Abstract
Purpose
Ward rounds play a crucial role in the delivery of patient care in inpatient settings, but involve a complex mix of tasks, skills and challenges for junior doctors to negotiate. This study informs the development of high-quality training by identifying the activities that junior doctors perform, and those associated with stress during real-life ward rounds.
Materials and methods
All activities performed by FY1 doctors (n = 60) over 2 ward rounds were coded in real-time by a trained observer using the work observation method by activity timing (WOMBAT). Doctors’ heart rate was continuously recorded and non-metabolic peaks in heart rate used as a physiological indicator of stress.
Results
During ward rounds, FY1 doctors commonly engaged in indirect patient care, professional communication, documentation and observation. Very little time was spent on direct patient care (6%) or explicit supervision/education (0.01%). Heart rate data indicated that stress was highest during administrative tasks while interacting directly with patients while stepping out of rounds to complete personal tasks, when answering bleeps and while multi-tasking.
Conclusions
Training that specifically covers the activities involved, skills required, and challenges inherent in real-life ward rounds may better prepare FY doctors for this complex area of practice.
Ward rounds play a crucial role in the delivery of patient care in inpatient settings, but involve a complex mix of tasks, skills and challenges for junior doctors to negotiate. This study informs the development of high-quality training by identifying the activities that junior doctors perform, and those associated with stress during real-life ward rounds.
Materials and methods
All activities performed by FY1 doctors (n = 60) over 2 ward rounds were coded in real-time by a trained observer using the work observation method by activity timing (WOMBAT). Doctors’ heart rate was continuously recorded and non-metabolic peaks in heart rate used as a physiological indicator of stress.
Results
During ward rounds, FY1 doctors commonly engaged in indirect patient care, professional communication, documentation and observation. Very little time was spent on direct patient care (6%) or explicit supervision/education (0.01%). Heart rate data indicated that stress was highest during administrative tasks while interacting directly with patients while stepping out of rounds to complete personal tasks, when answering bleeps and while multi-tasking.
Conclusions
Training that specifically covers the activities involved, skills required, and challenges inherent in real-life ward rounds may better prepare FY doctors for this complex area of practice.
| Original language | English |
|---|---|
| Pages (from-to) | 1294-1301 |
| Number of pages | 8 |
| Journal | Medical Teacher |
| Volume | 43 |
| Issue number | 11 |
| Early online date | 2 Jul 2021 |
| DOIs | |
| Publication status | Published - 2021 |
Bibliographical note
Founding: Economic and Social Research Council Open access via T&F agreementAcknowledgements
The authors would like to thank participating FY1 doctors and the senior staff who made this study possible.
Funding
The study was funded by the ESRC via a Doctoral Studentship awarded to CB.
Keywords
- Ward rounds
- junior doctors stress
- heart rate