LAUSR

Daily ward rounds (WRs) may not cater to the educational needs of medical students. WRs in the intensive care unit (ICU) typically include complex, problem-oriented discussions using concepts and terminology, further hindering student learning. To address these limitations, patient-centered, structured student activities were piloted during clinical WRs in our ICU. The activities were based on cognitive apprenticeship theory (Stalmeijer et al. 2009) with spaced repetition. During 2-week ICU clerkships, 2–4 final year medical students consented to and performed group bedside tasks on the daily WR, modeled by a consultant and then demonstrated by students. Decreasing consultant guidance was provided until group competency was demonstrated. During week 1, students performed primary assessments (Airway, Breathing, Circulation, Disability) on every patient, evaluating for life-threatening problems and suggesting appropriate interventions. Once mastered (usually within week 1), students demonstrated bedside tasks of increasing complexity; rapid identification of organ failure(s); formulating differential diagnoses based on organ failure patterns; devising early management plans based on differential diagnoses. Feedback and follow-up reading were given after each WR. Time was allocated for off-ward reading and reflective activities. Students (25 of 27, 92.6%) gave online feedback using a modified validated clinical workplace feedback tool (Manchester Clinical Placement Index) (Kelly et al. 2015). The structured group activities were popular. Mean(±sd) Likert scores [0 (strongly disagree); 3 (neutral); 6 (strongly agree)] for these and for overall clerkship teaching were 5.20(±1.44) and 4.40(±1.71), respectively [p1⁄4 0.027 (Mann–Whitney U-test)]. Students reported a change from “silent observers” to “being made to think.” The activities enabled “regular feedback,” “gave us clear learning goals,” and learning was “consistently engrained.” Furthermore, while demonstrating bedside activities, students achieved Kirkpatrick level-3 learning outcomes (Kirkpatrick and Kirkpatrick 2006). Three drawbacks were identified. Students thought the activities were “less value when very fast” and that they “impeded our ability to listen to the handover about patients,” prompting a mid-semester change to alternate patient learning. The activities also depended on having a “spare” doctor on WRs, commonplace in the ICU but a potential barrier to implementation in other clinical settings. Though cognitive apprenticeship theory may help explain bedside clinical skills learning, student feedback suggested other theoretical bases for effective WR learning including cognitivism (“kept my attention”), experiential learning (“invaluable learning experiences”), and communities of practice (“it helped integrate us as students in the ward round”). In summary, patient-centered group activities on daily WRs can result in demonstrable and transferable student learning, albeit at the cost of diverting WR staff from clinical to educational duties.