How to Make the Most of Rounds When Not Presenting

Rounding is the most important part of the day for the medical team. This is when in-depth discussions occur and daily plans of action are decided. As a medical student on clinical rotations in the hospital, your day revolves around morning rounds. For most rotations, a large part of your evaluation is based on performance and interactions during rounds. This is especially true of attending evaluations as your face time with them is often limited mostly to rounds. Hopefully you are carrying challenging patients, practicing oral presentations, and honing your clinical reasoning skills so you can shine during patient presentations. But what do you do when not presenting? Here I will discuss strategies that will help you make the most out of morning rounds.

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Pay Attention to Patients You Aren’t Covering

As a medical student, you will never be expected to know the fine details of every patient on the service. That’s a senior resident-level skill. However, I encourage you to keep short notes on each patient you aren’t covering. Nothing extensive – a one-liner, primary/working diagnosis, surface-level plan for diagnostic workup and treatment. If you need to cover another patient or a question arises and no one else is around, you will be better equipped to assist with any issues that surface. Additionally, by knowing a bit about each patient, you will be able to learn more and ask intelligent questions.

Ask Thoughtful Questions

When you ask thoughtful questions, you not only receive thoughtful answers, you also show that you are engaged and thinking critically. Try to get at least one or two good questions per day on rounds. Fewer questions, fewer learning points. If you are unsure of something, confused, or curious, you should ask a question. You are in a teaching environment and questions are expected. That being said, don’t ask a question just for the sake of asking, i.e., don’t ask if you already know the answer or can look it up very quickly. I find many of my questions, even now as a resident, surround clinical reasoning. When I am unsure of how a certain conclusion was reached, I always ask for an explanation of that person’s clinical reasoning. This shows curiosity (rather than blanket deferment to superiors) and initiative to build your own knowledge.

Stay Off Your Phone

Stay off your phone during rounds unless it is related to patient care (looking up a medication price, consulting UpToDate, using a medical calculator, etc.). You absolutely do not want colleagues to assume you’re texting or scrolling social media. That is a quick way to a bad evaluation. If you are going to use your device, make it clear that you are using it productively for patient care.

Volunteer to Follow Up on Tasks

During rounds, numerous tasks that need follow up will arise. This could be obtaining outside facility records, searching for relevant literature, pulling a line, or asking the patient a question. Volunteer to complete these tasks whenever possible. These are things that frequently fall through the cracks, and you can prevent that from happening. It will help the team and the patient alike.

Body Language

The best way to appear engaged, is to actually be engaged. When not presenting, make sure you are actively listening to your colleagues. Try not to lean casually against the wall, let your eyes drift aimlessly, or fiddle with items in your pocket. Focus on your colleagues and the patient.

Be Prepared for Everything

You can make rounds more efficient by anticipating certain needs for each patient. For all patients, it is helpful to have their bedside nurse present while you round. They are part of the care team and ought to be present to offer input as a part of team-based decision-making. You can make rounds smoother by alerting each nurse shortly before reaching the respective patient’s room. You can also stock your pockets with any supplies that may be needed on rounds. Some generic things include gauze, alcohol wipes, and a penlight. For surgery services, suture removal kits and supplies for dressing changes are often required. If something is needed that is not handy, go find it.  Being prepared for everything will save time, and you will look one step ahead on everything.

Rounds are where you have the most face time with attendings and where a large proportion of learning occurs. When not presenting patients, it can feel like you are just a fly on the wall. By attentively listening, asking questions, displaying positive body language, volunteering for new tasks, and enhancing the efficiency of rounds with good preparation, you can make rounds better for everyone involved.

Do you get a lot out of rounding? What do you do to actively learn from each patient that is seen and discussed on rounds? Comment below.

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Alan Gambril, MD
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