• Seek to understand the agenda
  • Seek to understand team roles

What does the team manage the ward round?

  • How are they setting priorities?
  • What are the competing demands?
  • What is expected of you?
    • Will anything interrupt your presence on the round? If so, let someone know.
  • Will anything interrupt your presence on the round? If so, let someone know.

Although your presence on the round may seem optional; your attendance is noticed. Turning up on time, contributing where you can and paying attention, even when conversations are not directed at you, are all important parts of professional behaviour. If the team feels you are engaged they will invest more in your learning.


Here is an example of agenda setting.


What roles do different team members have?

  • Who leads the patient encounter? Who examines? Who takes notes?
  • What “house-keeping” is done?
    • Review of medications, fluids, contingency plans eg. if IV falls out.

Roles you may discuss with the team about taking

  • Be an active observer (see Inspect and Reflect)
  • Take on the responsibility to follow-up and report back on one patient
  • Write ward round notes/on the patient communication board
  • Plot growth parameters in patient record
  • Order pathology/radiology to be countersigned by your supervising clinician.

tab 1

  • Target your learning

The team will teach you when they can, but you need to take charge of your own learning.

  • What patients are you seeing today?
  • What problems do they have and what differentials are being discussed?
    • Do you understand why?
  • How does this reflect your curriculum?
  • How does it build on or differ from what you have seen before?

Use each case to focus your own learning.

  • If the condition is new, look it up.
  • If the case is a common presentation, how does it compare to other cases you have seen? Why might there be a difference?
  • For undifferentiated problems, list the differentials and discuss with each other what you think is most likely and why.

Share what you have learnt with your peers.

  • No one will see every condition first hand during their rotation.
  • Could you give your peers a short summary of what you saw or learnt?
    • I saw a patient with XX…what I learnt was…
    • XX is…It is caused by…It presents with a history of…Examination findings include…Diagnosis is made by….Management includes…

tab 2

  • Inspect and reflect

Observe and actively reflect on clinical encounters and interactions. Choose one or two things to focus on each round.

Clinical

  • Is the child well or unwell? What information are you using to decide?
  • What clinical signs can you see from the end of the bed? What clinical signs are the team describing? What language do they use?
  • What monitoring is the child on? What medical devices are in the room? Why?
  • How are decisions about fluid, antibiotics, etc made? Do you understand them?

Communication

  • How are conditions or plans explained to families?
  • Would you be able to provide a similar explanation for a common condition such as fever, febrile convulsions, asthma or bronchiolitis?

The child and the family

  • The child and the family
  • How does the team engage children of different ages?
  • What are the children doing at different ages?

The parallel chart (MD course handbook)

  • The child and the family
    • How does the team engage children of different ages?
    • What are the children doing at different ages?

tab 3

  • Seek Closure
  • Clerk patients

Ward rounds and patient encounters end in different ways depending on work load and time.


Things to consider:

  • Do you want to clarify anything? (if time allows)
  • What did you learn from the round? (knowledge, skills, clinical decisions, communication, management)
    • Write it down
    • Talk about it with each other
    • …otherwise it is lost
  • Where does this fit in to what you already know?
  • What will you do to address gaps or consolidate the learning?

Here is an example of the team closing the learning from the round.


The ward round is not everything.

Nothing replaces the understanding you get from clerking patients yourself.

  • Organise to go back after the round to see a patient
    • Do a full history and examination, write down your own diagnosis and differential diagnosis before looking at the notes.
    • Did you miss any information compared to the doctors?
      • If so how can you avoid this next time?
    • If you turn up any new information or concerns, it is important that you inform the team.

tab 4