Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings’ Asking Questions

Figures & data

Table 1 Number of Questions Asked

Group	N=Attendings	Mean Number of Questions*	Standard Deviation	p-value^^	Confidence Intervals
Control	9	10.7778	6.15991	<0.001	[−17.4, −6.9]
Experimental	10	23.5000	4.72582	<0.001

Notes: *Represents mean question count per attending over two patient presentations on rounds. ^{^}Two-tailed independent Samples t-test

Table 2 Types of Questions Asked During Bedside Rounds

Question Type	Group	N = Attendings	Mean Number of Questions*	Standard Deviation	p-value	Confidence Intervals
Open Ended	Control	9	1.6667	1.25000	0.0001	[−6.5, −0.7]
	Experimental	10	5.6000	2.42441
Diagnostic	Control	9	0.5556	1.33333	0.050	[−3.4, 0.6]
	Experimental	10	1.7500	1.13652
Asking for Information	Control	9	7.0000	4.19706	0.118	[−5.5, 0.1]
	Experimental	10	9.8000	3.20763
Challenge	Control	9	0.0556	0.16667	0.021	[−3.1, −0.3]
	Experimental	10	1.2000	1.29529
Extension	Control	9	0.1667	0.35355	0.044	[−2.9, −0.6]
	Experimental	10	2.3500	2.99119
Combination	Control	9	0.0000	0.00000	0.357	[−0.2, 0.3]
	Experimental	10	0.0500	0.15811
Priority	Control	9	0.0000	0.00000	0.096	[−0.6, 0.1]
	Experimental	10	0.2500	0.42492
Action	Control	9	0.8889	0.85797	0.596	[−2.3, 0.8]
	Experimental	10	1.1000	0.84327
Prediction	Control	9	0.1111	0.3333	0.253	[−1.3, 0.1]
	Experimental	10	0.4500	0.79757
Generalizing Summarizing	Control	9	0.0556	0.16667	0.114	[−1.2, 0.2]
	Experimental	10	0.5000	0.78174

Note: *Represents mean question count per attending over two patient presentations on rounds.

Table 3 To Whom Questions Were Asked During Bedside Rounds

Person Addressed	Group	N= Attendings	Mean Number of Questions*	Standard Deviation	p-value	Confidence Intervals
Patient	Control	9	6.7222	5.00069	0.042	[−6.4, 0.1]
	Experimental	10	11.1500	3.77160
Resident	Control	9	3.8889	4.10623	0.003	[−9.5, −3.7]
	Experimental	10	10.3500	4.02112
Nurse	Control	9	0.0556	0.16667	0.370	[−0.1, 0.1]
	Experimental	10	0.8500	0.94428

Note: *Represents mean question count per attending over two patient presentations on rounds.

Table 4 Resident Perception of Rounds Based on Anonymous Survey Data

Morning Walk Rounds Were a Worthwhile Educational Experience for You Today	Experimental N=42	Control N=24	Exp-Control	p-value
Strongly Agree	59.5	29.2	30.3	0.009
Agree	30.9	50	−19.1	0.126
Neutral	7.1	20.8	−13.7	0.101
Disagree	2.4	0	2.4	0.447
Strongly Disagree	0	0	0	NA
Did You Feel Engaged in Teaching/Learning on Morning Walk Rounds Today?	Experimental N=42	Control N=24	Exp-Control	p-value
Strongly Agree	83.3	66.7	16.6	0.121
Agree	16.7	29.2	−12.5	0.234
Neutral	0	4.2	−4.2	0.184
Disagree	0	0	0	NA
Strongly Disagree	0	0	0	NA

Table 5 Verbatim Resident, Nurse and Pharmacist Comments

Person Surveyed	Experimental Group	Control Group
Residents	“Asking questions in a no pressure way, knowing that the attending won’t judge incorrect answers.” “I enjoy questions and discussion of the diagnostic and therapeutic plan after seeing the patient.” “When people put me on the spot and I have to answer questions.” “Open questions from students encouraged.”	“Mostly, I just wish there were more time for teaching.” “Spending sometime outside the room to discuss pertinent data and then share with patient. Also having a brief education regarding one main aspect from the problem list can be good for learning.” “They were very vibrant, inclusive and high-yield. It is especially engaging when we take a brief pause to go over relevant teaching points.” “Would give floor nurses more opportunity to comment/team like they do in units.”
Nurses	“Include patients and their families. Speak clearly to the room instead of just to each other.” “Engage nursing in some way.” “When the nurse is included it allows us all to effectively work together as a team when caring for the patient.”	“Make a priority of asking RN for input and making sure RN is asked to join rounds every day.” “Only suggestion is to ALWAYS include the nurse. At least letting the nurse know the team is rounding.”
Pharmacists	“The team is always very inclusive to pharmacy recommendations and education.”	“Love rounding with the team and being included.”