Does the structure of inpatient rounds affect medical student education?

OBJECTIVES: To assess whether the organization and structure of inpatient team rounds affects medical student perception of the overall quantity and quality of teaching on an inpatient general medicine service. METHODS: A pilot project to improve inpatient care was launched at the Department of Veterans Affairs Ann Arbor Healthcare System (VAAAHS). General medicine attending physicians involved in the pilot followed a “non-traditional” rounding structure (accentuating senior resident-run “work rounds” while time for “attending rounds” focused on critical issues and teaching). The remainder kept the “traditional” rounding structure (entire team rounds on patients one-by-one). In a cross-sectional design, third- and fourth-year medical students at the University of Michigan were surveyed after their rotation about their experience. Students were asked to rate their educational experience in 21 domains. Responses were evaluated by rounding structure. RESULTS: A total of 90 students (59%) responded. Across every domain surveyed, students rated the quantity and quality of teaching higher after experiencing “non-traditional” rounds. Statistically significant increases were seen in ratings for “teaching during rounds from senior resident”, “teaching during rounds from attending”, “sit-down teaching from attending”, “overall amount/quality of teaching”, and “overall improvement in internal medicine knowledge”, among others. CONCLUSIONS: The organization and structure of inpatient rounds can significantly impact medical student education. Teaching physicians and medical school clerkship directors should consider this when organizing inpatient team workflow.