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Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds

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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.

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Acknowledgements

The authors would like to thank the trainees and students at the University of Alabama at Birmingham for their participation in this study. The authors would also like to thank Dr. Carlos Estrada, Director of the Division of General Internal Medicine, University of Alabama at Birmingham, for his ongoing help and encouragement with this study.

Funding/Support

None.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Ethical Approval

University of Alabama at Birmingham Institutional Review Board approved this study.

Disclaimers

None.

Previous Presentations

Abstracts related to the current analysis were presented at the Southern Society of General Internal Medicine Annual Meeting, New Orleans, LA, 2009; and the Society of General Internal Medicine 33 rd Annual Meeting, April 28–May 1, 2010, Minneapolis, MN.

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Authors and Affiliations

  1. University of Alabama at Birmingham Department of Internal Medicine, Birmingham, AL, USA

    Brita Roy MD, MPH, MS

  2. Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Analia Castiglioni MD, Ryan R. Kraemer MD & Robert M. Centor MD

  3. Birmingham VA Medical Center, Birmingham, AL, USA

    Analia Castiglioni MD, Gustavo Heudebert MD & Robert M. Centor MD

  4. Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA

    Amanda H. Salanitro MD, MS, MSPH

  5. Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA

    Amanda H. Salanitro MD, MS, MSPH

  6. Department of Medicine, Division of General Internal Medicine, Birmingham, AL, USA

    Lisa L. Willett MD

  7. Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA

    Richard M. Shewchuk PhD & Haiyan Qu PhD

  8. University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA

    Gustavo Heudebert MD

  9. UAB Huntsville Regional Medical Campus, Huntsville, AL, USA

    Robert M. Centor MD

Authors
  1. Brita Roy MD, MPH, MS
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  2. Analia Castiglioni MD
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  3. Ryan R. Kraemer MD
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  4. Amanda H. Salanitro MD, MS, MSPH
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  5. Lisa L. Willett MD
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  6. Richard M. Shewchuk PhD
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  7. Haiyan Qu PhD
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  8. Gustavo Heudebert MD
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  9. Robert M. Centor MD
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Corresponding author

Correspondence to Brita Roy MD, MPH, MS.

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Roy, B., Castiglioni, A., Kraemer, R.R. et al. Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds. J GEN INTERN MED 27, 1492–1498 (2012). https://doi.org/10.1007/s11606-012-2121-6

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  • DOI: https://doi.org/10.1007/s11606-012-2121-6

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