Ward rounds
Leadership training for registrars on ward rounds Tom Levett, Department of Elderly Medicine, Royal Sussex County Hospital, Brighton, UK Gordon Caldwell, Diabetes Centre, Worthing Hospital, West Sussex, UK
There is an expectation that ‘on the job’ experience will provide sufficient preparation
SUMMARY Background: The post-take ward round (PTWR) provides formal consultant review of acutely unwell patients admitted to hospital, yet specialist medical registrars, the consultants of tomorrow, receive little to no formal training in this area. There is an expectation that ‘on the job’ experience will provide sufficient preparation for this important aspect of clinical leadership. Methods: We aimed to seek the opinions of medical registrars on the use of a structured considerative checklist and learning-byexample approach in PTWR leadership training, assessing
whether this model influences current and future practice. This was studied through a questionnaire-based survey of medical registrars working in Worthing Hospital from 2009 to 2011. Results: Eighteen of 25 registrars (72%) across a range of specialties returned questionnaires. Although a third of respondents had spent time considering how they conduct ward rounds, none had received formal training, with most feeling that ward round skills were acquired ‘on the job’ from observation and experience of those conducted by senior colleagues. Exposure to the considerative checklist changed
thinking in 94 per cent and changed practice in 88 per cent. Common positive themes included enhanced pre-ward round preparation, the importance of inclusion and communication, and the need for structure (facilitated by physical or mental checklist). Seventeen of 18 participants felt that this training would influence their consultant practice. Discussion: Trainees respond positively to participation in a structured PTWR using a considerative checklist as a model of good practice, leading to changes in their current and future practice, and could be considered as a training tool.
350 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354
tct_12167.indd 350
7/7/2014 8:26:47 PM
INTRODUCTION
The PTWR can provide a wide range of learning opportunities
T
he post-take ward round (PTWR) remains the cornerstone of senior medical review of acutely unwell patients admitted to hospital. Consultants review patients assessed by trainee doctors, and provide working diagnoses and management plans. Trainee exposure to PTWRs has undoubtedly reduced through the changing working patterns required by hours-ofwork legislation. The PTWR can provide a wide range of learning opportunities if junior doctors and consultants are aware of the potential.1
Specialist Registrars (SPRs) in training lead on the immediate clinical care of acute medical admissions. The hope is that this ‘on the job’ experience will sufficiently prepare SpRs to become leaders of the PTWR as consultants. The drive for improved training in leadership is evident in the curricula2; however, the methods of training in leadership are not well validated, and there is little literature on this topic. We therefore aimed to seek the opinions of medical registrars on the role of using a ‘sign in’, a considerative checklist and a ‘leading by example approach’ in learning how to conduct a PTWR, and to assess whether this approach could influence current and future practice.3
METHODS The setting for this questionnaire-based survey was Worthing Hospital, a district general hospital on the south coast of England. It receives approximately 10 000 acute medical admissions annually. All acute medical takes are supervised by an SpR. There are 13 medical registrars participating in a full rota, who receive clinical supervision from consultant doctors on the PTWRs. Dr Gordon Caldwell (G.C.) has developed a structured method of
conducting a ward round, using a sign in (Figure 1) and a considerative checklist (Figure S1 online).3 The checklist is designed to achieve a comprehensive, safe and timely review of newly admitted patients. The process divides into preparatory case discussions and bedside consultations, with checking, planning and a feedback stage. Multidisciplinary input and effective handover are actively encouraged, and verbal and written feedback on both clinical and leadership performance is provided.4 The SpRs from the 2009–10 and 2010–11 cohorts were asked to complete a structured questionnaire, providing feedback on the PTWR process. They were asked to comment on prior thoughts concerning how to conduct a ward round and
whether they had received formal teaching in this area, and then to comment on how exposure to the methods and feedback had altered their perceptions or practices. All consented to information sharing. Anonymity has been applied to all responses. The questionnaire promoted free-text answers, which have been analysed for common themes.
RESULTS Eighteen of 25 registrars (72%) returned questionnaires (the 2010–11 cohort had 12 SpRs), of which 11 (61%) were male, 17 were in their first three years (ST3–5) and one was in the final year of training (Table 1). Each SpR experienced between one and 15 (median seven)
Figure 1. The ‘sign in’ process
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354 351
tct_12167.indd 351
7/7/2014 8:26:49 PM
There was little prior thought given to the ‘process’ of running a ward round
Table 1. Demographic data for participants Demographics
n (18)
%
Cohort year 2009–10
11
61
2010–11
7
39
11
61
7
39
1
8
44
2
8
44
3
1
6
4
0
0
5
1
6
Acute medicine
2
11
Cardiology
4
22
Gastroenterology
2
11
Geriatrics
5
28
Renal
2
11
Respiratory
3
17
Gender Male Female Year of training
Specialty
• promotes good pre-ward round preparation; • reinforces the importance of all team members, particularly the inclusion of and communication with nursing staff; • promotes the need for structure and process, which many felt was aided by the checklist, although there was a trend towards favouring a ‘mental’ rather than formal written checklist. Participants were asked if they believed that this training would influence their practice as consultants, and 17/18 believed it would. The elements of this approach that would be carried forward to their consultant careers varied between individuals. There was particular positivity for pre-round discussion and expectation setting, the use of some sort of checklist (mental or written) and the provision of post-round feedback.
DISCUSSION PTWRs led by G.C. using the sign in and the considerative checklist. Ward round participants are asked to physically sign in on the checklist documentation to acknowledge their active participation in the ward round: performing designated roles and responsibilities supports the whole team, and encourages an open culture in which concerns, particularly regarding practice, can be aired. Although some thought that this was time-consuming and had potential to lack practicality, especially if team members were called away, the feedback was largely positive (Box 1), as it was felt to: • promote inclusivity – allowing an equal forum for all; • define roles and responsibilities; • set expectations.
Only one-third of respondents (6/18) had previously actively reflected on how to conduct ward rounds, and none had received any formal training in this area. There was a clear trend in thinking that developing the skills required to conduct ward rounds would be imparted through experience and the observation of senior colleagues, and to a lesser extent peers. Box 1 contains trainee responses illustrating these themes, along with those discussed below. Seventeen of the 18 (94%) trainees felt that their thinking about how they conduct ward rounds had changed through exposure to the considerative checklist. Furthermore, 16/18 (88%) had modified their current practice following experience of this model. Common positive themes that emerged included how the model:
Although this is a survey of a small number of trainees, respondents were from a breadth of specialties and all will have experienced PTWRs. There was little prior conscious thought given to the ‘process’ of running a ward round. Certainly no trainees had received any formal training in the subject. The use of the considerative checklist was received positively, with 94 per cent of respondents stating that it had changed their thinking and 88 per cent stating that it had changed their practice. All trainees felt that they would take aspects of this model forward into their consultant careers. There are naturally limitations of this study. It is a single-site study of small numbers, using a model practised in this full form by one individual consultant. However, a similar checklist has been validated for content and construct in work by Norgaard.5
352 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354
tct_12167.indd 352
7/7/2014 8:26:54 PM
Box 1. Direct trainee responses, illustrating common themes arising from the questionnaire Theme
Trainee responses
Thoughts on sign in process
‘I feel the juniors realise their role and feel good that their role is recognised’ ‘Sign in is very inclusive so makes everyone feel part of the team making management decisions’
17/18 participants believed this training would influence their practice as consultants
Thoughts on ward ‘Not taught but think about beforehand and learn from observing different…consultants and round process registrars and try to improve from that’ ‘As a trainee who sees…consultants doing rounds, the differences in styles and practices provokes you to think – “what works” or more likely why didn’t they do that?’ Learning through ‘One of those things you just “learn on the job” and hope you are doing it well.’ observation and ‘Learned from watching others – good and bad, trying to modify my practice along the way’ experience ‘Part of our training clearly anticipates you “pick up” the way a ward round operates’ Checklist promotes preparation
‘I now start preparing for the ward round early, plan the event’ ‘I haven’t significantly changed my rounds BUT I have changed the way I prepare myself for PTWRs’
Checklist alters behaviour
‘I ensure that communication particularly with nursing staff is improved and include them more actively’ ‘Have attempted to create a structure…to ensure that things are not missed’ ‘I have found the checklist…very useful in terms of managing avoidable harm. I now have a mental checklist’
Additionally, in clinical practice the WHO surgical safety checklist has been successful in reducing postoperative mortality and complications, whilst improving teamwork and communication.6 This process parallels our model through pre-round meeting (briefing), sign in and debriefing elements. Most SpRs surveyed (88%) were in the first 2 years of training. Given this distance from completion of training, individuals may be less inclined to have considered the best way to conduct a PTWR, or may have not yet received any available training in this area, although those in higher training years had still received no formal training. A study by Dewhurst promotes the idea that the PTWR provides a range of learning opportunities, but concluded that time constraints and a lack of consultants’ appreciation of the possibilities limits the incorporation into practice.1 This is supported by a large published audit, showing that target-driven changes to working practice negatively impacted on training
opportunities during the PTWR.7 These primarily focused on medical education, but ‘teaching time’ could easily be translated to a discussion of the process of leading a ward round. Dewhurst outlines role-modelling as a positive learning tool,1 which echoes our SpRs’ opinions of ‘learning on the job’ through direct observation of senior staff, with the incorporation of perceived good practice into their own. Role-modelling has long been used as a way of imparting knowledge, experience, professional values and behaviours, and in UK hospital practice and medical education this has primarily been provided by consultants. However, many traits of consultants’ personal practices positively or negatively influence the experience gained, and a shift towards a mentorship model may enhance the positive outcomes.8 In current UK postgraduate medical training, the allocation of an educational supervisor goes some way towards this goal, as the supervisor is trained in assessment and
feedback, and engage in ‘an educational contract’ with the trainee. This relationship and the use of work-based assessments could easily be directed towards assessing and enhancing ward round performance,9 and perhaps the assessment of leading a PTWR should be mandatory? Future work should seek to widen the use of this approach across consultant mentors in medicine and other specialties to further evaluate efficacy, and comparing against more traditional consultant PTWR models, via focus group methodologies, may help to distil which interventions have the greatest impact on learner practitioners. It would also be interesting to evaluate consultant opinion on the provision of this type of training. The hope would be that trainers may incorporate this into their practice, a suggestion echoed by Norgaard’s work, which promotes attention to the ‘non-medical’ aspects of competence that could be taught and assessed through the use of a checklist.5 Certainly a planned approach to education on the ward
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354 353
tct_12167.indd 353
7/7/2014 8:26:54 PM
Trainees respond positively to participation in a structured PTWR
round is thought to provide more reliable learning opportunities than unplanned or opportunistic training,10 and an active teaching approach, which can include analysing chains of thought or explaining points of view, enhances the learning experience.11
CONCLUSION Ward rounds are an integral part of the day-to-day activities of registrars in medical specialties, making reflection on practice important. Trainees respond positively to participation in a structured PTWR using a considerative checklist as a model of good practice, leading to changes in their current and future practice. Trainers should be mindful of the need to provide training in this area, which could use a checklist model and be formalised by the use of work-based assessments. REFERENCES 1. Dewhurst G. Time for change: teaching and learning on busy post-take ward rounds. Clin Med 2010;10:231–234.
2. Clarke J, Armit K. Leadership and the Curriculum. BMJ Careers 5 February 2009. Available at http://careers.bmj.com/ careers/advice/view-article. html?id=20000018. Accessed on 14 November 2012. 3. Mohan N, Caldwell G. A Considerative Checklist to ensure safe daily patient review. Clin Teach 2013;10:209–213. 4. Herring R, Desai T, Caldwell G. Quality and safety at the point of care: how long should a ward round take? Clin Med 2011;11: 20–22. 5. Norgaard K, Ringsted C, Dolmans D. Validation of a checklist to assess ward round performance in internal medicine. Med Educ 2004;38:700–707. 6. Haynes AB, Weiser TG, Berry WR et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–499. 7. Chaponda M, Borra M, Beeching NJ, Almond DS, Williams PS, Hammond MA, Price VA, Tarry L, Taegtmeyer M. The value of the post-take ward round: are new working patterns compromising junior doctor education? Clin Med 2009;9:323–326.
8. Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ 2002; 325:707–710. 9. Joint Royal Colleges of Physicians’ Training Board. Workplace based assessment. Available at http:// www.jrcptb.org.uk/assessment/ Pages/Workplace-BasedAssessment.aspx. Accessed on 14 November 2012. 10. Stanley P. Structuring ward rounds for learning: can opportunities be created? Med Educ 1998;32:239–243. 11. Talbot M. An interview study of the working ward round as an instrument of experiential learning in postgraduate medical education: a preparatory exploration. Journal of Vocational Education and Training 2000;52:149–159.
SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article at http:// onlinelibrary.wiley.com/doi: 10.1111/tct.12167/suppinfo Figure S1. The considerative checklist.4
Corresponding author’s contact details: Gordon Caldwell, Consultant Physician & Clinical Tutor, Diabetes Centre, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: No formal ethical approval sought. All participants were invited to take part, there was no obligation. Participation had no effect on training. All consented to participation and anonymity has been maintained. The article has been reviewed by the Vice-Chairman of the Brighton and Sussex Research Ethics Committee UK who confirms that the paper is an evaluation of a teaching methods and not a piece of research, and therefore does not require ethical approval. The authors made clear to the participants that the responses to the surveys would be published anonymously and there was sufficient consent to publication in the form of this article. doi: 10.1111/tct.12167
354 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354
tct_12167.indd 354
7/7/2014 8:26:54 PM
Leadership training for registrars on ward rounds Tom Levett, Department of Elderly Medicine, Royal Sussex County Hospital, Brighton, UK Gordon Caldwell, Diabetes Centre, Worthing Hospital, West Sussex, UK
There is an expectation that ‘on the job’ experience will provide sufficient preparation
SUMMARY Background: The post-take ward round (PTWR) provides formal consultant review of acutely unwell patients admitted to hospital, yet specialist medical registrars, the consultants of tomorrow, receive little to no formal training in this area. There is an expectation that ‘on the job’ experience will provide sufficient preparation for this important aspect of clinical leadership. Methods: We aimed to seek the opinions of medical registrars on the use of a structured considerative checklist and learning-byexample approach in PTWR leadership training, assessing
whether this model influences current and future practice. This was studied through a questionnaire-based survey of medical registrars working in Worthing Hospital from 2009 to 2011. Results: Eighteen of 25 registrars (72%) across a range of specialties returned questionnaires. Although a third of respondents had spent time considering how they conduct ward rounds, none had received formal training, with most feeling that ward round skills were acquired ‘on the job’ from observation and experience of those conducted by senior colleagues. Exposure to the considerative checklist changed
thinking in 94 per cent and changed practice in 88 per cent. Common positive themes included enhanced pre-ward round preparation, the importance of inclusion and communication, and the need for structure (facilitated by physical or mental checklist). Seventeen of 18 participants felt that this training would influence their consultant practice. Discussion: Trainees respond positively to participation in a structured PTWR using a considerative checklist as a model of good practice, leading to changes in their current and future practice, and could be considered as a training tool.
350 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354
tct_12167.indd 350
7/7/2014 8:26:47 PM
INTRODUCTION
The PTWR can provide a wide range of learning opportunities
T
he post-take ward round (PTWR) remains the cornerstone of senior medical review of acutely unwell patients admitted to hospital. Consultants review patients assessed by trainee doctors, and provide working diagnoses and management plans. Trainee exposure to PTWRs has undoubtedly reduced through the changing working patterns required by hours-ofwork legislation. The PTWR can provide a wide range of learning opportunities if junior doctors and consultants are aware of the potential.1
Specialist Registrars (SPRs) in training lead on the immediate clinical care of acute medical admissions. The hope is that this ‘on the job’ experience will sufficiently prepare SpRs to become leaders of the PTWR as consultants. The drive for improved training in leadership is evident in the curricula2; however, the methods of training in leadership are not well validated, and there is little literature on this topic. We therefore aimed to seek the opinions of medical registrars on the role of using a ‘sign in’, a considerative checklist and a ‘leading by example approach’ in learning how to conduct a PTWR, and to assess whether this approach could influence current and future practice.3
METHODS The setting for this questionnaire-based survey was Worthing Hospital, a district general hospital on the south coast of England. It receives approximately 10 000 acute medical admissions annually. All acute medical takes are supervised by an SpR. There are 13 medical registrars participating in a full rota, who receive clinical supervision from consultant doctors on the PTWRs. Dr Gordon Caldwell (G.C.) has developed a structured method of
conducting a ward round, using a sign in (Figure 1) and a considerative checklist (Figure S1 online).3 The checklist is designed to achieve a comprehensive, safe and timely review of newly admitted patients. The process divides into preparatory case discussions and bedside consultations, with checking, planning and a feedback stage. Multidisciplinary input and effective handover are actively encouraged, and verbal and written feedback on both clinical and leadership performance is provided.4 The SpRs from the 2009–10 and 2010–11 cohorts were asked to complete a structured questionnaire, providing feedback on the PTWR process. They were asked to comment on prior thoughts concerning how to conduct a ward round and
whether they had received formal teaching in this area, and then to comment on how exposure to the methods and feedback had altered their perceptions or practices. All consented to information sharing. Anonymity has been applied to all responses. The questionnaire promoted free-text answers, which have been analysed for common themes.
RESULTS Eighteen of 25 registrars (72%) returned questionnaires (the 2010–11 cohort had 12 SpRs), of which 11 (61%) were male, 17 were in their first three years (ST3–5) and one was in the final year of training (Table 1). Each SpR experienced between one and 15 (median seven)
Figure 1. The ‘sign in’ process
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354 351
tct_12167.indd 351
7/7/2014 8:26:49 PM
There was little prior thought given to the ‘process’ of running a ward round
Table 1. Demographic data for participants Demographics
n (18)
%
Cohort year 2009–10
11
61
2010–11
7
39
11
61
7
39
1
8
44
2
8
44
3
1
6
4
0
0
5
1
6
Acute medicine
2
11
Cardiology
4
22
Gastroenterology
2
11
Geriatrics
5
28
Renal
2
11
Respiratory
3
17
Gender Male Female Year of training
Specialty
• promotes good pre-ward round preparation; • reinforces the importance of all team members, particularly the inclusion of and communication with nursing staff; • promotes the need for structure and process, which many felt was aided by the checklist, although there was a trend towards favouring a ‘mental’ rather than formal written checklist. Participants were asked if they believed that this training would influence their practice as consultants, and 17/18 believed it would. The elements of this approach that would be carried forward to their consultant careers varied between individuals. There was particular positivity for pre-round discussion and expectation setting, the use of some sort of checklist (mental or written) and the provision of post-round feedback.
DISCUSSION PTWRs led by G.C. using the sign in and the considerative checklist. Ward round participants are asked to physically sign in on the checklist documentation to acknowledge their active participation in the ward round: performing designated roles and responsibilities supports the whole team, and encourages an open culture in which concerns, particularly regarding practice, can be aired. Although some thought that this was time-consuming and had potential to lack practicality, especially if team members were called away, the feedback was largely positive (Box 1), as it was felt to: • promote inclusivity – allowing an equal forum for all; • define roles and responsibilities; • set expectations.
Only one-third of respondents (6/18) had previously actively reflected on how to conduct ward rounds, and none had received any formal training in this area. There was a clear trend in thinking that developing the skills required to conduct ward rounds would be imparted through experience and the observation of senior colleagues, and to a lesser extent peers. Box 1 contains trainee responses illustrating these themes, along with those discussed below. Seventeen of the 18 (94%) trainees felt that their thinking about how they conduct ward rounds had changed through exposure to the considerative checklist. Furthermore, 16/18 (88%) had modified their current practice following experience of this model. Common positive themes that emerged included how the model:
Although this is a survey of a small number of trainees, respondents were from a breadth of specialties and all will have experienced PTWRs. There was little prior conscious thought given to the ‘process’ of running a ward round. Certainly no trainees had received any formal training in the subject. The use of the considerative checklist was received positively, with 94 per cent of respondents stating that it had changed their thinking and 88 per cent stating that it had changed their practice. All trainees felt that they would take aspects of this model forward into their consultant careers. There are naturally limitations of this study. It is a single-site study of small numbers, using a model practised in this full form by one individual consultant. However, a similar checklist has been validated for content and construct in work by Norgaard.5
352 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354
tct_12167.indd 352
7/7/2014 8:26:54 PM
Box 1. Direct trainee responses, illustrating common themes arising from the questionnaire Theme
Trainee responses
Thoughts on sign in process
‘I feel the juniors realise their role and feel good that their role is recognised’ ‘Sign in is very inclusive so makes everyone feel part of the team making management decisions’
17/18 participants believed this training would influence their practice as consultants
Thoughts on ward ‘Not taught but think about beforehand and learn from observing different…consultants and round process registrars and try to improve from that’ ‘As a trainee who sees…consultants doing rounds, the differences in styles and practices provokes you to think – “what works” or more likely why didn’t they do that?’ Learning through ‘One of those things you just “learn on the job” and hope you are doing it well.’ observation and ‘Learned from watching others – good and bad, trying to modify my practice along the way’ experience ‘Part of our training clearly anticipates you “pick up” the way a ward round operates’ Checklist promotes preparation
‘I now start preparing for the ward round early, plan the event’ ‘I haven’t significantly changed my rounds BUT I have changed the way I prepare myself for PTWRs’
Checklist alters behaviour
‘I ensure that communication particularly with nursing staff is improved and include them more actively’ ‘Have attempted to create a structure…to ensure that things are not missed’ ‘I have found the checklist…very useful in terms of managing avoidable harm. I now have a mental checklist’
Additionally, in clinical practice the WHO surgical safety checklist has been successful in reducing postoperative mortality and complications, whilst improving teamwork and communication.6 This process parallels our model through pre-round meeting (briefing), sign in and debriefing elements. Most SpRs surveyed (88%) were in the first 2 years of training. Given this distance from completion of training, individuals may be less inclined to have considered the best way to conduct a PTWR, or may have not yet received any available training in this area, although those in higher training years had still received no formal training. A study by Dewhurst promotes the idea that the PTWR provides a range of learning opportunities, but concluded that time constraints and a lack of consultants’ appreciation of the possibilities limits the incorporation into practice.1 This is supported by a large published audit, showing that target-driven changes to working practice negatively impacted on training
opportunities during the PTWR.7 These primarily focused on medical education, but ‘teaching time’ could easily be translated to a discussion of the process of leading a ward round. Dewhurst outlines role-modelling as a positive learning tool,1 which echoes our SpRs’ opinions of ‘learning on the job’ through direct observation of senior staff, with the incorporation of perceived good practice into their own. Role-modelling has long been used as a way of imparting knowledge, experience, professional values and behaviours, and in UK hospital practice and medical education this has primarily been provided by consultants. However, many traits of consultants’ personal practices positively or negatively influence the experience gained, and a shift towards a mentorship model may enhance the positive outcomes.8 In current UK postgraduate medical training, the allocation of an educational supervisor goes some way towards this goal, as the supervisor is trained in assessment and
feedback, and engage in ‘an educational contract’ with the trainee. This relationship and the use of work-based assessments could easily be directed towards assessing and enhancing ward round performance,9 and perhaps the assessment of leading a PTWR should be mandatory? Future work should seek to widen the use of this approach across consultant mentors in medicine and other specialties to further evaluate efficacy, and comparing against more traditional consultant PTWR models, via focus group methodologies, may help to distil which interventions have the greatest impact on learner practitioners. It would also be interesting to evaluate consultant opinion on the provision of this type of training. The hope would be that trainers may incorporate this into their practice, a suggestion echoed by Norgaard’s work, which promotes attention to the ‘non-medical’ aspects of competence that could be taught and assessed through the use of a checklist.5 Certainly a planned approach to education on the ward
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354 353
tct_12167.indd 353
7/7/2014 8:26:54 PM
Trainees respond positively to participation in a structured PTWR
round is thought to provide more reliable learning opportunities than unplanned or opportunistic training,10 and an active teaching approach, which can include analysing chains of thought or explaining points of view, enhances the learning experience.11
CONCLUSION Ward rounds are an integral part of the day-to-day activities of registrars in medical specialties, making reflection on practice important. Trainees respond positively to participation in a structured PTWR using a considerative checklist as a model of good practice, leading to changes in their current and future practice. Trainers should be mindful of the need to provide training in this area, which could use a checklist model and be formalised by the use of work-based assessments. REFERENCES 1. Dewhurst G. Time for change: teaching and learning on busy post-take ward rounds. Clin Med 2010;10:231–234.
2. Clarke J, Armit K. Leadership and the Curriculum. BMJ Careers 5 February 2009. Available at http://careers.bmj.com/ careers/advice/view-article. html?id=20000018. Accessed on 14 November 2012. 3. Mohan N, Caldwell G. A Considerative Checklist to ensure safe daily patient review. Clin Teach 2013;10:209–213. 4. Herring R, Desai T, Caldwell G. Quality and safety at the point of care: how long should a ward round take? Clin Med 2011;11: 20–22. 5. Norgaard K, Ringsted C, Dolmans D. Validation of a checklist to assess ward round performance in internal medicine. Med Educ 2004;38:700–707. 6. Haynes AB, Weiser TG, Berry WR et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–499. 7. Chaponda M, Borra M, Beeching NJ, Almond DS, Williams PS, Hammond MA, Price VA, Tarry L, Taegtmeyer M. The value of the post-take ward round: are new working patterns compromising junior doctor education? Clin Med 2009;9:323–326.
8. Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ 2002; 325:707–710. 9. Joint Royal Colleges of Physicians’ Training Board. Workplace based assessment. Available at http:// www.jrcptb.org.uk/assessment/ Pages/Workplace-BasedAssessment.aspx. Accessed on 14 November 2012. 10. Stanley P. Structuring ward rounds for learning: can opportunities be created? Med Educ 1998;32:239–243. 11. Talbot M. An interview study of the working ward round as an instrument of experiential learning in postgraduate medical education: a preparatory exploration. Journal of Vocational Education and Training 2000;52:149–159.
SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article at http:// onlinelibrary.wiley.com/doi: 10.1111/tct.12167/suppinfo Figure S1. The considerative checklist.4
Corresponding author’s contact details: Gordon Caldwell, Consultant Physician & Clinical Tutor, Diabetes Centre, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: No formal ethical approval sought. All participants were invited to take part, there was no obligation. Participation had no effect on training. All consented to participation and anonymity has been maintained. The article has been reviewed by the Vice-Chairman of the Brighton and Sussex Research Ethics Committee UK who confirms that the paper is an evaluation of a teaching methods and not a piece of research, and therefore does not require ethical approval. The authors made clear to the participants that the responses to the surveys would be published anonymously and there was sufficient consent to publication in the form of this article. doi: 10.1111/tct.12167
354 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 350–354
tct_12167.indd 354
7/7/2014 8:26:54 PM
