Things We Do for No Reason™: Card Flipping Rounds

Interprofessional bedside rounding improves quality of feedback to resident physicians

PURPOSE

Obtaining high quality feedback in residency education is challenging, in part due to limited opportunities for faculty observation of authentic clinical work. This study reviewed the impact of interprofessional bedside rounds ('iPACE™') on the length and quality of faculty narrative evaluations of residents as compared to usual inpatient teaching rounds.

METHODS

Narrative comments from faculty evaluations of Internal Medicine (IM) residents both on usual teaching service as well as the iPACE™ service (spanning 2017-2020) were reviewed and coded using a deductive content analysis approach.

RESULTS

Six hundred ninety-two narrative evaluations by 63 attendings of 103 residents were included. Evaluations of iPACE™ residents were significantly longer than those of residents on usual teams (109 vs. 69 words, p < 0.001). iPACE™ evaluations contained a higher average occurrence of direct observations of patient/family interactions (0.72 vs. 0.32, p < 0.001), references to interprofessionalism (0.17 vs. 0.05, p < 0.001), as well as specific (3.21 vs. 2.26, p < 0.001), actionable (1.01 vs. 0.69, p < 0.001), and corrective feedback (1.2 vs. 0.88, p = 0.001) per evaluation.

CONCLUSIONS

This study suggests that the iPACE™ model, which prioritizes interprofessional bedside rounds, had a positive impact on the quantity and quality of feedback, as measured via narrative comments on weekly evaluations.

Impact of Bedside Rounding on Attending Teaching Evaluations

OBJECTIVE

To examine associations between bedside rounding (BSR) and other rounding strategies (ORS) with resident evaluations of teaching attendings and self-reported attending characteristics.

METHODS

Faculty from three academic medical centers who attended resident teaching services for ≥4 weeks during the 2018-2019 academic year were invited to complete a survey about personal and rounding characteristics. The survey instrument was iteratively developed to assess rounding strategy as well as factors that could affect choosing one rounding strategy over another. Survey results and teaching evaluation scores were linked, then deidentified and analyzed in aggregate. Included evaluation items assessed resident perceptions of autonomy, time management, professionalism, and teaching effectiveness, as well as a composite score (the numeric average of each attending's scores for all of the items at his or her institution). BSR was defined as spending >50% of rounding time in patients' rooms with the team. Hallway rounding and conference room rounding were combined into the ORS category and defined as >50% of rounding time in these settings. All of the scores were normalized to a 10-point scale to allow aggregation across sites.

RESULTS

A total of 105 attendings were invited to participate, and 65 (62%) completed the survey. None of the resident evaluation scores significantly differed based on rounding strategy. Composite scores were similar for BSR and ORS (difference of <0.1 on a 10-point scale). Spearman correlation coefficients identified no statistically significant correlation between rounding strategy and evaluation scores. An exploratory analysis of variance model identified no single factor that was significantly associated with composite teaching scores (P > 0.45 for all) or the domains of teaching efficacy, professionalism, or autonomy (P > 0.13 for all). Having a formal educational role was significantly associated with better evaluation scores for time management, and the number of lectures delivered per year approached statistical significance for the same domain.

CONCLUSIONS

Conducting BSR did not significantly affect resident evaluations of teaching attendings. Resident perception of teaching effectiveness based on rounding strategy should be neither a motivator nor a barrier to widespread institution of BSR.