Module 7: Teaching in the Inpatient Setting

Attending Rounds

The formats of traditional attending rounds are quite varied. Most noticeable variations occur along specialty lines. Many surgeons’ attending rounds occur in the operating room, the clinic or during postoperative patient rounds. Primary care rounds tend to occur at a predetermined time period.

Each attending should have a general routine for rounds with announced expectations to all learners at the beginning of the block. Of course, much of the discussion is patient-centered, yet can transition at times to learner-centered discussion depending on the topic or the experience level of the students/residents. Most medical students hunger for information and a chance to test their knowledge whereas an experienced resident seeks clinical pearls. Effective teachers recognize and anticipate teachable moments, no matter how brief.

Discussions are most effectively facilitated with open-ended questions or probing learners for their opinions. Although it is common and easier for the teacher to ask close-ended questions (recalling facts), these questions tend to stifle discussion. Close-ended questions are often perceived as “pimping” or a game of “Guess what I am thinking?” Questions that require regurgitation of factual knowledge are best suited for occasional use with very junior learners. Such questions can serve to actually improve their confidence and risk-taking in the learning environment.

Remember that each student or resident will have varied agendas and a personal learning style. Aggressive learners may be enthusiastic, eager to please, overconfident, covering lack of confidence or showing off. Do not equate quiet or reserved learners as lacking knowledge or uninterested. Introverted personality types need time to think within themselves first, whereas extroverted learners think aloud. A skillful attending can engage all learners based on the perceived learning styles in the group. The most dynamic teams seem to have a nice mix of introverts and extroverts.