Leadership in medical ward rounds

Abstract

Leadership in Medical Ward Rounds: Abstract

Medical ward rounds are an under researched area. The medical post take ward round has been cited as being a source of anxiety for new consultants. The non-technical skills involved may well be those that new consultants feel underprepared for in contrast to clinical skills. Ward rounds historically have been a principal vehicle for teaching junior doctors. There have been many changes in how junior doctors work which has potentially impacted their training and preparation towards being a consultant. The overarching aims of this thesis are firstly to expand our current understanding of the incorporation of training into medical ward rounds, and secondly to translate this understanding into an instrument that evaluates senior trainees or consultants skills in leading a ward round. Ultimately, improved training and assessment of the ward round process should enhance patient safety and effectiveness of care on medical wards. This thesis incorporates a narrative review on training and ward rounds. There is also a literature review on non-technical skills tools used in hospital medicine, how they were developed and their psychometric evaluation. The second review of non-technical skills tools leads to a choice of tool on which to base the development of a ward round leadership tool. The review on training and ward rounds, provides background to the thesis but also some of the findings are used for the instrument development. A post take ward round simulation was developed alongside the ward round leadership tool, which serves 2 purposes. One is to develop a training program by which to train senior medical registrars to lead post take ward rounds, and secondly, it is used to psychometrically evaluate the developed medical ward round leadership tool. There is also a chapter reporting an interview study of medical consultants and patients about training and post take ward rounds. The findings from this chapter feed directly into the tool and simulation development. The development of the simulation and tool are described and evaluated in detail. The tool is evaluated in terms of reliability and validity.