Using cognitive mapping to define key domains for successful attending rounds.
BACKGROUND
Ward attending rounds are an integral part of internal medicine education. Being a good teacher is necessary, but not sufficient for successful rounds. Understanding perceptions of successful attending rounds (AR) may help define key areas of focus for enhancing learning, teaching and patient care.


OBJECTIVE
We sought to expand the conceptual framework of 30 previously identified attributes contributing to successful AR by: 1) identifying the most important attributes, 2) grouping similar attributes, and 3) creating a cognitive map to define dimensions and domains contributing to successful rounds.


METHODS
Multi-institutional, cross-sectional study design.


METHODS
We recruited residents and medical students from a university-based internal medicine residency program and a community-based family medicine residency program. Faculty attending a regional general medicine conference, affiliated with multiple institutions, also participated.


METHODS
Participants performed an unforced card-sorting exercise, grouping attributes based on perceived similarity, then rated the importance of attributes on a 5-point Likert scale. We translated our data into a cognitive map through multi-dimensional scaling and hierarchical cluster analysis.


RESULTS
Thirty-six faculty, 49 residents and 40 students participated. The highest rated attributes (mean rating) were "Teach by example (bedside manner)" (4.50), "Sharing of attending's thought processes" (4.46), "Be approachable-not intimidating" (4.45), "Insist on respect for all team members" (4.43), "Conduct rounds in an organized, efficient & timely fashion" (4.39), and "State expectations for residents/students" (4.37). Attributes were plotted on a two-dimensional cognitive map, and adequate convergence was achieved. We identified five distinct domains of related attributes: 1) Learning Atmosphere, 2) Clinical Teaching, 3) Teaching Style, 4) Communicating Expectations, and 5) Team Management.


CONCLUSIONS
We identified five domains of related attributes essential to the success of ward attending rounds.
University of Alabama at Birmingham Department of Internal Medicine, Birmingham, AL, USA. britaroy@uab.edu
Brita
B
Roy
Analia
A
Castiglioni
Ryan R
RR
Kraemer
Amanda H
AH
Salanitro
Lisa L
LL
Willett
Richard M
RM
Shewchuk
Haiyan
H
Qu
Gustavo
G
Heudebert
Robert M
RM
Centor
D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D013337:Students, Medical; D056164:Teaching Rounds / Q000379:methods*