Ward Round Skills Research Articles

Design and evaluation of the student led ward round - a multidisciplinary intervention allowing practice of essential ward round skills for final year medical students

Design and evaluation of the student led ward round - a multidisciplinary intervention allowing practice of essential ward round skills for final year medical students

Evaluation of the feasibility of a video-transmitted surgical ward round: a proof of concept study

BackgroundSurgical ward rounds are key element to point-of-care interprofessional postoperative treatment and technical and communicational aspects are relevant for the patient’s safety and satisfaction. Due to COVID-19 restrictions, the training opportunity of experiencing a face-to-face surgical ward round was massively hampered and thus, we developed a digital concept. This study aims to investigate the feasibility of video-transmitted ward rounds integrating surgical and communicational aspects with live streaming from wards. Further, medical students were asked for their satisfaction and their subjective learning success.MethodsThe proof-of-concept study consisted of self-reported subjective evaluation of competences in ward round skills. Qualitative feedback was collected to gain deeper insight and students’ empathy was rated by using the student version of the Jefferson Empathy Scale (JES).ResultsOne hundred three medical students participated. The students were satisfied with the video-transmitted ward round (M = 3.54; SD = 1.22). In the subjective evaluation students’ ward round competencies rose significantly (p < .001, Mpre = 3.00, SD = 0.77; Mpost = 3.76, SD = 0.75). The surgeon was rated as empathic (M = 119.05; SD = 10.09). In the qualitative feedback they named helpful aspects like including an expert for communication. However, they preferred the face-to-face setting in comparison to the digital concept.ConclusionsIt was feasible to implement a video-transmitted ward round within a pandemic. The format worked technically, was well-accepted and also led to a subjective rise in the students’ competencies. Video-transmitted ward rounds may be integrated to support the medical education, though, they cannot replace the face-to-face setting.

Exploring different stakeholders’ perspectives on ward rounds in paediatric oncology: a qualitative study

Rational/Aims and ObjectivesWard rounds are a core routine for interprofessional communication and clinical care planning: Health care professionals and patients meet regularly and it encourages patients to actively participate. In paediatric oncology, the long treatment process, the serious diagnosis, and involvement of both patients and their parents in shared-decision-making require specific ward round skills. Despite its high value for patient-centred care, a universal definition of ward round is lacking. Little is known about attitudes and expectations of different participants towards a ‘good’ ward round. This study aims to capture experiences and expectations of different stakeholders to better understand ward round needs in paediatric oncology and serve as a basis to improve future ward rounds.MethodSemi-structured interviews were conducted with patients, parents, nurses and medical doctors of a paediatric oncology ward until theoretical saturation (13 interviews). A standardised qualitative analysis using the phenomenological framework defined by Colaizzi was used to identify important aspects in the interviews.ResultsThree major themes were identified in the interviews: [1] Structure and Organisation; [2] Communication; [3] Education. Further analysis revealed 23 categories and elucidated several opportunities and unmet needs recognized by stakeholders: Ward round functions in comforting families in stressful situations, and relationship building. Interviewees expressed their concerns about missing structures. Families pleaded for smaller ward round teams and layperson language. Health care professionals underscored the lack of ward round training. Paediatric patients stated that ward round scared them without proper explanation. All interviewees emphasized the need for professionalization of the ward round in the setting of paediatric oncology.ConclusionThis study gives important insights into ward round functions and organisational requirements. It addresses special challenges for ward round participants in paediatric oncology, such as consideration of the emotional aspect of cancer treatment or the limits of shared decision making. Furthermore, this study underscores the great significance of ward rounds in paediatric oncology, with an emphasis on communication and relationship-building. Although performed universally, ward rounds are poorly explored or evaluated. This structured analysis synthesizes important expectations of different WR stakeholders, revealing opportunities of improvement and stressing the need for guidelines, training, and preparation.

Using a checklist within simulation improves trainees' confidence on ward rounds

Ward rounds are integral to maintaining patient safety in everyday clinical care. Junior doctors are often expected to conduct independent rounds on graduation, but many feel ill-equipped to do so. We developed a safety checklist and simulation sessions to improve junior-led ward round practice at one district general hospital. We found that embedding a checklist within simulation is an effective way to teach ward round skills and increase confidence among undergraduate and postgraduate medical trainees.

Ward Round Management Skills of Pediatric Surgery Residents During Pediatric Burn Intensive Care Unit Rounds

Aim: Ward rounds are a central activity that all healthcare professionals are expected to perform daily in the hospital. In this study, it was aimed to evaluate the ward round management skills of pediatric surgery residents during their Pediatric Burn Intensive Care Unit ward rounds.Methods: In this cross-sectional study, the observation method was used. The study group of the research consisted of 8 pediatric surgery residents working in the pediatric surgery department of the center where the research was conducted. Two bedside clinical observations were made for each pediatric surgery resident participating in the study. In order to assess the ward round management skills of pediatric surgery residents, observations of 114 bedside patient rounds were made in 43 rounds. Number, percentage, mean and Mann Whitney U test were used to evaluate the data.Results: In both observations, it was determined that the averages of non-technical ward round management skills of the residents were lower than the averages of technical ward round skills. At the end of the first observation, there was no difference in terms of the experience period of the physicians and pediatric surgeons of the residents, but at the end of the second observation, there was a difference (p=0.044) in the mean score of the non-technical ward round management skills of the residents.Conclusions: It was observed that the technical ward round management skills of pediatric surgery residents were higher than the non-technical ward round management skills. According to the results of the second observation, non-technical ward round management were found to differ according to the experience and level of pediatric surgery residents.

Core trainee boot camp, a method for improving technical and non-technical skills of novice surgical trainees. A before and after study

IntroductionThe transition to surgical training can be a stressful time for trainees and is most evident during national handover periods where new graduates start and senior trainees rotate to new programmes. During this time, patient mortality can increase and Hospital efficiency reduces. This influence is compounded by the impact of working time directives. Intensive, simulation rich training programmes or “Boot Camps” have been postulated as a solution. This article highlights the development of a surgical boot camp for novice surgical trainees and the impact this can have on training. MethodA novel surgical boot camp was developed for all trainees within a surgical training region including nine acute NHS trusts. Participating cohort of trainees completed pre and post course questionnaires to assess technical and non-technical skills. Results25 trainees attended and completed the pre and post boot camp questionnaire. Significant improvements were seen with technical skills (p = 0.0429), overall non-technical skills (p < 0.001) including leadership (p = 0.022), communication (p = 0.010), situational awareness (p = 0.022), patient handover (p = 0.003), ward round skills (p = 0.005) and outpatient skill (p = 0.002). Trainees reported significantly increased ability to assess and manage a critically unwell patient (p = 0.001) and a trauma patient (p = 0.001). 96% of trainees have utilised the skills they learnt on Boot Camp and all trainees would recommend it as an induction programme. ConclusionSurgical Boot Camps offer a timely chance to develop technical and non-technical skills whilst enhancing a trainee's confidence and knowledge and reduce the patient safety impact of the handover period.

Ward round simulation in final year medical students: Does it promote students learning?

Introduction: Ward round skills are essential for doctors in hospital settings. Literature shows medical students’ deficiencies in these skills. Simulation has been used to train these skills. However, exposing learners to simulation at an early stage may be associated with a high cognitive load and limited learning. This study aims to determine how students experience this load and its interplay with performance and which factors promote and impair learning.Methods: Fifty-six final year medical students participated in a simulated ward round training exercise. Both students’ performance and cognitive load were measured to determine if there was any correlation and interviews were carried out to understand which factors support and impair learning.Results: Performance scores revealed deficiencies in ward round skills. Students experienced a cognitive load that weakly correlated with performance. Qualitative findings provided important insights into simulated ward-based learning. It is clear that well-designed clinical scenarios, prioritization tasks, teamwork and feedback support students’ learning process whereas distractions impair learning.Conclusions: WRS proved to be a good teaching method to improve clinical skills at this stage as the cognitive load is not too high to impair learning. Hence, including tasks in the simulation design can enhance the learning process.

Improving the non-technical ward round skills of medical students

Improving the non-technical ward round skills of medical students

The evaluation of a framework for measuring the non-technical ward round skills of final year nursing students: An observational study

BackgroundThe importance of non-technical skills (NTS) to patient outcomes is increasingly being recognised, however, there is limited research into how such skills can be taught and evaluated in student nurses in relation toward rounds. ObjectivesThis pilot study describes an evaluation of a NTS framework that could potentially be used to measure ward round skills of student nurses. Design and MethodsThe study used an observational design. Potential key NTS were identified from existing literature and NTS taxonomies. The proposed framework was then used to evaluate whether the identified NTS were evident in a series of ward round simulations that final year general nursing students undertook as part of their training. Finally, the views of a small group of qualified nurse educators, qualified nurses and general nursing students were sought about whether the identified NTS were important and relevant to practice. ResultsThe proposed NTS framework included seven categories: Communication, Decision Making, Situational Awareness, Teamwork and Task Management, Student Initiative and Responsiveness to Patient. All were rated as important and relevant to practice. ConclusionThe pilot study suggests that the proposed NTS framework could be used as a means of evaluating student nurse competencies in respect of many non-technical skills required for a successful ward round. Further work is required to establish the validity of the framework in educational settings and to determine the extent to which it is of use in a non-simulated ward round setting.

Developing non-technical ward-round skills.

Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an apriori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin etal. Ninety-seven percent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum.

Teaching a ‘good’ ward round

Ward rounds are a vital part of hospital medicine and junior doctors play a key role in their delivery. Despite the importance of ward rounds to patient care and experience, we believe that junior doctors may lack the training and skills to carry them out most effectively. We designed a simulation-based training session focusing on ward round skills themed to key patient safety issues and have delivered the training to over 100 learners (medical students and foundation year one doctors). Few learners had any prior training in ward rounds. The session was highly valued by all participants and surveys completed both before and after the session showed statistically significant improvements in confidence in leading and documenting ward rounds. In addition, 94% of final year medical students and 93% of doctors felt such training should be included in the undergraduate curriculum. We believe there is a current gap in training around ward round skills and would strongly encourage simulation-based ward round training to be developed for undergraduates. Further sessions following qualification may then consolidate and develop ward round skills adapted to the level of the doctor.

Design and validation of the surgical ward round assessment tool: a quantitative observational study

BackgroundWard round skills are essential for the best management of surgical inpatients, but assessment of their quality has received inadequate attention. This study aims to design and validate the surgical ward round assessment tool (SWAT). MethodsWe used modified Healthcare Failure Mode and Effects Analysis to develop the SWAT by identifying ward round steps. We assessed the validity of the SWAT using simulated and real surgical ward rounds. ResultsThe Healthcare Failure Mode and Effects Analysis identified 30 ward round steps that were developed into the SWAT. Nineteen surgeons completed simulated surgical ward rounds. Eight fully trained surgeons scored significantly higher than 11 trainee surgeons when assessed with the SWAT (P = .001). On average, the participants thought the realism of the simulation was good. Forty-four surgeons completed real surgical ward rounds. Fifteen experts scored significantly higher than 29 trainee surgeons when assessed with SWAT (P = .001). Inter-rater reliability was .85 to .89, respectively. ConclusionsThe SWAT can be used to assess the quality of task-based and nontechnical surgical ward round skills.

Leadership training for registrars on ward rounds

The post-take ward round (PTWR) provides formal consultant review of acutely unwell patients admitted to hospital, yet specialist medical registrars, the consultants of tomorrow, receive little to no formal training in this area. There is an expectation that 'on the job' experience will provide sufficient preparation for this important aspect of clinical leadership. We aimed to seek the opinions of medical registrars on the use of a structured considerative checklist and learning-by-example approach in PTWR leadership training, assessing whether this model influences current and future practice. This was studied through a questionnaire-based survey of medical registrars working in Worthing Hospital from 2009 to 2011. Eighteen of 25 registrars (72%) across a range of specialties returned questionnaires. Although a third of respondents had spent time considering how they conduct ward rounds, none had received formal training, with most feeling that ward round skills were acquired 'on the job' from observation and experience of those conducted by senior colleagues. Exposure to the considerative checklist changed thinking in 94percent and changed practice in 88percent. Common positive themes included enhanced pre-ward round preparation, the importance of inclusion and communication, and the need for structure (facilitated by physical or mental checklist). Seventeen of 18 participants felt that this training would influence their consultant practice. Trainees respond positively to participation in a structured PTWR using a considerative checklist as a model of good practice, leading to changes in their current and future practice, and could be considered as a training tool.

Improving ward round skills

Background: Ward rounds represent an important task in clinical settings. Despite their importance, students show substantial deficits in ward round competencies (e.g. physical examination, drug prescription, documentation). Previously reported teaching methods such as ward round training with standardized patients or educational wards, however, are time-consuming and expensive.Aims: To assess the effects of a structured on-ward supervision program for final-year students with specially trained supervising doctors focusing on ward round competencies.Method: A total of 36 medical students were randomly assigned to an intervention group (IG) and a control group (CG). During an eight-week-long training course, the intervention group (IG; n = 18) received structured ward round training while the control group (CG; n = 18) received on-ward training regarding how to take patient histories and perform physical examinations. Ward round competencies were assessed using simulated ward round scenarios with objective checklist ratings and standardized patient ratings.Results: The IG achieved significantly more predefined learning goals compared to the CG. Standardized patient ratings did not differ significantly between groups.Conclusions: Results provide evidence that the presented program is a feasible and efficient tool for teaching ward round skills at the bedside. Further research should focus on cost effectiveness compared to alternative models.