Problem Based Attending Rounds

Abstract

Clinical clerkships are a vital link between basic cognitive information and its application in real patient care situations. However, studies have repeatedly shown deficiencies of attending physicians in promoting understanding of the application of basic science information to clinical problems, promoting the development of clinical skills and providing constructive feedback on student's clinical abilities. Problem based attending rounds (PBAR) is an educational process which attending physicians can follow to overcome these deficiencies despite the complexity of actual patients and time constraints of patient care activities. In PBAR, one student presents a short patient profile, a complete current problem list and then selects one problem to present. Then the student presents only those data pertinent to that problem in the SOAP format of the problem oriented medical record. After the patient profile and subjective data, students offer early diagnostic hunches and anticipate physical findings and possible laboratory results. The group moves to the bedside to seek abnormalities and pertinent negative findings. An assessment of the problem under discussion is given and other students challenge the reasoning and offer alternative explanations. Gaps in students' understanding are identified and assignments are made to find and report the new knowledge at the next session. The attending physician's role is more of an educational manager than a medical encyclopedia.

Student reactions to PBAR are generally positive, although some prefer to vary the nature of attending rounds to meet other learning needs, especially late in the third year. PBAR seems to overcome many of the deficiencies of clinical education.