LETTERS TO THE EDITOR

To the Editor:—We read with interest the report by Smith et al.¹ describing a new instrument for evaluating teaching faculty, incorporating the changed expectations of today's teachers. Such an instrument is badly needed. Hospital rounds are not what they used to be.

A key issue in this area of research is the definition of “teaching rounds.”^2,3,4 Terms such as “ward rounds,”“bedside rounds,”“attending rounds,”“teaching rounds,” or (as in this article) “bedside work rounds” and “postcall rounds” are used without explanation. Because of the idiosyncratic nature of rounds, the same term may refer to entirely different activities.

The instrument described in this article evaluates faculty on “postcall rounds” and “bedside work rounds” (the latter to be conducted “entirely at the bedside” and “daily for the first week, then at least twice a week thereafter”). There is no description of separate “teaching rounds.”

We have no comparable rounds at our institution. Faculty round 7 days a week, 50% to 75% at bedside, of which approximately two thirds is formal “teaching” (e.g., reviewing physical findings and exploring diagnostic reasoning) and the rest “work” (reviewing and modifying, if required, management decisions of the residents). We call this entity “attending rounds.”“Work rounds” are a separate informal gathering run by the senior resident and devoted to details of management.

Local modifications of the authors' instrument, primarily in the “clinical supervision” component, will be needed. Some elements refer to supervisory requirements rather than teaching excellence (e.g., faculty are to “help speak with consultants and arrange tests” and “see every patient every day”). It would be useful to separate these components to enhance the instrument's generalizability.

Of note, at least 8 resident observations are required for reliability, limiting its usefulness for smaller programs or occasional rotations.

With these caveats, this instrument is a valuable step forward in educational research. We welcome the integrated approach taken by Smith et al. and agree there is no longer any plausible or desirable separation between “teaching rounds” and “work rounds.” Classic rounds were a passive strategy that relied largely on faculty expertise, while today's teaching rounds combine active learning with immediate application of knowledge. We think Osler would have approved.