How To Survive on the Ward Round - MedicGuild

How To Survive on the Ward Round

Jun 17, 2020

Written by Arjun Nagpal

Arjun is a MD3 student at the University of Melbourne

When I first started going to ward rounds, it was a disaster. I would often come home frustrated, dissatisfied and exhausted. 

However, over time, and through a lot of trial and error, I slowly came up with solutions for each new problem. Here's a brief list of handy hints to maximise your ward rounds, so that your transition to clinical placement is much smoother than my own!

You Will Feel Overwhelmed At First

My very first ward round was on a surgical rotation. I had shown up to the hospital at 6.30 am, 30 minutes early, hoping to show my professionalism and eagerness to learn. 

In my mind, it was going to be the perfect day. I would finally see patients in the hospital, observe doctors talk about their conditions in real time and learn by observation. One of my best friends, Andrew, was with me for this rotation. We walked into the ward to where the doctors were discussing patients. They seemed busy. We waited almost 5 minutes to introduce ourselves, hesitant to interrupt their work.

As they discussed the patients, I felt like I was listening to a different language; the team used so many unfamiliar terms and acronyms. Even in the briefing, they moved between patients so quickly I could barely keep up with where the patient was on the page before they had already moved on. 

The whole ward round lasted about 60 minutes. In that time, we saw 28 patients and the brief patient interactions left little time to ask questions. Pretty soon, I was overwhelmed with so many questions in my head. 

The doctors asked questions that made no sense, performed examinations I had never seen and ordered tests I had never heard of. Afterwards, it was time for the coffee round – here the consultant (attending) asked the junior doctors if they had any questions. Finally, he turned to Andrew and I to ask us if we had any questions. We didn’t know where to begin.

Keeping Up Takes Practice

Don’t worry if you don’t understand what is happening the first time you see a patient.

There are many reasons why you may struggle to understand what your team is doing during the ward round. Part of it is often the huge gap in knowledge. Another part is that the medical team often knows their patients much better than you do; your unfamiliarity with the patients is a big challenge when you start the rotation. 

The medical team will often print out patient notes at the start. In many ward rounds, I have noticed junior doctors writing a to-do checklist next to each patient. This list includes everything they need to do for the patient, such as tests they need to organise and any medication or management changes that need to be made. 

As a student, I also create a list for each patient. Usually my list includes what I didn’t understand about the patient, any unfamiliar conditions and procedures, management guidelines and investigations. After the ward round I would use this list to guide my study for the next few hours. 

Most patients in the hospital are there over multiple days. This means you will have a chance to see them again with your newfound knowledge. If, after all your research, something still doesn’t make sense, you can always ask a question.

Knowing When to Ask Questions

Most teams are extremely busy during the ward round, so it can be very difficult to find time to ask questions. Furthermore, you have to consider where it is appropriate to ask your questions. Specific details about a patient shouldn’t be discussed in the corridors or in earshot of other people. Certain questions may cause distress to the patient, so be mindful about asking sensitive questions in front of them.

Generally, provided your question doesn’t risk breaching patient confidentiality, walking in between patients is a great time to ask questions. Coffee rounds after the ward round is also a good time to ask a question. The junior doctors usually use this time to clarify anything they are confused about and you can too. It’s also better to spread your questions out across the team,  so you don’t take up too much of a particular doctor’s time.

Linking Ward Rounds to Theory

Ward teaching is based on whatever patient walks through the door and so it won't always line up neatly with what you learn in the classroom. 

When you are about to start a specific rotation, revise the lectures related to it. Most of the time the ward rounds will be a great adjunct to lectures, particularly in real life management of the conditions. This is really important to know for clinical exams, especially as you reach the end of medical school.

As you progress, you will also want to make sure you know what the basic management guidelines for presentations are. Your textbooks will focus on medication and surgeries, but the doctors on ward rounds will take a holistic approach. They will consider what that a specific patient needs. Even if understanding each patient’s needs seems highly specific to that one case, over time you will start to recognise patterns and learn broad management strategies for all the conditions which incorporate things from allied health, social support and financial assistance.

Ward Rounds Make You Hungry

Some ward rounds were quick, like my surgical ones but others stretched across 7-8 hours. It’s particularly challenging to keep up your energy levels during long ward rounds. When I start to get hungry, I often disengage from learning.

The easiest way around this is to carry some food with you. I don’t mean a burger or anything obvious, that would look unprofessional and put you at risk of infection. I usually carry a few almonds or lollies in my pockets. This can be really helpful because you can eat them discreetly between patients.

It’s a bonus if you are on surgical rotations because scrubs are great for carrying stationary, books, calculators, tendon hammers and food (they can pretty much fit everything).

How to Keep Learning in the ‘In-between Times’

As a medical student you may feel like you can’t do much in the team, but the truth is far from it. Most teams are happy for you to check the vitals, interpret the ECG, type up notes or even examine the patient. However, in my experience, most teams won’t ask you to do it. You’ll have to use your initiative and suggest it. This can be scary, but having the team pick up on your mistakes is a great learning experience.

One of my colleagues, Sarah, wrote a whole article about what to do in those times when you're waiting around on the wards, I suggest you check it out below.

15 Things to Do with Your Spare Time on the Wards

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