Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds
Ward attending rounds are an integral part of internal medicine education. Being a good teacher is necessary, but not sufficient for successful rounds. Understanding perceptions of successful attending rounds (AR) may help define key areas of focus for enhancing learning, teaching and patient care.
We sought to expand the conceptual framework of 30 previously identified attributes contributing to successful AR by: 1) identifying the most important attributes, 2) grouping similar attributes, and 3) creating a cognitive map to define dimensions and domains contributing to successful rounds.
Multi-institutional, cross-sectional study design.
We recruited residents and medical students from a university-based internal medicine residency program and a community-based family medicine residency program. Faculty attending a regional general medicine conference, affiliated with multiple institutions, also participated.
Participants performed an unforced card-sorting exercise, grouping attributes based on perceived similarity, then rated the importance of attributes on a 5-point Likert scale. We translated our data into a cognitive map through multi-dimensional scaling and hierarchical cluster analysis.
Thirty-six faculty, 49 residents and 40 students participated. The highest rated attributes (mean rating) were “Teach by example (bedside manner)” (4.50), “Sharing of attending’s thought processes” (4.46), “Be approachable—not intimidating” (4.45), “Insist on respect for all team members” (4.43), “Conduct rounds in an organized, efficient & timely fashion” (4.39), and “State expectations for residents/students” (4.37). Attributes were plotted on a two-dimensional cognitive map, and adequate convergence was achieved. We identified five distinct domains of related attributes: 1) Learning Atmosphere, 2) Clinical Teaching, 3) Teaching Style, 4) Communicating Expectations, and 5) Team Management.
We identified five domains of related attributes essential to the success of ward attending rounds.
- Gonzalo J, Masters P, Simons R, Chuang C. Attending rounds and bedside case presentations: medical student and medicine resident experiences and attitudes. Teach Learn Med. 2009;21(2):105–110. CrossRef
- Ende J. What if Osler were one of us? Inpatient teaching today. J Gen Intern Med. 1997;12(Suppl 2):S41–48. CrossRef
- Harrison R, Allen E. Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations. J Gen Intern Med. 2006;21(5):447–452. CrossRef
- Irby D. Clinical teacher effectiveness in medicine. J Med Educ. 1978;53(10):808–815. CrossRef
- Irby D. What clinical teachers in medicine need to know. Acad Med. 1994;69(5):333–342. CrossRef
- Kroenke K. Attending rounds: guidelines for teaching on the wards. J Gen Intern Med. 1992;7(1):68–75. CrossRef
- Mattern W, Weinholtz D, Friedman C. The attending physician as teacher. N Engl J Med. 1983;308(19):1129–1132. CrossRef
- McLeod P. A successful formula for ward rounds. CMAJ. 1986;134(8):902–904.
- Wright S, Kern D, Kolodner K, Howard D, Brancati F. Attributes of excellent attending-physician role models. N Engl J Med. 1998;339(27):1986–1993. CrossRef
- Tariq M, Motiwala A, Ali S, Riaz M, Awan S, Akhter J. The learners' perspective on internal medicine ward rounds: a cross-sectional study. BMC Med Educ. 2010;10(1):53. CrossRef
- Skeff K. The chromosomal analysis of teaching: the search for promoter genes. Trans Am Clin Climatol Assoc. 2007;118:123–132.
- Kroenke K, Simmons J, Copley J, Smith C. Attending rounds: a survey of physician attitudes. J Gen Intern Med. 1990;5(3):229–233. CrossRef
- Castiglioni A, Shewchuk R, Willett L, Heudebert G, Centor R. A pilot study using nominal group technique to assess residents' perceptions of successful attending rounds. J Gen Intern Med. 2008;23(7):1060–1065. CrossRef
- Salanitro A, Castiglioni A, Shewchuk R, et al. Housestaff views on successful attending rounds: A multi-institutional study. J Gen Intern Med. 2007;22(S1).
- Miller D, Shewchuk R, Elliot TR, Richards S. Nominal group technique: a process for identifying diabetes self-care issues among patients and caregivers. Diabetes Educ. 2000;26(2):305–310. 312, 314. CrossRef
- Van de Ven A, Delbecq A. The Nominal Group as a Research Instrument for Exploratory Health Studies. AJPH. 1972;62:3337–3342.
- Schiffman SS, Reynolds ML, Young FW. Introduction to multidimensional scaling: theory, methods, and applications. New York: Academic Press; 1981.
- Aldenderfer MS, Blashfield RK. Cluster analysis. Beverly Hills: Sage Publications; 1984.
- Speece D. Methodological issues in cluster analysis: how clusters become real. In: Learning disabilities: Theoretical research issues. Hillsdale, NJ 1990:210–213.
- Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med. 2010;85(7):1118–1124. CrossRef
- Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds
Journal of General Internal Medicine
Volume 27, Issue 11 , pp 1492-1498
- Cover Date
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- Online ISSN
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- medical education
- clinical teaching
- ward rounds
- Industry Sectors
- Author Affiliations
- 1. University of Alabama at Birmingham Department of Internal Medicine, Birmingham, AL, USA
- 2. Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- 3. Birmingham VA Medical Center, Birmingham, AL, USA
- 4. Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- 5. Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA
- 6. Department of Medicine, Division of General Internal Medicine, Birmingham, AL, USA
- 7. Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- 8. University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
- 9. UAB Huntsville Regional Medical Campus, Huntsville, AL, USA