Purpose Over the last century, internal medicine education of medical students and residents has been dominated by "attending rounds " on inpatient teaching services. However, these teaching sessions have changed substantially over the last several decades with increased patient turnover and more pressure to limit inpatient stays. The purpose of this study was to evaluate the impact of increased patient care workload on quality of inpatient teaching rounds.
Methods For 2 consecutive years (2004 and 2005), trained research assistants surveyed residents working on our internal medicine inpatient teams during a 3-month summer block. After attending rounds, residents and interns were asked to complete a short questionnaire, which included rating the following statements on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree): "My rounds went well " and "My attending spent enough time teaching. " Daily census data were collected for each of the internal medicine teams during the survey period, including patient census, the number of discharges, and the number of admissions. Data were analyzed using descriptive statistics and simple correlations to assess the association of patient workload (census, discharges, and admissions) on resident ratings of teaching rounds.
Results A total of 163 attending rounds sessions were evaluated, with a total of 271 resident surveys returned. Residents were generally pleased with rounds, with a mean rating of the "My rounds went well " statement of 4.2 6 0.7 and a mean rating of "My attending spent enough time teaching " of 4.1 6 0.9. The average census for inpatient services was 8.6 6 3.0 with an average of 2.1 discharges and 2.2 admissions each day. Total team census was negatively correlated with both subjective rating of rounds that went well (r = 2.26, p < .0001) and with the time spent teaching during rounds (r = 2.13, p = .05). In addition, residents gave lower ratings of rounds when a greater number of discharges occurred that day (r = 2.14, p = .03).
Conclusions Resident rating of attending rounds quality was negatively associated with an increase in patient census and workload. Residency programs must determine the optimum census and workload to ensure balance of patient care and teaching on inpatient medicine rotations.
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