Original Research

Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1492-1498

Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds

  • Brita RoyAffiliated withUniversity of Alabama at Birmingham Department of Internal Medicine Email author 
  • , Analia CastiglioniAffiliated withDivision of General Internal Medicine, University of Alabama at BirminghamBirmingham VA Medical Center
  • , Ryan R. KraemerAffiliated withDivision of General Internal Medicine, University of Alabama at Birmingham
  • , Amanda H. SalanitroAffiliated withDepartment of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC)Section of Hospital Medicine, Vanderbilt University
  • , Lisa L. WillettAffiliated withDepartment of Medicine, Division of General Internal Medicine
  • , Richard M. ShewchukAffiliated withDepartment of Health Services Administration, School of Health Professions, University of Alabama at Birmingham
  • , Haiyan QuAffiliated withDepartment of Health Services Administration, School of Health Professions, University of Alabama at Birmingham
  • , Gustavo HeudebertAffiliated withBirmingham VA Medical CenterUniversity of Alabama at Birmingham School of Public Health
  • , Robert M. CentorAffiliated withDivision of General Internal Medicine, University of Alabama at BirminghamBirmingham VA Medical CenterUAB Huntsville Regional Medical Campus

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Abstract

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

Multi-institutional, cross-sectional study design.

PARTICIPANTS

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.

MAIN MEASURES

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.

KEY RESULTS

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.

CONCLUSIONS

We identified five domains of related attributes essential to the success of ward attending rounds.

KEY WORDS

medical education clinical teaching ward rounds