HOUSESTAFF VIEWS ON SUCCESSFUL ATTENDING ROUNDS: A MULTIINSTITUTIONAL STUDY

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 HOUSESTAFF VIEWS ON SUCCESSFUL ATTENDING
ROUNDS A MULTI-INSTITUTIONAL STUDY

• Amanda H Salanitro, M.D.
• Analia Castiglioni, M.D.
• Richard M Shewchuk, Ph.D.
• Lisa L Willett, M.D.
• Gustavo R Heudebert, M.D.
• Robert M Centor, M.D.
• Division of General Internal Medicine

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Attending Physicians

• Excellent teachers
• Commit time to teaching
• Stress doctor-patient relationship
• Teach psychosocial aspects
• Experience as Chief Resident

Wright SM NEJM 19983391986-93.
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Attending Rounds
Dr. Chalkboard -Sit down rounds -Board
talks -Topic oriented -Focused bedside teaching
Dr. Bedside -Bedside rounds -Few board
talks -Patient oriented -Broad range of
bedside topics
?
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Prior Study- UAB

• Residents and interns
• Teaching-work rounds tradition
• Nominal group technique
• Successful factors
• Interns attending approachability, enthusiasm,
  and quality of teaching
• Residents duration of rounds, housestaff
  autonomy, specific goals and expectations

SSGIM Proceedings 2005
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Study Aim

• Define elements that characterize successful ward
  attending rounds
• Interns and residents perceptions
• Multi-institutional level
• Compare to our local results

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Methods

• Participants Multiple institutions
• Method
• Web-based/Conference Call Nominal Group Technique
• Outcomes
• Define elements that characterize successful ward
  attending rounds
• Assess interns and residents perceptions of
  ward attending rounds

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Nominal Group Technique (NGT)

• Structured group process
• Responses to a question
• Silent generation of ideas
• Round-robin recording
• Serial discussion for clarification only
• Voting
• - 3 most important factors
• Ranked list of responses

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Advantages of NGT

• Wide variety of ideas
• Eliminates dominant personalities and process
  loss
• Prioritization of ideas

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Web-based/Conference Call NGT

• UAB innovation
• Participants linked virtually
• Occurs in real-time, involving participants at
  varied locations

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Study Design
4 Clinician-Educators Expert moderator Not too
broad / narrow
Question Development
Contacted programs Participants recruited in
fall 2006
Multi-institutional
Intern NGT n 13 4 sites
Resident NGT n 9 2 sites
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Participating sites
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Question

• What are the factors / elements that
  contribute to successful attending rounds?

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Results Successful Factors
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Most Highly Ranked Successful Factors Interns

• Multi-institutional
• Positive/negative feedback for trainee
• Serious but relaxed atmosphere
• Expectations outlined at outset

• UAB
• Attending approachability
• Attending showing enthusiasm
• Teaching of high quality

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Most Highly Ranked Successful Factors Residents

• Multi-institutional
• Attending approachability
• Dedicated time to teaching and rounding
• No interruptions until presentations finished

• UAB
• Length of rounds
• Housestaff autonomy
• Setting goals and expectations

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Limitations

• Voluntary participation
• Unequal representation
• One sampling

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Conclusions

• Successful Ward Attending Rounds
• Attention to time
• Autonomy
• Approachability
• Respect
• Common themes transcended
• Location
• Structure of rounds
• Style of attendings

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Successful Attending Rounds
Dr. Bedside
Dr. Chalkboard
Attention to time Autonomy Approachability Respect
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Implications

• Successful rounds Good manager
• Individual attributes less important than
  managerial skills
• Utilize technology for medical education

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Acknowledgments

• Residents and interns who participated
• Program directors
• Caroline Milne, MDUniv. of Utah
• Kelly J. Caverzagie, MDUniv. of Penn
• Linnea Capps, MDHarlem Hospital
• Peter Watson, MDHenry Ford
• General Internal Medicine faculty at UAB

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