Advances in Medical Education and Practice (Dec 2020)
Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings’ Asking Questions
Abstract
Helen M Shields,1 James P Honan,2 Jeffrey D Goldsmith,3,* Rachna Madan,4,* Stephen R Pelletier,5 Christopher L Roy,6 Lindsey C Wu6 1Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; 2Harvard Graduate School of Education, Cambridge, MA, USA; 3Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA; 4Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; 5Office of Educational Quality Improvement, Harvard Medical School, Boston, MA, USA; 6Division of Hospitalist Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Helen M ShieldsBrigham and Women’s Hospital, Boston, MA, USATel +1 (617) 678-6077Email [email protected]: Morning bedside rounds remain an essential part of Internal Medicine residency education, but rounds vary widely in terms of educational value and learner engagement.Objective: To evaluate the efficacy of an intervention to increase the number and variety of questions asked by attendings at the bedside and assess its impact.Design: We conducted a randomized, controlled trial to evaluate the efficacy of our intervention.Participants: Hospitalist attendings on the general medicine service were invited to participate. Twelve hospitalists were randomized to the experimental group and ten hospitalists to the control group.Intervention: A one-hour interactive session which teaches and models the method of asking questions using a non-medical case, followed by practice using role plays with medical cases.Main Measures: Our primary outcome was the number of questions asked by attendings during rounds. We used audio-video recordings of rounds evaluated by blinded reviewers to quantify the number of questions asked, and we also recorded the type of question and the person asked. We assessed whether learners found rounds worthwhile using anonymous surveys of residents, patients, and nurses.Key Results: Blinded analysis of the audio-video recordings demonstrated significantly more questions asked by attendings in the experimental group compared to the control group (mean number of questions 23.5 versus 10.8, p< 0.001) with significantly more questions asked of the residents (p< 0.003). Residents rated morning bedside rounds with the experimental attendings as significantly more worthwhile compared to rounds with the control group attendings (p=0.009).Conclusion: Our study findings highlight the benefits of a one-hour intervention to teach faculty a method of asking questions during bedside rounds. This educational strategy had the positive outcome of including significantly more resident voices at the bedside. Residents who rounded with attendings in the experimental group were more likely to “strongly agree” that bedside rounds were “worthwhile”.Keywords: bedside rounds, teaching strategies, randomized controlled trial, clinical reasoning, asking questions
