Learning clinical communication on ward-rounds: an ethnographic case study.

OBJECTIVE: To explore what factors influence student-doctors' learning of clinical communication on ward-rounds and how such learning can be enhanced.

METHODS: Adopting a qualitative ethnographic approach, the author audio recorded and observed 63 bedside episodes within 18 ward-rounds on four different wards over an 8-week period. Nine fourth year student-doctors and four clinicians also participated in semi-structured interviews. The combination of observations, audio-recordings, transcriptions, field notes, and interview data allowed us to produce a detailed description of the case.

RESULTS: Each bedside episode offered opportunities for learning about clinical communication. However, the student-doctors did not always recognise that they were learning about clinical communication, since in this context, they were not being explicitly taught about communication. Student-doctors were rarely invited to participate in the ward-round and clinicians overlooked opportunities for learning. Some student-doctors questioned the educational value of ward-rounds and did not always attend.

CONCLUSIONS: Ward-rounds are a rich site for learning clinical communication but opportunities for learning are often overlooked.

PRACTICE IMPLICATIONS: By being alert to the power of role modelling and the importance of inclusion and participation, student-doctors' learning of clinical communication can be enhanced even on busy ward rounds.