Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning.

PROBLEM: Inpatient rotations remain a central component in residency training, particularly in specialties such as internal medicine. However, maintaining the quality of this important learning experience has become a challenge. Recent approaches to redesigning the inpatient rounding experience have included reductions in the number of admissions and in patient census, which may not be feasible or desirable for many programs. APPROACH: The authors designed and implemented an approach to inpatient teaching that maintained the standard patient volume. It had the following five goals: (1) enhance bedside clinical skills, (2) promote a culture of patient safety, (3) emphasize diagnostic reasoning, (4) engage patients, and (5) provide learners with an expanded perspective on patients' experiences of care. This redesign, called the Chiefs' Service (CS) program, was implemented in 2013. The CS team acted as the intervention group in a quasi-experimental design study evaluating and comparing their experiences and outcomes with those of the standard inpatient medical teams not using the CS model. OUTCOMES: Five key team activities, or elements, were developed, piloted, and refined with learner, attending, and patient feedback. Those elements were morning huddle, bedside rounds, diagnostic "time-outs," day-of-discharge rounds, and postdischarge follow-up rounds. NEXT STEPS: A robust evaluation process is under way; initial impressions from attendings, learners, and patients have been positive. Several educational outcomes also are being measured and compared with those of the standard inpatient medical teams. Further evaluations will guide modifications to the CS program and direct plans for dissemination within the institution and to other institutions.