Letters to the Editor
To the Editor:
Walk the halls of most academic medical centers at 9 AM, and you will likely find circles of teams huddled, talking quietly about patients outside of their closed doors—the patient’s voice conspicuously missing. And then comes the knock, and the care team enters the room, beginning a prepared discussion, which is more so dictated to the patient rather than created with him or her. When early physician teachers—from Franciscus Sylvius to William Osler—taught at the bedside, the patient was at the center of rounds. But since the 1970s, rounds have moved from the patient’s side to the hallway or the conference room.1 Multiple studies have demonstrated that residents shy away from bedside rounds for many reasons, including a fear for patient anxiety, worries of increased rounding times, decreased teaching, and decreased ability to have discussions in front of the patient.2–4 However, based on our experience as medical educators, we feel that bedside rounding increases the face time our learners spend with patients while simultaneously making rounds more efficient.
Bedside rounding promotes opportunities for bedside teaching, as well as for more thorough communication between residents and their patients, an increasingly important issue as our learners spend more time on electronic health record systems. How then do we get residents to not only participate in, but to embrace, bedside rounds?
Malcolm Gladwell5 writes that ideas and messages, along with behaviors, “spread like viruses do” in part because of people who act as “connectors.” Our “connectors” are our residents. Two of our second-year residents became champions for bedside rounding and worked with our chief residents to outline a systematic approach for rolling out bedside rounding. Implementation of a bedside rounding strategy decreased average per patient rounding duration from 11’45” to 9’22” (P < .001) and increased time spent with patients on average from 4’43” to 6’31” (P < .001). Residents reported feeling closer to their patients, and a majority of our residents now report that they would like to see bedside rounds as the standard at our institution. The key to getting residents to like bedside rounds is getting them to try bedside rounds.
The authors would like to acknowledge the Department of Medicine leadership for their support in the implementation of this project.
Anthony J. Mazzella, MD
Chief resident, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; email@example.com; ORCID: https://orcid.org/0000-0003-2036-9254.
Rosanne Tiller, MD
Chief resident, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Debra Bynum, MD
Associate professor and residency program director, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
1. Stickrath C, Noble M, Prochazka A, et al. Attending rounds in the current era: What is and is not happening. JAMA Intern Med. 2013;173:1084–1089.
2. Gonzalo JD, Masters PA, Simons RJ, Chuang CH. Attending rounds and bedside case presentations: Medical student and medicine resident experiences and attitudes. Teach Learn Med. 2009;21:105–110.
3. Merchant NB, Federman DG. Patient-centred bedside rounds—Exploring patient preferences before patient-centred care [published online ahead of print February 29, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005372
4. Gonzalo JD, Kuperman E, Lehman E, Haidet P. Bedside interprofessional rounds: Perceptions of benefits and barriers by internal medicine nursing staff, attending physicians, and housestaff physicians. J Hosp Med. 2014;9:646–651.
5. Gladwell M. The Tipping Point: How Little Things Can Make a Big Difference. 2000.Boston, MA: Little, Brown.