effective (2.1 vs. 1.4 vs. 1.5; p = .03). There were significant differences in the frequencies of 3 out of the 9 specific teaching activities observed, including answering specific patient-care related questions (77% vs. 66% vs. 47%; p = .003), teaching on learner chosen topics (8% vs. 2% vs. 2%; p = .02), and providing feedback (31% vs. 10% vs. 0.1%; p = .001).

Conclusions: Specific categories of teaching activities—patient-specific teaching, teaching on learner-identified topics, and providing real-time feedback—are performed more frequently by the highest-rated attending physicians, which can guide faculty development.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Bedside Teaching: A part of clinical rounds where both student and instructor attends the patient's bedside to discuss the case and/or demonstrate a clinical procedure. This is the student's opportunity to see how the attending physician relates to the patient and to get hands-on instruction in interviewing a patient, physical examination, and counseling skills.Wojtczak, A. (2003) Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE.

Learner-Centred Education: A method of teaching in which the students' needs have priority. Learners are responsible for identifying knowledge gaps, actively participating in filling them, and keeping track of their learning gains. Teachers are expected to facilitate this process instead of supplying "spoon-fed" information. This approach increases the students' motivation to learn and prepares them for self-learning and continuous education. Learner-centered education is the opposite of teacher-centered education.Wojtczak, A. (2003) Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE.

Notes on contributors

Frank W. Merritt, MD, is an Instructor of Medicine at the University of Colorado School of Medicine.

Melissa N. Noble, MD, is a Family Medicine Resident at the University of Colorado.

Allan V. Prochazka, MD, MSc, is a Professor of Medicine in the Division of General Internal Medicine, the Director of Mentored Scholarly Activity for the University of Colorado School of Medicine, and Assistant Chief of Research and Ambulatory Care for the Denver VA.

Eva M. Aagaard, MD, is a Professor of Medicine at the University of Colorado School of Medicine where she serves as the Director of the Academy of Medical Educators, Associate Dean for Educational Strategy, and as the Vice Chair for Medical Education.

Chad R. Stickrath, MD, is an Assistant Professor at the University of Colorado School of Medicine where he serves as Assistant Dean for Medical Education at the Colorado Springs Branch.