Background Ward attending rounds (AR) are a fundamental teaching component of internal medicine training programs. These daily sessions differ in style and effectiveness. Better understanding of residents' perceptions of successful attending rounds should aid teaching programs and inform attending physicians.
Methods Nominal group technique (NGT) is a multistep, structured group process used to elicit and prioritize answers to a specific question. We convened NGT meetings with two groups of medical residents, eliciting their perceptions on ward AR. We asked the first group (G1) to identify factors that contribute to “successful” ward AR. We then had them prioritize these factors with respect to a) their importance and b) the extent they had experienced during their own ward AR experience. We had the second group (G2) identify factors that detract from the success of ward AR and had them prioritize these with respect to their a) importance and b) the extent to which they were encountered during their own ward AR experience.
Results G1 (n = 9) identified 32 factors that contribute to successful rounding experiences. This group expressed considerable consensus in ranking: attention to length of rounds, permitting house staff autonomy (not micromanaging), and establishing goals/expectations at the start of rotations as the three factors most important to successful ward AR. Successful factors most encountered in their own rounding experiences included having a collaborative/inclusive environment, providing a comfortable environment for discussions/questions, and evincing interest in teaching/being on rounds. G2 (n = 6) identified 34 factors that detract from the ward AR experience. The results from G2's prioritization task indicated general agreement that: very long rounds, interruptions, time constraints and other responsibilities, and poor rapport between the attending and team members are the most significant detractors of successful ward AR. G2 agreed that only very long rounds had been a significant detractor in their own ward AR experience.
Conclusions This qualitative study shows that NGT is an effective method of eliciting consensus among housestaff. Respect for residents' time and autonomy are the main determinants of successful ward attending rounds. These and other elements should be included in the evaluation and feedback of ward attending physicians.
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