Roundsmanship: inherent control on a medical teaching ward.

Abstract

Abstract Instead of focusing on the “outcomes” of imposed regulatory mechanisms in medical settings, this article describes the operation of an inherent control mechanism—roundsmanship—that exists as a natural and emergent feature of medical work and instruction in teaching hospitals. Qualitative research findings used in this article are based on field observations of and interviews with medical staff in three teaching hospitals. The first section of the article examines the nature of roundsmanship. As a control mechanism, it is viewed by physicians in training as an academic game that approximates the use of tests in schools. The second section of the article examines the uses of roundsmanship to physicians in training. It is used to establish trust among peers on the ward, to control instruction by attending physicians, to control supervision by attending physicians, and to establish temporary status in a setting where competence and ability are unclear. Finally, implications of studying inherent control mechanisms for conventional thinking about supervision and regulation in medicine are reviewed.