Teaching on Ward Rounds – is it possible?

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    Fiona LAke

    I post this on behalf of a colleague Dr David Goddard who is the the lead Fellow in education in the Australasian Faculty of Occupational&  Environmental Medicine.
    David writes……….I would like some input about the idea about teachable moments which is discussed in “Teaching on the Run” , and in particular in the setting of a ward round –  who benefits – if anyone, from these teachable moments.  A ward round is both for patient care and for teaching.  Learning can be about professionalism, clinical judgment and acculturation to medical practice.  Yet I find myself asking “If you are on the run, what can you teach and to whom?”.
    Busy consultants often an almost impossible task in regard to teaching.  A ward round, by its nature has no explicit learning objectives.  The implicit learning objectives would be overlapping but different depending on whether you are patient, med student, intern or registrar.   I can’t honestly see how a teachable moment can span across the needs of all these different learners, particularly on a ‘post-take’ ward round.  On the run ward rounds often end with the professionalism not being a good model to follow (Patient left confused as not enough time left explaining) but there was a bit of learning about clinical judgment – how to present a patient’s story so that you can ‘see the wood for the trees’ (easier to discuss than professionalism). Acculturation was about hidden curriculum – how to survive and thrive in a medical unit.
    My questions are: “If you are on the run, should you restrict who you try to teach to?”  Should you say to the intern and med student that you will not ask questions during the round but will discuss two or three of the salient features of cases in the tea room afterwards? Should the med student even be there, i.e. Is the episode of learning so inefficient that a separate round should be conducted?

    #882 Reply

    Fiona LAke

    I posted David’s question to me – so I better also give an answer!
    Firstly, I do not think it is acceptable to leave patients feeling disregarded and so that needs to be addressed but perhaps it is our concept of “teaching” that needs to change.
    I  think learning can be done better – here is a link MJA Insight, which has a small piece I wrote adn subsequent discussion going on.  https://www.mja.com.au/insight/issue-31-19-august-2013. Also another variation Teaching: What happens during patient rounds? – in the COP Topic of the Month.

    Some respondents agree with you that is all too difficult.  But if you are going to do a ward round, you need to spend time on it (we cannot keep reducing the length of a ward round because we are getting busier). Secondly, what I try and do is not “teach” but throw the individuals in so they have an active role then debrief what we learned – so the Y4 AND registrar get to be the lead person speaking to the patient but then we make sure after we speak we very clearly debrief – simple things such as “I indicated before we went in you should introduce all members of the team – why did you not do that?” It would have been better to sit at the level of the patient” What do you think the patient understood from your explanation? Can you see why I took over – my approach which is one of many is to……
    “Learning” as in causes of or treatment can often be linked but done elsewhere, self-directed etc.  My rule is to address things they cannot get from textbooks – otherwise you are not making the best use of my (consultant) time and expertise (I am an expensive way to regurgitate a textbook!).



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