Journal of General Internal Medicine

, Volume 33, Issue 6, pp 969–974 | Cite as

Asking a Variety of Questions on Walk Rounds: a Pilot Study

  • Helen M. Shields
  • Stephen R. Pelletier
  • Christopher L. Roy
  • James P. Honan
Innovation and Improvement: Innovations in Medical Education



Morning walk rounds have lost some of their engagement while remaining a useful and valued practice.


We created a pilot study to evaluate the impact on rounds of learning to asking a variety of different questions.


One-hour intervention sessions were voluntarily offered to members of the Department of Medicine and taught by an expert in the question, listen, and respond method.


Participants included attendings and residents in Internal Medicine on medical teams.

Program Description

Questionnaires were collected on six pre-intervention and six post-intervention days. Nine months later, an anonymous online survey was sent to participants asking about their use of a wider variety of questions.

Program Evaluation

Two hundred eight physicians (residents 175 (45.5%), attending physicians 25 (27.7%)) filled out pre-intervention surveys. One hundred eighty-one physicians (residents 155 (40.3%), attending physicians 18 (20%)) filled out post-intervention surveys. When survey responses from the attendings and residents on the medical teams were combined, post-intervention rounds were perceived as more worthwhile (1.99 pre-intervention and 1.55 post-intervention, [95% confidence interval 1.831–2.143]) (p < 0.001) and more engaging (1.68 pre-intervention and 1.30 post-intervention, [95% confidence interval 1.407–1.688]) (p < 0.001).Non-medical teams’ survey responses did not change. Patient census data indicated no significant difference in the hospital’s census on the pre- and post-intervention dates. Spontaneous suggestions for improving rounds came largely from the residents and included teaching points, clinical pearls, patient focus, more interactive, increased dedicated time for teaching, inclusive/multidisciplinary, questions, and evidence-based teaching. Of the participants who answered the online survey 9 months later, 75% (6/8) reported that they “actually asked a wider variety of types of questions.”


This pilot study indicates that the 1-h intervention of learning to ask a variety of different questions is associated with rounds that are rated as more worthwhile and engaging by the medical teams.


asking questions morning walk rounds engagement worthwhile educational experience 



We are grateful to members of the Teaching on Rounds Committee: Dr. Nadaa Ali, Dr. Christopher Cannon, Dr. James Colbert, Dr. Julia Caton, Dr. Joel Katz, Dr. Natalia Khalaf, Dr. Walter Kim, Dr. Anthony Komaroff, Patricia McCormick, MBA, Dr. Vanessa Mitsialis, Dr. Jennifer Nayor, Dr. Alyssa Perez, Dr. Sonny Qazi, and Dr. Marshall Wolf, for their excellent recommendations. We are particularly grateful to David Braun, M.D., Ph.D. Chief Resident in Internal Medicine, at Brigham and Women’s Hospital and Kim Galvin in the Admitting Office at Brigham and Women’s Hospital. We greatly appreciate the expert help of Angel Ayala, Department of Audio-Visual Communications at Brigham and Women’s Hospital in Boston.

Compliance with ethical standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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  1. 1.
    Crumlish CM, Yialamas MA, McMahon GT. Quantification of bedside teaching by an academic hospitalist group. J Hosp Med. 2009;4:304–307.CrossRefPubMedGoogle Scholar
  2. 2.
    Ende J. What if Osler were one of us? J Gen Intern Med. 1997;12(Supplement2):S41–S48.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Carlos WG, Kritek PA, Clay AS, et al. Teaching at the bedside. Maximal Impact in Minimal Time. Ann Am Thorac Soc. 2016; 13:545–548.PubMedGoogle Scholar
  4. 4.
    Landsberg L. On Rounds: 1000 Internal Medicine Pearls. Clinical Aphorisms and Related Pathophysiology. 2015 Wolters Kluwer, PhiladelphiaGoogle Scholar
  5. 5.
    Arseneau R. Residents’ question-asking behaviors during work rounds. 1997. Acad Med. 72: 71.PubMedGoogle Scholar
  6. 6.
    Colbert J, Pelletier S, Xavier-Depina F, et al. A pilot study of team learning on in-patient rounds. 2016. Clin Teach. 13: 38–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Martin SK, Farnan JM, Arora VM. Future: new strategies for hospitalists to overcome challenges in teaching on today’s wards. J Hosp Med.2013; 8: 409–413.CrossRefPubMedGoogle Scholar
  8. 8.
    Christensen CR. The discussion teacher in action: questioning, listening and response. In: CR Christensen, DA Garvin, Sweet A, eds. Education for Judgment: The Artistry of Discussion Leadership. Boston: Harvard Business School Press; 1991:193–213.Google Scholar
  9. 9.
    Shields HM, Guss D, Somers SC, et al. A faculty development program to train tutors to be discussion leaders rather than facilitators. Acad Med. 2007;82:486–492.CrossRefPubMedGoogle Scholar
  10. 10.
    Porter, SR, Whitcomb, ME, Weitzer WH. Multiple Surveys of Students and Survey Fatigue. Chapter 5 In: New Directions for Institutional Research, no. 121, Spring 2004, Wiley Periodicals, 63–73.Google Scholar
  11. 11.
    Grava-Gubins I, Scott S. Effects of various methodological strategies. Survey response rates among Canadian physicians and physicians-in-training. Can Fam Physician. 2008;54:1424–1430.PubMedPubMedCentralGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Helen M. Shields
    • 1
    • 2
  • Stephen R. Pelletier
    • 1
    • 3
  • Christopher L. Roy
    • 1
    • 4
  • James P. Honan
    • 5
  1. 1.Harvard Medical SchoolBostonUSA
  2. 2.Division of Medical Communications, Department of Medicine Brigham and Women’s HospitalBostonUSA
  3. 3.Office of Educational Quality ImprovementHarvard Medical SchoolBostonUSA
  4. 4.Hospitalist Service, Department of MedicineBrigham and Women’s HospitalBostonUSA
  5. 5.Harvard Graduate School of EducationCambridgeUSA

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