A Day in the Life

Work Rounds

Key Takeaways

• The overall tone of the team members during rounds is fairly relaxed and informal yet still professional and polite.
• The presentation of the patient usually follows a typical format that includes explaining all critical patient information.
• Discussion of the patient’s individual case and medical management serves as the focus for medical teaching and learning. The dialogue frequently switches back and forth between discussion of the actual patient and hypothetical questions that arise out of the discussion.
• Most teaching is initiated by posing questions to the junior team members and medical students.
• Teaching is not restricted to the senior resident; often junior residents can teach each other or medical students.
• It is not expected that the team members will be able to answer all questions, and it is acceptable for them to say that they do not know the answer. Sometimes they will be directed to research the issue or subject after rounds; other times the question will be posed to another team member.
• Pocket reference materials, either paper or electronic, are often carried by residents and students, and may be consulted during rounds.
• All staff routinely wash their hands or use hand sanitizer upon entering and leaving a patient’s room.
• Patients are approached respectfully, and all team members are introduced.
• The senior resident does most, but not all, of the talking to the patient.
• The patient’s condition and treatment plans are explained in terms that she can understand, and she is invited to ask questions.
• The patient’s permission is obtained before beginning a physical examination, and the examination is conducted with consideration of the patient’s comfort and modesty.
• Nurses provide valuable information, and their input should be an integral part of the rounding process.
• Laboratory results and x-rays may be used to provide some additional context.
• Although teaching and learning are important goals of work rounds, it is most important that the team clearly identify next steps in the patient’s care and agree on management, disposition, and assignments for individual team members.

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