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      A Response to “Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings’ Asking Questions” – A Medical Student Perspective [Letter]

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      Advances in Medical Education and Practice

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          Abstract

          Dear editor We read with interest the article by Shields et al1 in which they discussed the results of teaching students an effective way of asking questions in a ward round. They implemented the famous “question listen respond” strategy, which is an engagement method used in business and law. Being on placement is a leap forward for medical students as they are required to apply hours of lectures and theory into real-life clinical practice. While this clinical trial showed positive results in the experimental group compared to the control, there are certain aspects of this study we would like to highlight. The study showed that the aforementioned technique yielded in more “open-ended” and “analytical” questions by the students. However, discrepancies were seen in the length of the ward rounds between the experimental group and the control group, being 16 minutes and 13 minutes, respectively. In reality, medical ward rounds last for a few hours covering more patients, each with their unique clinical background and history.2 Due to the number of patients as well as other responsibilities, some doctors will primarily focus on completing the ward round instead of directed teaching to students. Shields et al did not expose the students to the different styles of ward rounds, signifying that this trial may not be an accurate representation of ward dynamics. While it is understandable that ward rounds are of great value to building clinical experience, it may not always be feasible to ask questions due to the number of patients and/or limited time.3 Moreover, the study only focused on the number of questions being asked and did not discuss in detail what questions were asked or its relevance to their own experiences. It is understandable that this is subjective to each participant, although more questions does not always equate to a relevant and fruitful learning experience. It is also important to note that the majority of medical students merely observe the ward round and hardly participate directly by means of documenting in patient’s notes, checking blood results online, reviewing the drug chart etc. This paper would benefit by seeing the outcome of both the quality and quantity of the questions asked by students who undertook in such tasks against those who did not. However, dedicated time for ward-based teaching has proven to be effective.4 At Dundee University, some blocks offer students a chance to clerk patients and gather their laboratory and radiological data to be then discussed with the consultant. This correlates with Shields et al’s study, while it may be challenging to engage in a ward round, getting students involved through this teaching method creates a protected environment in which teachers can facilitate student learning. Overall, we believe the trial has shown with good practice, students can be more confident in asking questions and be further engaged in a ward round. Further research into improving the quality of questions issued by students will be more valuable, alongside optimising the ward round experience.

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          Quality and safety at the point of care: how long should a ward round take?

           Roselle Herring (corresponding) ,  Tejal Desai,  Gordon Caldwell (2011)
          In April 2009 a 'considerative checklist' was developed to ensure that all important aspects of care on a team's routine and post-take general internal medicine ward rounds had been addressed and in order to answer the question: How long should a ward round take, when conducted to high standards of quality and safety at the point of care? The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. Overall, the average time per patient was 12 minutes (10 minutes on routine rounds and 14 minutes on post-take rounds). The considerative checklist has encouraged and enabled documented evidence of high quality and safe medical care, and anecdotally improved team working, communication with patients, and team and patient satisfaction.
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            Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study

            Objectives To optimise medical students’ early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students’ perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture. Design and setting Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice. Participants 21 medical students and 30 supervisors participated. Results Two themes were identified: Nervousness and curiosity—students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved—students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives. Conclusions This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.
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              What is the educational value of ward rounds? A learner and teacher perspective

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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                amep
                amep
                Advances in Medical Education and Practice
                Dove
                1179-7258
                28 January 2021
                2021
                : 12
                : 109-110
                Affiliations
                [1 ]University of Dundee, School of Medicine , Dundee, UK
                Author notes
                Correspondence: Ahmed Sayed Hassane University of Dundee, School of Medicine , DundeeDD1 9SY, UK Email aszhassane@gmail.com
                Article
                298408
                10.2147/AMEP.S298408
                7850164
                33536806
                © 2021 Hassane et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

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