Certificate in Teaching in Higher Education (CTHE) 2022 Post ward round discussion in medical student teaching results in better understanding Joel Arudchelvam Advantages of ward round teaching Problems related to the wards The responses from the students Future plans

1. Joel Arudchelvam
Seminar number 8
Certificate in Teaching in Higher
Education (CTHE) 2022
Post ward round discussion in medical
student teaching results in better
understanding

2. Learning objectives
After listening to my presentation you will be able to:
• Define the problems of teaching medical students during the ward
rounds.
• Identify the factors leading to the above mentioned problems.
• Understand the methods applied to overcome these problems
• How to maintain the changes in the future.

3. Post ward round discussion in medical student
teaching results in better understanding
Present practice of ward
clinical teaching
• At present the ward rounds
and the clinical teaching of
the medical students are
done together (Traditional
way)
• By the academic staff
(consultants and others)

4. Ward rounds
• The consultant assesses
the patients and plan the
treatment
• Consultant also
• Teaches the students
• Discuss with the students

5. Advantages of ward round teaching
• Traditional way of “Clinical teaching” to the students *
• Clinical teaching - Students are taught about history
taking, patient examination (assessment) and
treatment (management).
• Clinical exposure - introducing the student to future
patient assessment and treatment
McLeod PJ: A successful formula for ward rounds. CMAJ. 1986, 134 (8): 902-4.

6. Why I want to change the present practice
Problems in teaching during the ward rounds
• Problems are related to;
• Ward environment
• Teacher related factors
Wenger E. Learning in landscapes of practice: boundaries, identity, and knowledgeability in practice-
based learning Routledge; 2015.

7. Problems related to the wards
The wards are;
• Busy places
• Not spacious
• Noisy
Results in
• The students not being able to hear
• Not being able to concentrate
• Do not take part actively in learning
Nair, B., Coughlan, J., & Hensley, M. (1998). Impediments to bed-side teaching. Medical education, 32(2), 159-162.

8. Problems related to the teacher
The teacher
• Busy - concentrating on the
patients
• lacks time to teach the
students
• This results in suboptimal
student teaching

9. Advantages of post ward round discussion
Studies have shown that discussion in a quiet place (after the
ward round) improve the students understanding and also
improves participation.
Nair, B., Coughlan, J., & Hensley, M. (1998). Impediments to bed-side teaching. Medical education, 32(2),
159-162.

10. How did I do it?
• A group of students selected
Before starting the ward round
• Explained the students of the benefits of discussing the
questions arising at ward rounds in a quiet environment
during the post ward round period
• Explained why it is difficult to discuss during the ward
round
• Did the ward rounds with the students

11. How did I do it?
• Asked the students to record the questions about
patients arising during the ward round
• After the ward round, I got all the students to a classroom
in the ward and discussed the answers to the questions

12. How I assessed the outcome
• By providing the
students with a
feedback form at the
end of the ward round
teaching session

13. Outcome I expected
I expected students to understand theoretical basis behind
the clinical scenario (Patients condition)better

14. Response
• The students were happy
• They were able to engage in a discussion
• They also agreed that engaging in a discussion in
the middle of a ward round is difficult

15. The responses from the students
• 90% responded
• 77.8% - already joined > 55 traditional ward rounds during
their medical student career

16. The responses from the students
Difficulties faced during traditional ward round classes
• 33.3% - Noise
• 22.2% - Distraction of attention by the busy staff

17. The responses from the students
When asked about their active involvement during the
traditional ward round teaching in the past;
• Only 33.3% said that they participated actively
33%
67%
Level of participation
Active
Not active

18. The responses from the students
When asked about their involvement during the post ward
round discussion
• 88.9% said that they actively participated and were able to
engage in a discussion
• (p < 0.05).

19. The responses from the students
• This difference in the level of involvement was significant
• Traditional round teaching vs Post ward round teaching –
33.3% vs 88.9% (p < 0.05).

20. The responses from the students
When asked about the level of the understanding of the subject discussed
in the post ward round
• 77.7% said that they understood the clinical scenario well.

21. The responses from the students
• 75% of the students wanted to have post ward round
discussion in the future as well.

22. Conclusions and summary
• Student teaching during the ward rounds is associated
with problems due to;
• Ward environment
• Teacher related factors
Wenger E. Learning in landscapes of practice: boundaries, identity, and knowledgeability in practice-
based learning Routledge; 2015.

23. Conclusions and summary
• Student feed back findings suggests that the
Students like to have discussion in a quiet place
after the ward round
• This has resulted in
• More active participation
• Better student understanding of the subject
• More student satisfaction

24. Future plans
What I planned to implement and maintain
• Decided to implement above mentioned type of
teaching (post ward round class )following all the
ward rounds
• Introduce this to the whole group of students
• To introduce this to my colleagues
• Reassess the changes in the future to further improve
the student teaching.

26. Future plans
But;
• Some clinical
demonstrations e.g.
• Clinical signs
• Measurement e.g. blood
pressure
• Should be done by
bedside

27. The ward class room

28. Happy students and teacher

29. References
• McLeod PJ: A successful formula for ward rounds. CMAJ. 1986, 134 (8): 902-4.
• Nair, B., Coughlan, J., & Hensley, M. (1998). Impediments to bed-side
teaching. Medical education, 32(2), 159-162.
• Khan MA, Rajendram R, Al-Jahdali H, Al-Harbi A, Al-Ghamdi M, Hasan I,
Obaidi MM, Masuadi E. Do ward rounds offer effective teaching and
training? Obstacles to learning and what makes good teaching in a large
tertiary care hospital from trainee doctor's perspective. GMS J Med Educ.
2021 Sep 15;38(6)