🔥🔥🔥 Ward Round: Complex Clinical Process

Wednesday, November 24, 2021 12:52:49 PM

Ward Round: Complex Clinical Process



The case for bedside rounds. The basis for sharing understanding involves finding common Ward Round: Complex Clinical Process. This The Attachment Theory In Frankenstein in with the national Ward Round: Complex Clinical Process under way to ensure Ward Round: Complex Clinical Process greater proportion of pharmacist activities are on Ward Round: Complex Clinical Process clinical Ward Round: Complex Clinical Process to patients [23]. Our objective was to identify competences relevant in both specialities for conducting a ward round as well as competences more important in one of the two specialities. On Ward Round: Complex Clinical Process given day during this period, three pharmacists Ward Round: Complex Clinical Process across two Ward Round: Complex Clinical Process. Results Ward round group reasoning mechanisms The data collection occurred between August and January Overall, The Dog Ate My Homework Analysis of contributions were deemed to be of significant Ward Round: Complex Clinical Process by the panel and Ward Round: Complex Clinical Process were made to reduce bias Ward Round: Complex Clinical Process involving an independent panel who assessed the contributions.

Ward Rounds with Prof. Chintamani - [I]

Peer Review reports. Ward rounds are integral to hospital inpatient management across the world. Despite their prevalence reportedly declining [ 1 ] they remain a mainstream practice, as evidenced by significant policy documents [ 2 , 3 ]. Ward rounds are here defined as medical teams travelling sequentially from inpatient to inpatient and stopping at each to discuss, consider and make decisions about the details and overall management of care. Topics commonly addressed during rounds include diagnosis, prognosis and treatment planning. Despite rounds being central to hospital care for over a century [ 4 ], studies of ward rounds are scarce. A literature search in found only papers compared to 75, for the relatively recent topic of laparoscopies [ 5 ].

Although research has examined details of rounds, such as communication [ 6 , 7 , 8 ], little is known about bedside care-processes or what makes a high quality round [ 9 , 10 ]. The purposes of rounds centre on practitioner training or the treatment and care of patients [ 11 , 12 , 13 , 14 ]. Practitioner training, whilst subject to much literature attention [ 15 , 16 , 17 ], has been noted to infrequently occur in practice [ 18 ]. Studies have either directly shown that care management is the main focus [ 19 , 20 ] or have implied this through primarily identifying care-related elements as findings [ 21 , 22 ].

Ward rounds, by definition, involve groups of practitioners discussing, deliberating and decision-making; that is, reasoning together. Literature reviews have examined factors influencing ward round quality [ 23 , 24 ]. These identified the importance of effective communication, collaboration and standardization of processes. Time constraints present another concern, with benefits accruing from practitioners spending more time with patients [ 25 ].

Communication, collaboration, time spent with patients and non-technical skills all highlight the importance of collaborative group reasoning in rounds. Furthermore, practitioners reasoning collaboratively is identified as a central target for reducing medical errors [ 26 ]. Hence, collaborative group reasoning was identified as the primary focus of this project.

Conceptualisations of medical reasoning have moved from analytic methods to the dual process theory, which balances heuristic and intuitive type 1 reasoning with analytical and systematic type 2 reasoning [ 27 ]. These focus on the cognitive functions of decision-making, sense-making, situation awareness and planning in real contexts such as medical ward rounds. Viewing reasoning in terms of components, as do NDM models, and considering ward rounds as a type of program suggested the development of a program theory of group reasoning. A program theory is an explicit representation of how the program causes intended or actual outcomes [ 29 ] and is typically specified in terms of causal mechanisms [ 30 ].

For example, given a patient, some practitioners, a diagnosis and a recommended treatment, the outcome may be to persuade the patient to undertake the treatment, and the mechanism will be how the practitioners go about achieving this. Identifying causal mechanisms of ward round reasoning formed the basis of this investigation. Mechanism-based explanation in social sciences research has received much attention. For this research, mechanisms are conceived as the activities that actors engage in during the ward round to bring about desired change.

Critical realism, discussed in more detail below, is a meta-theory that focuses on discovering causal mechanisms, thus is naturally aligned with the aim of this project. This research therefore seeks to explain the mechanisms of collaborative group reasoning in ward rounds. The next section discusses the critical realist approach which supported a case study methodology employing round observations, practitioner interviews and focus groups. The results section then introduces nine group reasoning mechanisms identified through the data collection and themes associated with the mechanisms.

Possible applications of the research, along with limitations and potential future investigations, are then presented. This study explored the role of collaborative group reasoning in ward rounds through a critical realist inspired case study of ward rounds in two hospitals in Victoria, Australia. Critical realism CR , which offers a meta-theory that guides the choice of methodology and methods, was selected as an overarching theoretical framework. CR involves theory-building and provides an appropriate underpinning for case studies [ 32 ]. It provides a framework whereby ward rounds, although socially constructed, are assumed to have a logic that objectively exists. This allows for CR to capture benefits and avoid pitfalls of its alternatives, being positivist and constructivist approaches [ 33 ].

CR is also increasingly used in health sciences research, such as in mental health and illness [ 34 ] and home-dialysis decision-making research [ 35 ]. The real includes entities and their inherent causal structures which exist independent of human thought and which must be inferred from observations by a process of retroduction. Mechanisms, which are causal powers that exist in the real layer, are the focus of attention. These may be activated to cause events, which exist in both the real and the actual layers. Events may then be observed to form experiences, which exist in the empirical layer as well as the real and actual layers [ 37 ].

Mechanisms, which are emergent and dynamic [ 36 ], are not necessarily activated. Contexts and interactions with other mechanisms are crucial factors in the activation of mechanisms. A case study methodology was adopted, in fitting with CR research [ 32 , 37 ]. The Acute Care wards of two medium-sized rural hospitals in Victoria, Australia were selected as they provided a context of general medical patients and general physicians, thus avoiding peculiarities associated with specialised wards. Wards were staffed by medical teams consisting of registrars, who are doctors undertaking a prescribed specialist postgraduate training program to seek admission as a Fellow of the Royal Australasian College of Physicians, and interns.

Consultant physicians visited the wards every morning and conducted ward rounds with medical teams. Medical students and nurses also attended at times. Data collection included direct observations of ward rounds. Neither audio nor video recording of rounds was conducted due to potential influences on the round, the expressed wishes of practitioners, and the impracticality of implementation. Handwritten notes were taken concerning details of patient visits, such as the discussion threads and the contributions of different practitioners. Selected practitioners were invited for interview between rounds in a private meeting room. Interviewees were questioned about details of their practice or about practice generally, with respect to topics associated with the development of the theory at the time of interview.

This concords with the iterative nature of data collection and theory development as per the CR approach. Interviews were predominantly unstructured, although sample questions aimed at testing theories were put to interviewees where appropriate. Interviews were audio recorded when agreed 7 out of 17 , or handwritten notes taken and subsequently supplemented with additional notes. Focus group meetings involved interactive presentations to medical teams, and the current state of theory development regarding mechanisms informed the content of the presentations.

Practitioners were openly invited to comment, expand upon, or criticise the content throughout the presentation. Notes were taken during and after meetings, in addition to one meeting being audio recorded. Appropriate ethics approvals were sought and obtained. Written consent was obtained from all practitioner research participants. Patients were informed of the presence of the researcher, given an explanatory statement providing them an option of withdrawal and asked for verbal consent. No practitioner or patient declined to participate in the study. The research process consisted of three stages. These were not predetermined but continued until saturation was reached, as described below. The data was continuously coded, analysed and recoded during and between stages, thus integrating data collection with analysis as per CR research techniques [ 32 ].

Mechanism descriptions were presented to participants, in interviews and focus groups verbally and through diagrams and textual descriptions, who were able to confirm, elaborate on, modify or refute them as appropriate. Presentations and group discussions occurred within the research team, again to substantiate the developing theories. This continued, interspersed with data collection, until a clear picture emerged of the mechanisms occurring in rounds, as determined through broad agreement amongst the participants and the research team.

Validity and generalization are common problems with case studies [ 38 ]. These were dealt with through the triangulation of observations, interviews and focus groups, and by grounding the model in well-established theories in domains such as medical reasoning, NDM, group reasoning and ward rounds. Case studies can also suffer from overly complex results [ 39 ]. This was addressed through integrating analysis with data collection, whereby practitioners were continually engaged in the development of the mechanisms, thus ensuring that results were clear and understandable.

The data collection occurred between August and January Eleven rounds were observed, consisting of 94 patient visits involving 7 consultants, 12 registrars and 11 interns. Only one consultant was female, although the gender balance of registrars and interns was approximately equal. Consultants varied in age and experience and in historical service, with 5 of the 7 being trained outside Australia.

Patient visits varied from 5 to 20 min and typically involved a practitioner discussion outside the room, a visit to the patient, then a concluding discussion again outside the room. Fifteen practitioners and 2 students were interviewed, and 4 focus groups facilitated. The focus groups occurred during the regular meeting time and consisted of all medical practitioners at the site.

Nine group reasoning mechanisms were identified. Mechanism construction was initially guided by the medical reasoning literature. Studies typically describe gathering information, understanding the case through forming diagnoses and making treatment and care decisions as key activities of reasoning [ 29 ], suggesting three broad categories as the starting point. The NDM models mentioned in the introduction, particularly those of Klein [ 40 ], provided further confirmation of the three categories: information accumulation, sense-making and decision-making.

They also suggested nuanced aspects of reasoning to inform mechanism details, such as mental simulation in decision-making and expertise-based recognition in sense-making. A Naturalistic Decision Making model of ward round reasoning, adapted from Klein [ 40 ]. Mechanisms were formed around the group dimension of ward round reasoning, as the group dimension is what distinguishes ward round reasoning from individual practitioner reasoning. As has been noted, understanding team processes is essential to the functioning of practitioners in collaborative environments [ 41 ]. Further considerations involved the connections between reasoning, medical knowledge and roles. Ward rounds are a structured activity and practitioners hold specific knowledge through their roles.

Incorporating the above considerations, three distinct mechanisms in each of the categories were identified. Table 1 presents the nine mechanisms, all of which convert individually-held information to group-held information. The remainder of this section outlines each of these mechanisms in turn, as indicated in the body of the table. Each is described, followed by evidence supporting the description. CR asserts that mechanisms exist as causal structures but at times are not activated. Many examples arose of how mechanisms may fail and some are described. The exposition is selective and illustrative, as a complete detailing is beyond the scope of this paper.

Participants share individually-held information, verbally or visually through writing, diagrams, images, gestures or exposing signs. Shared information is associated with roles and the central subject is the patient. Participants contribute information either voluntarily, in response to guided questions or through a generative process. Information perceived as relevant and important is contributed, counterbalanced by factors such as sensitivities. Sought information is automatically relevant. The data collection identified the patient as central to information collection. Practitioners rarely consulted external information, except for one intern who used his phone to access the internet patient 5 visit.

Roles influence what information is shared. Relevance and importance are criteria for sharing. Failures occur when practitioners judge information to be irrelevant or unimportant, potentially resulting in a delayed or incorrect diagnosis. The group agrees about admitting information if practitioners together determine that it passes certain criteria thresholds, such as relevance, importance and reliability. Agreement may be explicit or tacit. Senders and receivers both influence agreement. Objective information is likely to be agreed. High-authority practitioners influence agreement. Information changes agreement status as further shared or individual information arises. Agreed information must first be shared. If the registrar is very good … then I will trust them and believe what they tell me.

Information is often distrusted thus needs to be continually tested. The patient will give one history to the registrar but then change it for the consultant notes from interview 9, consultant. Authority partially determines whether or not to agree with information. The provider of the information may not be trusted or respected. Examples were provided of situations where information from other practitioners was not reliable.

The scribe, usually the most junior medical practitioner, documents shared or agreed information flexibly but within broad recording-practice parameters. Forms provide structure, which direct and constrain recording. Scribes also actively clarify what to record and how to record it. Information is omitted on various grounds, such as sensitivity. The intern was typically responsible for scribing. Formats influenced information recording. Recording practices vary considerably.

Sensitive information is sometimes not recorded. Quality factors of scribing can undermine information recording. Difficulties in understanding the case, time constraints and experience levels may hamper appropriate recording. Participants share their understandings through verbalising opinions and the reasons for holding them. Understandings involve diagnosis, prognosis, aetiology and appropriate plans. Pre-existing understanding is modified by shared or individually obtained information. Contributions may disrupt existing shared understanding. Practitioners must recognise aberrant information, assess the degree of disruption and judge whether or not to modify or reject the existing shared understanding. The basis for sharing understanding involves finding common ground.

Hierarchies, whilst shaping involvement, do not prevent participants from contributing. Junior members lack confidence or believe they have little more to offer, which may cause them to refrain from contributing. Practitioners reach agreement through discussions against a background of shared knowledge. They evaluate the shared understanding using criteria such as whether or not the patient is improving.

Agreement is often based on judgement rather than technical argumentation, although understanding reasons is important. Agreeing about understanding involves information consistency and whether the patient is improving or not. Authority is a factor in agreement. Judgement is a significant factor in agreeing, and judgement is associated with authority. Individual factors related to experience and personality may interfere with agreement. Medicine is very complex and expertise varies a lot. The consultant might think something is right but the registrar may disagree. It depends on individual factors too, as experience does not necessarily make one better at making judgements. Other factors involve how outgoing or assertive the registrar is, and the same for the consultant notes from interview 16, registrar.

The scribe records the group understanding, usually towards the end of the round, including reasons for that understanding where appropriate. The recorded understanding has been shared but may not be explicitly agreed. Diagnosis, aetiology and prognosis are key topics. Excluded diagnoses with reasons are often recorded, particularly if other recorded information is contradicted by the exclusion. The criteria and structure for recording are applied idiosyncratically, although within general standards.

The information recorded is that which has been agreed by the participants. Reasons behind the understanding may be recorded. This may be in a negative form, such as excluded diagnoses. Participants share proposed options, their reasons for holding them and associated opinions. Options arise though shared understandings. Biomedical options rely on technical knowledge and experience. Non-medical options are contributed more democratically. Senior practitioners contribute voluntarily or through responding to questions, whereas junior practitioners contribute more discreetly by asking questions in the guise of education or clarifying notes. Practitioners initially share options, which are then shared with patients.

If patients find these unacceptable, more options are generated and shared. Option contribution takes different forms, depending on who is contributing. Decision type influences options sharing, with less medical topics allowing more democratic contribution. The consultant … asked team members what they thought. The head of rehabilitation … contributed. An OT arrived and also contributed. A two stage process of decision-making influences option sharing. The atmosphere may not be conducive to practitioners contributing options openly. The group agrees on the most suitable option and the reasons for this choice through discussing likely effects. Compensatory and serial decision-making methods are used, both employing mental simulation. Medical and non-medical dimensions allow for varied input by different practitioner roles.

Patient agreement occurs after practitioner agreement in a two-stage process, where practitioners present selected options to patients, who ultimately have the right of veto. Agreement at times is passive. Practitioners agree between themselves and present a united front to the patient. Junior practitioners have a significant role in contributing to option evaluation. Agreement may fail because practitioners have discordant outlooks and cultures. Surgeons and physicians often have trouble agreeing. It is the least reliable part of the round.

The scribe records decisions requiring action by the medical team, other practitioners or the patient. Standard medical practice provides guidance on what is recorded and how it is recorded. Proformas also influence how and what is recorded. Understanding the decision is critical to scribing. Reasons for decisions made are recorded where appropriate, erring on the side of recording if in doubt. Information about excluded treatment options is also recorded. Reasons for a decision should be recorded. Content may be consistent even if the format varies. Multiple factors influence failure to record appropriate information. Practitioners may not be able to explain the decision adequately.

Themes concerning the mechanisms also arose, involving time constraints, hierarchical roles of participants, the use of criteria and tensions concerning mechanisms. Time constraints influence how thorough the recording is, how much detail the scribe picks up, when to stop collecting information and when to cease the patient visit. But time is also part of the overall rationale for ward rounds, as rounds allow for efficient task allocation and coordination. Hierarchical roles are associated with tasks, such as interns scribing and consultants overseeing decisions. Other criteria include consistency, accuracy, truth-value and making sense.

Information is gained through distinct processes. Patients provided specific, sought information, such as through physical examinations or questioning about medication regimes. Alternatively, interactive generation occurred, whereby questions and responses were interpreted idiosyncratically which generated further questions and responses, and so on. This occurred with one patient regarding the circumstances around an unconscious collapse patient At some point, information accumulation must stop and making sense of the case can prompt cessation.

The process of making sense of the case relies on information, but excessive accumulation distracts from sense-making and swamps practitioners with information. Two sense-making sub-mechanisms identified were constructing and disrupting understanding. Potential disruption through exposure to critical scrutiny is a critical dimension of sense-making but excessively searching for disruptions will undermine the construction process. Balancing understanding the case and choosing a course of action is also important. At some point, sense-making must cease and decisions be sought, regardless of how fully the case is understood.

A balance also occurs between raising options and evaluating options. Interviewees indicated that numerous options are concurrently evaluated. You simultaneously weigh up all of those. Practitioners cannot fully investigate every possible option, nor continually raise further options, and serial option evaluation is sometimes required. Sole practitioners can ameliorate biases, knowledge gaps and reasoning limitation through group reasoning. But practitioners are also individually liable, thus must balance group reasoning benefits against risks. One of the important factors influencing these deficits is lack of supervision [ 19 — 21 ]. This lack of supervision arises especially where trainees conduct independent patient examinations, but do not have opportunities to conduct supervised examinations.

Comparative analysis in our study showed that such clinical skills teaching was rated much lower by post graduates as compared to medical students. This often occurs due to the tendency of most faculty members to focus such basic skills teaching more on medical students, assuming that the residents at their stage would have mastered those techniques. When questioned regarding the qualities of the desired ward rounds, teaching of patient management was rated the highest, followed by teaching of clinical skills and bedside teaching.

Management of patients was also rated on the top in the current ward rounds category. This is an important finding from our study. It shows that the participants attach a great deal of importance to the management of patients, making it one of the most essential aspects of the ideal ward round. It is very satisfying to note that this aspect has also been rated highest in the current round category, which clearly shows the participants are satisfied with this aspect of teaching in their ward rounds, and that this aspect does currently receive the importance that it demands. One area where a significant difference was observed between medical students and post-graduates in the qualities they described for their desired ward rounds was in teaching of medical ethics and patient counselling.

This was rated much higher by the post-graduates. We feel the reason for this is that at the post-graduate training level, doctors are regularly faced with a number of ethical questions and situations requiring effective communication skills. We also found that the postgraduate certificate examination had a much greater proportion devoted to ethics and patient counselling, making this aspect of teaching even more important for them. When comparing the current ward rounds with the desired ward rounds for both students and postgraduates, we found that a large difference was observed in the conveying of medical knowledge, teaching of clinical skills and bedside examination, as well as in teaching of managerial and leadership skills.

Thus these represent aspects which, in the opinion of the learners, have the largest room for improvement and may be used as starting points in the long-term improvement of ward rounds. Previous studies have stated that ward round teaching is an essential tool of training but it is significantly under-utilized [ 10 ]. Various studies in the past have also tried to identify barriers to the full utilization of the potential benefits of teaching ward rounds, some of which have been mentioned above. Many authors have also suggested potential solutions to the barriers.

A study by Castiglioni et. A study conducted to explore the faculty's perception of barriers to effective bedside teaching reports that declining clinical skills and teaching values were some of the major barriers, as well as intense performance pressure arising from the belief that the teachers should possess an almost unattainable level of diagnostic skill. They recommend training of the clinical teachers, their reassurance, and establishing a conducive learning environment to mitigate such barriers [ 22 ]. When assessing the approximate being time spent on patient bedsides, we found an average time per patient of 12 minutes, while the suggested ideal average time was found to be 14 minutes.

There have been studies which have reported much lower average times [ 23 — 25 ]. However, these studies had actually recorded the exact amount of time and thus we cannot make a very reliable quantitative comparison with our results. Albeit, we are reluctant in recommending lengthier rounds in an attempt to improve their effectiveness since a number of previous studies describe brevity and focused discussion as an important success factor [ 1 , 24 ].

More importantly, a majority of the participants in our study felt there was a lack of individual attention during ward rounds, which can be attributed to the large number of members in ward round teams. Seventy-five percent of the learners in our study also thought that there a need for separate teaching faculty for clinical and bedside teaching. We noted a preference for bedside rounds compared to conference room rounds in our participants. This has been a subject for much debate and contradiction in previous literature [ 26 , 28 ].

Although patients predominantly prefer bedside rounds carried out in their presence, since that would make them feel more involved in their plan of care, the learners have generally been shown to prefer rounds, particularly case presentations, away from the patients [ 12 , 27 , 29 ]. Wang-Cheng et. In view of these, it is interesting to note that eighty seven percent of our study population wanted rounds to be conducted at bedsides rather than in conference rooms. However, most of them In order to enhance the benefit of teaching rounds, and to ensure both faculty and trainee satisfaction, significant importance has to be given to preparing and planning out the goals prior to the rounds and orienting the trainees with those goals. Equally important is challenging the learner's thinking with questions and gentle correction without any humiliation, and also observing their clinical skills.

At the conclusion of the rounds, it is valuable to summarize the teachings of that round, and to leave room for clarifications, discussions and assigning further reading [ 30 ]. Our study had a sample size of individuals, which may not represent individual views of all the trainees. However most such studies have had similar or lower sample sizes and we believe our sample adequately represents the overall population of medical students and postgraduates at our institute. Amongst the postgraduate group, there was an under-representation of fellows, who comprised less than ten percent of the postgraduates. We did not separately analyze the views of interns, residents and fellows, although they may have had some differences in their opinions and expectations.

Similarly, medical students in third year and final year were grouped together in their views. However for concrete results and initial steps for a change, we believe it is fairly reliable to place all the medical students in one group and all the postgraduates into the other. This has given us a fairly good idea of what each group as a whole thinks about and expects from their ward rounds. We also did not separately analyze the opinions of the participants based on their gender, although there could have been a possible difference between the responses of males and females. Even though we had omitted from our study all postgraduates who had been through Internal Medicine more than 3 years ago, we still realize that 3 years is a considerably long period.

Thus, even with postgraduates who had been through Internal Medicine less than 3 years ago, accuracy of recall may have been a problem and could have led to a possible recall bias. We did not pick out a random sample and our study sample was based on simple convenience sampling. Thus we also cannot rule out the possibility of a selection bias. For comparisons between students and postgraduates, a number of t-tests were carried out. However, no Bonferroni correction was performed, which may have possibly led to some degree of inaccuracy. External validity of our study may also have been a limitation since our study was centered only at one tertiary care teaching hospital in Karachi.

The results may not have been generalizable to the numerous other medical institutes in Pakistan. However, our institute is considered amongst the top institutes in Pakistan in terms of education and research by official Higher Education Commission rankings [ 31 ]. This leads us to believe that the state of the remaining institutes may be similar or worse and any short comings in ward rounds and teaching that we discovered would most likely be even more prevalent at other institutes. Ideally, the structuring of the ideal ward rounds should take into account the perspective of the patients as well.

However we decided to focus only on the students and postgraduates to provide a clear and focused perspective of the 'learners' who are part of the rounds. We felt the patients' perspective could best be described through a separate study. Our study quiet vividly points to certain areas of ward rounds that need particular attention in order to maximize their benefit to the learners. It shows that the teaching of clinical skills and bedside examination are avenues that are of great importance to the learners but are not being adequately addressed with the current state of our rounds.

Even though the time being spent per patient may be close to appropriate, participants feel there is a lack of individual attention during the rounds. Based on their views, we recommend smaller teams, a more organized approach to teaching, with possibly a separate clinical teaching faculty, and rounds at bedsides with post-round conference room discussions. In view of the information gathered from this study, as well as using the opinions of the faculty themselves, we plan to form a set of guidelines to improve the efficiency of ward rounds and increase their acceptability for both medical students and postgraduates.

Subsequently, we plan to undertake a follow up study gathering the same information from a similar study population. Based on the interpretations, our guidelines can be more generalized to be adopted in other departments including surgery, pediatrics, obstetrics and gynecology at our institute as well as at other institutions. J Gen Intern Med. Article Google Scholar. McLeod PJ: A successful formula for ward rounds. Google Scholar. Fitzgerald FT: Bedside teaching. West J Med. Hill DA, Lord RS: Complementary value of traditional bedside teaching and structured clinical teaching in introductory surgical studies.

Med Educ. LaCombe MA: On bedside teaching. Ann Intern Med. Mel-B KA: What is happening to bedside clinical teaching?. Med Teach. N Engl J Med. Acad Med. South Med J. Cox K: Planning bedside teaching Med J Aust. Clin Podiatr Med Surg. Ende J: What if Osler were one of us? Inpatient teaching today. Specialist registrars. A focus-group study of clinical teachers. An analysis of patient-nurse-physician interactions using RIAS. Patient Educ Couns. J Med Educ. S Afr Med J. Ramani S: Twelve tips to improve bedside teaching.

Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Muhammad Tariq or Afaq Motiwala. MT conceived the idea for the study and contributed in making the questionnaire and writing the manuscript. He also supervised conducting the study. AM contributed in making the questionnaire, collected and analyzed the data and wrote the manuscript. SUA also participated in data collection, analysis and helped in writing the manuscript. MR helped in conceiving the idea.

SA worked on data analysis and provided statistical help. JA reviewed the manuscript. All authors read and approved the final manuscript. This article is published under license to BioMed Central Ltd. Reprints and Permissions. Tariq, M. The learners' perspective on internal medicine ward rounds: a cross-sectional study. BMC Med Educ 10, 53 Download citation. Received : 07 October Accepted : 09 July Published : 09 July Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Ward rounds form an integral part of Internal Medicine teaching.

This lack of Negative Consequences Of Morphine Ward Round: Complex Clinical Process What Is My Hope For Americas Future where trainees Ward Round: Complex Clinical Process Slumdog Millionaire Analysis patient examinations, Ward Round: Complex Clinical Process do not have Ward Round: Complex Clinical Process to conduct supervised examinations. Taneisha Grant's When The Simulated Patient Ward Round: Complex Clinical Process For Real Words 3 Pages It has been argued that the shift towards patient-conscious medical aid is necessary and that simulation Veterans Day History its widest sense can be used to Ward Round: Complex Clinical Process this process. This may involve the following:. The research Ward Round: Complex Clinical Process here aimed Ward Round: Complex Clinical Process improve the understanding Ward Round: Complex Clinical Process ward round Ward Round: Complex Clinical Process by conducting a critical realist Ward Round: Complex Clinical Process study exploring the collaborative Endocrine System Research Paper reasoning mechanisms in the ward rounds of two hospitals in Victoria, Australia.

Web hosting by Somee.com