Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1492–1498 | Cite as

Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds

  • Brita RoyEmail author
  • Analia Castiglioni
  • Ryan R. Kraemer
  • Amanda H. Salanitro
  • Lisa L. Willett
  • Richard M. Shewchuk
  • Haiyan Qu
  • Gustavo Heudebert
  • Robert M. Centor
Original Research



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.


medical education clinical teaching ward rounds 



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.



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.



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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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Brita Roy
    • 1
    Email author
  • Analia Castiglioni
    • 2
    • 3
  • Ryan R. Kraemer
    • 2
  • Amanda H. Salanitro
    • 4
    • 5
  • Lisa L. Willett
    • 6
  • Richard M. Shewchuk
    • 7
  • Haiyan Qu
    • 7
  • Gustavo Heudebert
    • 3
    • 8
  • Robert M. Centor
    • 2
    • 3
    • 9
  1. 1.University of Alabama at Birmingham Department of Internal MedicineBirminghamUSA
  2. 2.Division of General Internal MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Birmingham VA Medical CenterBirminghamUSA
  4. 4.Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC)NashvilleUSA
  5. 5.Section of Hospital MedicineVanderbilt UniversityNashvilleUSA
  6. 6.Department of Medicine, Division of General Internal MedicineBirminghamUSA
  7. 7.Department of Health Services Administration, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamUSA
  8. 8.University of Alabama at Birmingham School of Public HealthBirminghamUSA
  9. 9.UAB Huntsville Regional Medical CampusHuntsvilleUSA

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