An ethnographic study of attending rounds in general paediatrics

Understanding the ritual

Dorene F. Balmer, Christina L. Master, Boyd F. Richards, Janet Rose Serwint, Angelo P. Giardino

Research output: Contribution to journalArticle

Abstract

Objectives Teaching at the bedside during attending rounds is considered to be fundamental to medical education. We conducted an ethnographic case study to investigate such teaching in general paediatrics as a social phenomenon and to explore change over time in both the meaning of rounds and the context in which rounds take place. Methods We conducted a case study from January to August 2006 on a 22-bed general paediatric unit in an urban children's hospital and focused our observation on interns, senior residents and attending physicians. We observed the medical team during its normal activities on the study unit and conducted semi-structured interviews with a sample of attendings, interns and senior residents. We compiled a list of codes that emerged from patterns in the data and constructed a rich description of rounds according to the principles of inductive analysis. Results Four themes emerged from the data: (i) attending rounds are a pervasive and routine part of clinical education; (ii) interns, senior residents and attending physicians hold assumptions about what should happen on rounds; (iii) tension exists between interns', senior residents' and attending physicians' assumptions about bedside teaching during rounds and the reality imposed by contextual factors, and (iv) bedside teaching during rounds is impacted, but not prohibited, by contextual factors. Conclusions Our case study provides evidence that bedside teaching during rounds is a pedagogical ideal entrenched in medical education. Participants readily acknowledged teaching at the bedside during rounds as something they perceived should happen, although, in actuality, it was infrequently achieved. This study revealed a telling inconsistency in language and behaviour: 'bedside rounds' was embedded in the participants' ordinary language, but the activity was not necessarily part of their ordinary behaviour. We propose that the practice of bedside teaching is best explained as a ritual. Considering bedside teaching as a ritual helps to explain why rounds are sacrosanct and helps to develop more appropriate expectations for rounds.

Original languageEnglish (US)
Pages (from-to)1105-1116
Number of pages12
JournalMedical Education
Volume44
Issue number11
DOIs
StatePublished - Nov 2010

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Teaching Rounds
Ceremonial Behavior
religious behavior
Teaching
Pediatrics
Medical Education
Physicians
resident
Language
physician
Urban Hospitals
children's hospital
education
Interviews
Education
language

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

An ethnographic study of attending rounds in general paediatrics : Understanding the ritual. / Balmer, Dorene F.; Master, Christina L.; Richards, Boyd F.; Serwint, Janet Rose; Giardino, Angelo P.

In: Medical Education, Vol. 44, No. 11, 11.2010, p. 1105-1116.

Research output: Contribution to journalArticle

Balmer, Dorene F. ; Master, Christina L. ; Richards, Boyd F. ; Serwint, Janet Rose ; Giardino, Angelo P. / An ethnographic study of attending rounds in general paediatrics : Understanding the ritual. In: Medical Education. 2010 ; Vol. 44, No. 11. pp. 1105-1116.
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