Article Text

  1. A. H. Salanitro1,
  2. A. Castiglioni1,3,
  3. R. M. Shewchuk2,
  4. L. L. Willett1,
  5. G. R. Heudebert1,3,
  6. R. M. Centor1,3
  1. 1Division of General Internal Medicine
  2. 2Department of Medicine and Department of Health Informatics, University of Alabama at Birmingham, Birmingham, AL
  3. 3Birmingham VAMC, Birmingham, AL


Background Ward attending rounds (ARs) are a fundamental component of residency training. Prior work at our institution suggests that housestaff consider elements related to learning climate and control of session as most important for the success of ward ARs. We sought to determine interns' and residents' perceptions on successful ARs across different internal medicine programs in the country.

Methods Nominal group technique (NGT) is a multistep, structured group process used to elicit and prioritize answers to a specific question. We convened two separate Internet/conference call-based NGT sessions with one group of medical interns and one group of medical residents (representing a total of three residency programs) to elicit their perceptions on ward ARs. We asked both groups to identify factors that contribute to “successful” ward ARs. We then had them prioritize these factors with respect to their importance.

results The group of interns (n = 5) identified a total of 31 factors that contribute to successful rounding experiences. This group expressed consensus in ranking giving feedback to all members of the team and discussing expectations of the rotation with all team members prior to the rotation as the two factors most important for successful ward ARs. Residents (n = 9) identified 54 factors that contribute to successful ARs. The results from the resident's prioritization task indicated general agreement that approachability of the attending physician, require attending to dedicate time to teaching and rounding, and ensure that no one talks or interrupts until presentations are finished are the most significant successful factors.

Conclusions Similarly to our local results, the results of this multi-institutional study show that internal medicine interns and residents across different residency programs mostly endorsed factors related to the process of running a team and learning climate as most important in contributing to the success of ward ARs. These results suggest that the managerial function of conducting rounds, which included issues related to feedback, attention to time, and learning climate, rather than the physician/attending related factors, dominates how housestaff value rounds.

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