Purpose The attending is considered the clinical teacher on traditional general internal medicine ward services, with contributions from various learners, including residents, interns and medical students. Few studies have reported the quantity of time devoted to patient care, separate teaching sessions and administrative work during attending rounds. We explored the relative contribution of these components during the daily attending rounds on a typical university hospital's general medicine inpatient service.
Methods Over a four month period, trained research assistants (second year medical students) observed attending rounds at our university hospital. The research assistants coded the two most predominant activities for 90 minutes of each session in 5-minute intervals with respect to content and involvement of the teams' members quality of the teaching and presence of the patient during the discussions. The activity on rounds was conceptualized as patient care, teaching, or administrative work. The discussions on rounds were conceptualized as open discussions involving most members of the team, interactions between two team members (dyad), lecture by a single individual or none of the three (“dead” time). After rounds, the research assistants rated the rounds with regards to involvement of each of the key team members (1 = not involved, 10 = very involved).
Results Overall, 96 distinct daily rounds sessions were evaluated. Patient care was the focus of the discussion of the majority of the time spent, ranging from 55% to 83% of total time spent on attending rounds (median = 66%). Separate time allocated to teaching comprised 3-11% of the rounds (median = 6%), while 0-9% of time was spent on administrative work (median = 3%). Of interest, the median time spent at the bedside with the patient present was 28% (range 1-40%). In our sample, open discussions dominated rounding activities, while solo and dyad discussions were noted less frequently. “Dead” time was minimal. The attending was involved in teaching discussions most frequently throughout rounds, with diminishing amounts of involvement of the resident, intern and student
Conclusions The largest majority of time spent teaching on attending rounds is in the context of patient care (i.e. - bedside rounds). Only 6% of time teaching is spent in separate sessions and even less time was spent on administrative work. While most of the teaching is performed at the bedside, only 28% is with the patient present during the discussion. The attending is the dominant teacher at the bedside in our institution, using open discussion more frequently than solo or dyad discussions.