gms | German Medical Science

Background: Ward rounds represent a crucial activity in physicians’ daily practice in hospital. However, medical curricula lack adequate preparation for this task, and students report difficulties in performing and understanding ward rounds properly. We aimed at identifying differences in ward round scripts [1] between medical students and more experienced physicians. Differentiating between scenes (individual expectations regarding phases of a ward round), roles (participants) and scriptlets (activities) [2], we examined scriptlets with regard to

1.

their content (medical, social, administrative, teaching and learning) [3] and

2.

potential for knowledge construction (interactive, constructive, active, passive) [4].

Methods: We conducted standardized interviews with N=50 medical students and physicians at different expertise stages at a University Hospital using the structure formation technique [5] to map individuals’ scripts.

Results: While scripts of individuals at different expertise stages showed a high similarity on a superficial level, in-depth analysis of scriptlets’ content and potential for knowledge construction revealed significant differences between groups: residents mainly mentioned activities bound to patient care, while students and more experienced physicians also perceived teaching and learning activities as typical for ward rounds (H(3)=7.128, p<0.01). In terms of activities’ potential for knowledge construction, students reported significantly more passive activities than all other groups (H(3)=18.25, p<0.001), whereas residents reported significantly more active activities than other groups (H(3)=9.71, p=0.02).

Discussion: Our study detected expertise-related differences in scripts: residents did not perceive teaching and learning activities as typical for ward rounds. Given students’ deficits in understanding rounds as encounter for knowledge construction this conception is especially fatal, when preparing students for conducting rounds. It is not only necessary to support students to recognize activities at higher levels of knowledge construction and to understand themselves as active ward round participants. Moreover, there is a need to facilitating residents to understand ward rounds as encounter for teaching and learning.