Taking a New Approach to Improve Teaching Rounds
James Hudspeth, MD, a Clinical Associate Professor of Medicine in the Section of General Internal Medicine, and co-authors from the Department of Medicine recently published an Innovations in Medical Education article in the Journal of General Internal Medicine as first author, titled “Changing the Presentation of Overnight Admissions to Improve Teaching Rounds.”
The team performed a pilot study assessing a new approach to morning rounds presentations. The “increased use of night float systems for overnight admissions in internal medicine has led to trainees presenting newly admitted patients that they did not personally admit.” “The combination of a shift to night float coverage with increased EHR access raises the possibility of changing the structure of morning rounds to improve education and efficiency,” said the co-authors.
To test their theory, the co-authors piloted an alternative presentation model where “the attending and supervising resident were asked to review overnight admissions before the rounds, use a streamlined patient presentation, and encourage critical review of the initial clinical reasoning.” During a 3-week rotation, teams “used the traditional presentation for 1 week and then the new model for the subsequent 2 weeks.” They then surveyed program participants on the new approach vs. the traditional approach.
The co-authors found that “a small set of changes in the approach to overnight admissions resulted in perceived improvements in education and efficiency without prolonging rounds.” Participants in the pilot study “generally rated the new approach superior to the traditional approach.” Not only was the new approach favored, but it “required no extra funding, was simple to implement, and did not increase rounding time.”
“We believe that improving the structure of attending rounds as a central aspect of internal medicine education can have a large impact on the overall residency experience, and that our pilot shows the feasibility and perceived benefit of one proposed model to address a common challenge created by a night float system,” concluded the co-authors.