Effective hospital work rounds require attention to multiple components: physicians should be able to review patients’ course, test results, and treatment plan while attending to their comfort and answering questions. In general, it also provides the opportunity to enhance patient satisfaction. Poor execution of these tasks can lead to adverse patient outcomes and decreased patient satisfaction. Residents are the first line physicians at teaching hospitals and are expected to perform highquality work rounds. Yet training for this difficult, multifaceted interaction is not consistently addressed in undergraduate or graduate medical education. Furthermore, it is not known which behaviors are performed well and which require increased attention. In previous work, we reported that standardized patient (SP) encounters improved resident confidence in performing highquality work rounds. With a large and diverse sample of residents from the current year, we now report resident performance on specific behaviors in a SP work rounds scenario.
A “work rounds” SP encounter involving a patient with a partial small bowel obstruction was created. The encounter scenario takes place on hospital Day 1, centering on pain management and patient education about their hospital stay. We created a checklist deconstructing the residentSP interaction into discrete behaviors that were then grouped into six domains (Table 1). A score of 0, 1, or 2 was recorded for each component behavior for adequate, partial, and inadequate performance. A resident’s score in a behavior domain was the sum of individual component scores and thus an itemized measure of their performance. Oneway ANOVA was performed to determine, if there were significant differences between the scores in behavior domains.
Performance data from 197 house staff from 17 programs at 10 hospitals were collected. Mean percentage of possible points for all examinees with standard deviation and percentage of examinees performing each component adequately are reported in Table 2. Strongest performance was in the verbal and nonverbal communication domains, while the weakest performance was in the anticipatory guidance domain with oneway ANOVA confirming that the differences in scores between domains were statistically significant (p < 0.001).
Using standardized patients, we found significant deficits in resident ability to perform highquality work rounds in multiple behavioral categories. Physicians and trainees can use this information to improve their practice. In addition, residency program directors and hospital quality officers can use this information to design educational interventions for quality improvement.
|Assessed pain severity|
|Assessed efficacy of pain medications|
|Explains what will be done to decrease patient’s pain.|
|Empathy for the inadequate pain control|
|Patient education: disease|
|Review results of Xray without medical jargon|
|Reviews clinical information supporting the diagnosis|
|Explains how the tests planned will change management|
|Explains why nasograstic tube helps the patient|
|Assesses wheter the patient understands the information discussed (teachback)|
|Patient education: anticipatory guidance|
|Apologizes to patient for delay in testing and explains why it is occurring|
|Sets expectations about timing of CT scan|
|Sets expectations about length of stay in the hospital|
|Summarizes information at end of encounter|
|Verbal communication skills|
|Greets patient by name in a respectful manner|
|Uses open ended questions|
|Avoids multiple linked questions|
|Does not interrupt|
|Avoids medical jargon|
|Nonverbal communication skills|
|Makes an effort to appear unrushed|
|Uses appropriate body language to enhance communication|
|Acknowledges patient’s feelings, discomforts and concerns|
|Clarifies team care approach|
|Alerts the patient that other physicians other than the primary team will visit them|
|Encourages additional questions or discussion|
Table 2Domain Performance
|Domain||Mean Percentage||Standard Deviation||Percentage of Examinees Performing All Components Adequately|
|Verbal communication skills||85.3||10.5||13|
|Nonverbal communication skills||75.9||23.3||36|
To cite this abstract:Chang D, Friedman E, Smith K, Mann M, Fallar R, Sommer T. Do Housestaff Provide Adequate Work Rounds? Results from 17 Training Programs. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97546. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/do-housestaff-provide-adequate-work-rounds-results-from-17-training-programs/. Accessed May 23, 2019.