Unpacking the learning on consultant-led ward rounds: Lessons from ethnography in paediatrics

Helen Patricia Enright; Amy Gray

doi:10.11157/fohpe.v21i3.336

Authors

Helen Patricia Enright La Trobe University, Melbourne University of Melbourne Royal Children's Hospital Melbourne http://orcid.org/0000-0003-1955-1948
Amy Gray University of Melbourne Royal Children's Hospital, Melbourne http://orcid.org/0000-0003-0127-0769

DOI:

https://doi.org/10.11157/fohpe.v21i3.336

Keywords:

ward round education, medical education, paediatrics, child health, learning and teaching, clinical learning, work-based education

Abstract

Introduction: Consultant-led ward round education in a busy paediatric setting is a complex process and is often ad hoc. We aimed to observe ward rounds to better understand the education opportunities available.

Methods: Drawing on Argyris and Schön's (1974) theory of action, we used an ethnographic approach to observe 30 general medical ward rounds over a 3-month period, from September to December 2016. For this study we analysed the learning opportunities and the content that is explicitly taught in relation to the domains of professional practice that we espouse to teach.

Results: There were many layers of learning potential observed in ward round practice. These included clinical learning, communication, professional skills and identity and institutional cultural context. Clinical learning was prioritised; however, other learning domains remained implicit and were often ignored.

Discussion: Our findings highlight great complexity in ward round learning and teaching. There was significant missed educational potential in the ward round environment as well as a need for a major shift in educational focus from clinical to other professional domains. Following Argyris and Schön (1974), it is necessary to examine what we espouse against our actual educational practice. This can inform a planned or structured approach to exploit the maximum potential of ward round learning and teaching.

Conclusions: Ward round education is a priority that benefits from observation, reflection and development of new models of practice. If we are not conscious of what we are teaching on rounds, and how this is occurring, we risk losing opportunities to draw on all of the learning potential available.

Author Biographies

Helen Patricia Enright, La Trobe University, Melbourne University of Melbourne Royal Children's Hospital Melbourne

Helen Enright is a Senior Lecturer in Professional Education and Quality Enhancement in the La Trobe Learning and Teaching Unit. Formerly, she was the Learning and Teaching Coordinator at the Department of Paediatrics, the University of Melbourne, the Royal Children's Hospital, Melbourne.

Amy Gray, University of Melbourne Royal Children's Hospital, Melbourne

Dr Amy Gray is the Director of Medical Education, Royal Children's Hospital, Melbourne and a Senior Lecturer, Departmernt of Paediatrics, University of Melbourne

References

Argyris, C., Putnam, R., & Smith, D. M. (1985). Action science. Jossey-Bass.

Argyris, C., & Schön, D. A. (1974). Theory in practice: Increasing professional effectiveness (1st ed.). Jossey-Bass.

Barrett, J., Trumble, S. C., & McColl, G. (2017). Novice students navigating the clinical environment in an early medical clerkship. Medical Education, 51(10), 1014–1024. https://doi.org/10.1111/medu.13357

Billett, S. (2020). Learning in the workplace: Strategies for effective practice. Allen & Unwin.

Dent, J. A., & Harden, R. M. (2009). A practical guide for medical teachers (3rd ed.). Elsevier Churchill Livingstone.

Dewhurst, G. (2010). Time for change: Teaching and learning on busy post-take ward rounds. Clinical Medicine, 10(3), 231–234. https://doi.org/10.7861/clinmedicine.10-3-231

Fish, D., & Coles, C. (2005). Medical education: Developing a curriculum for practice. Open University Press.

Frank, J. R., Snell, L., & Sherbino, J. (Eds.). (2015). CanMEDS 2015 physician competency framework. Royal College of Physicians and Surgeons of Canada.

Gray, A., & Enright, H. (2018). Opening the black box: An observational study of teaching and learning interactions for paediatrics trainees on consultant ward rounds. Journal of Paediatrics and Child Health, 54(9), 1011–1015. https://doi.org/10.1111/jpc.14056

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1199/1049732305276687

Ker, J., Cantillon, P., & Ambrose, L. (2008). Teaching on a ward round. BMJ, 337, Article 1930. https://doi.org/10.1136/bmj.a1930

Laskaratos, F. M., Parry, D., & El-Mileik, H. (2016). The educational value of post-take ward rounds for senior trainees. Ulster Medical Journal, 85(2), 113–117. https://discovery.ucl.ac.uk/id/eprint/10078763/

Laskaratos, F. M., Wallace, D., Gkotsi, D., Burns, A., & Epstein, O. (2015). The educational value of ward rounds for junior trainees. Medical Education Online, 20, Article 27559.

https://doi.org/10.3402/meo.v20.27559

Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press.

Melo Prado, H., Hannois Falbo, G., Rodrigues Falbo, A., & Natal Figueirôa, J. (2011). Active learning on the ward: Outcomes from a comparative trial with traditional methods. Medical Education,45(3), 273–279. https://doi.org/10.1111/j.1365-2923.2010.03846.x

Merritt, C., Munzer, B. W., Wolff, M., & Santen, S. A. (2018). Not another bedside lecture: Active learning techniques for clinical instruction. AEM Education and Training, 2(1), 48–50. https://doi.org/10.1002/aet2.10069

Mickelson, J. J., & MacNeily, A. E. (2008). Translational education: Tools for implementing the CanMEDS competencies in Canadian urology residency training. CUAJ, 2(4), 395–404. https://doi.org/10.5489/cuaj.838

Nunan, D. (1991). Language teaching methodology: A textbook for teachers. Prentice Hall.

O'Hare, J. A. (2008). Anatomy of the ward round. European Journal of Internal Medicine, 19(5), 309–313. https://doi.org/10.1016/j.ejim.2007.09.016

Patton M. (2011). Developmental evaluation: Applying complexity concepts to enhance innovation use. The Guildford Press.

Powell, N., Bruce, C. G., & Redfern, O. (2015). Teaching a "good" ward round. Clinical Medicine, 15(2), 135–138. https://doi.org/10.7861/clinmedicine.15-2-135

Richards, J., & Renandya, W. A. (2002). Methodology in language teaching: An anthology of current practice. Cambridge University Press.

Silverman, J., Kurtz, S. M., & Draper, J. (2013). Skills for communicating with patients. Radcliffe.

Stanley, P. (1998). Structuring ward rounds for learning: Can opportunities be created? Medical Education, 32(3), 239–243. https://doi.org/10.1046/j.1365-2923.1998.00201.x

Swanwick, T. (2014). Understanding medical education: Evidence, theory, and practice (2nd ed.). Wiley Blackwell.

Toubassi, D., Singwi, A., & Waters, I. (2018). Implementation of a patient-based feedback tool to assess the CanMEDS-FM communicator role. Canadian Family Physician, 64(10), 778–779. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6184951/

USAID Center for Development Information and Evaluation (USAID). (1996). Performance monitoring and evaluation tips. https://pdf.usaid.gov/pdf_docs/PNABS541.pdf

Trimble, M. (2015). The thinking doctor's ward round. Ulster Medical Journal, 84(1), 3–7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330798/

West, C., Stewart, L., Foster, K., & Usher, K. (2013). Accidental insider: Living the PhD study. Collegian, 20(1), 61–65. https://doi.org/10.1016/j.colegn.2012.03.005