Pre-round separately or as a group?

[hopefulscribe2]

Hey there,

I am wondering if the residents should pre-round separately or as a group with medical students for inpatient pts (psychosis, bipolar, SI). Some of the medical students prefer independence and appear to get annoyed if you round together. However, some pts seem preoccupied about discharge and i would hate for the pts to get aggressive because we bother them with the same questions

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[When is graduation again?]

I'd have them pre-round together for safety's sake as you have no idea what med students are saying to patients or what degree they are aware of their surroundings. That said, I think it's all about how you frame it. When I was a resident, I would let the med students run the interviews and only jump in if necessary. I'd then go over the patients with the med student before rounding and talk through treatment options, so the medical student could present and look good. I don't think there were too many med students that were upset with that setup. Though, the success of that depends on how much a resident is willing to seed control.

 

[Celexa]

Hey there,

I am wondering if the residents should pre-round separately or as a group with medical students for inpatient pts (psychosis, bipolar, SI). Some of the medical students prefer independence and appear to get annoyed if you round together. However, some pts seem preoccupied about discharge and i would hate for the pts to get aggressive because we bother them with the same questions

When I orient medical students at the very start of the rotation I flat out tell them that due to the nature of the issues we deal with they will see patients by themselves less often than on other rotations and it is not a reflection on them and we will have them interview pts with us there. It goes fine.

I will send medical students alone to do things like safety plan. Or I CL once they're a few days in and we see they aren't totally inept talking to a patient we might send then to see "sad bc in hospital" type patients. But I don't have them go by themselves often to acutely psychotic or manic pts. In my residency we often didn't pre round at all and just saw these pts as a team anyway.

 

[heartsink]

Our attending joined us for the initial interview we had when seeing new patients on the floor our first couple days, and then after being satisfied we weren't completely inept or unaware of our surroundings let us interview most other patients (including new consults and follow ups) on our own. There were a few we were told to wait to round with the attending, but those were the exceptions and not the rule. That really worked well for us and I felt I got a lot stronger at conducting interviews when it was really up to me, as my attending would grill us heavily if we forgot to ask something / dig deeper, and that became a good incentive for me to not make the same mistakes twice.

 

[hopefulscribe2]

Our attending joined us for the initial interview we had when seeing new patients on the floor our first couple days, and then after being satisfied we weren't completely inept or unaware of our surroundings let us interview most other patients (including new consults and follow ups) on our own. There were a few we were told to wait to round with the attending, but those were the exceptions and not the rule. That really worked well for us and I felt I got a lot stronger at conducting interviews when it was really up to me, as my attending would grill us heavily if we forgot to ask something / dig deeper, and that became a good incentive for me to not make the same mistakes twice.

Was there a resident or just the attending and students?

 

[FlowRate]

I think we usually did a mix of together/separate rounding when I was a M3 or a resident with an M4 (I didn't do any inpatient as an M4.) Usually it depends on the patients they're assigned so I think a one-size answer is usually wrong.

 

[comp1]

This is so specific to your setting. I know in our forensic setting, the entire treatment team including the charge nurse, med students, residents, attending, sheriff, etc rounded on every patient together as a group. The patients were extremely sick and we could literally round on 18 patients in 2 hours even with med students doing the interview as most patients were either completely non-verbal or just made threats. I couldn't imagine anything like that on a less acute setting. I do second the above that you don't know what the med students are telling the patients and that med students can be quite oblivious to their surroundings and safety. That said...these aren't often problems in moderate or lower acuity units and very rarely are they problems on a CL service. CL patients are the same patients they are pre-rounding on at 4 AM during their medical clerkship. A key point is to do a really good and thorough orientation about safety and the role of a medical student, which is primarily information collection at this stage in their career. Rule 1 of being a med student is to excuse yourself immediately and tell someone if a patient is starting to get agitated and rule 2 is to never, ever promise the patient anything other than that you will bring their concerns to the team.

 

[heartsink]

Was there a resident or just the attending and students?

Just us and the attendings. No residents on the unit.

 

[Cath Up]

My attending made all of the PGY1s round on all general inpatients (unless he had a brief scheduling issue or something) with them the entire first year. Very little autonomy, you didn't learn MDM (he usually dictated the plan) and patients were uncomfortable with a big team of the attending, resident, and med students- didn't learn how to build good 1 on 1 rapport as well without deliberate effort to see patients alone at the very beginning or end of the day. He didn't do any therapy as well, made his residents write the notes and left early with minimal teaching. Don't do that.