INNOVATION AND IMPROVEMENT
Asking a Variety of Questions on Walk Rounds: a Pilot Study
Helen M. Shields, M.D
, Stephen R. Pelletier, Ph.D
, Christopher L. Roy, M.D
James P. Honan, Ed. D
Harvard Medical School, Boston, MA, USA;
Division of Medical Communications, Department of Medicine, Brigham and Women’sHospital,
Boston, MA, USA;
Office of Educational Quality Improvement, Harvard Medical School, Boston, MA, USA;
Hospitalist Service, Department of
Medicine, Brigham and Women’s Hospital, Boston, MA, USA;
Harvard Graduate School of Education, Cambridge, MA, USA.
BACKGROUND: Morning walk rounds have lost some of
their engagement while remaining a useful and valued
AIM: We created a pilot study to evaluate the impact on
rounds of learning to asking a variety of different questions.
SETTING: One-hour intervention sessions were voluntar-
ily offered to members of the Department of Medicine and
taught by an expert in the question, listen, and respond
PARTICIPANTS: Participants included attendings and
residents in Internal Medicine on medical teams.
PROGRAM DESCRIPTION: Questionnaires were collect-
ed 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
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 physi-
cians 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-medi-
cal teams’ survey responses did not change. Patient cen-
sus data indicated no significant difference in the hospi-
tal’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 partici-
pants who answered the online survey 9 months later,
75% (6/8) reported that they “actually asked a wider va-
riety of types of questions.”
DISCUSSION: This pilot study indicates that the 1-h in-
tervention 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.
KEY WORDS: asking questions; morning walk rounds; engagement;
worthwhile educational experience.
J Gen Intern Med 33(6):969–74
© Society of General Internal Medicine 2018
Morning walk rounds have lost some of their engagement
while remaining a useful and valued practice.
include high census counts, time pressures, and early dis-
Crumlish et al. noted hospitalists felt unprepared
to teach at the bedside.
In 1997, Ende encouraged preparation
for rounds and the use of questions to probe reasoning and
keep everyone on the team engaged and included in the
discussion at the bedside.
Ende referred to the Harvard Busi-
ness School method of leading discussions where using a
variety of questions is the major strategy for including every-
one in the conversation.
Recently, Carlos et al. in a review of bedside teaching
recommended that educators ask team members “relevant
questions” to keep those learning at the bedside “focused.”
The exact number of questions that residents ask on daily
work rounds was studied by Arseneau
who found that resi-
dents used few questions during work rounds. He recommend-
ed sessions to teach residents how to ask questions on work
rounds and to practice asking “effective questions.”
of pre-set self-assessment quiz questions at the start of rounds
followed by peer-to-peer discussion is another way to improve
learning on in-patient rounds.
Others have proposed “flip-
ping” teaching rounds to have “discussion and group work”
take place during rounds with lectures and presentation mod-
ules watched beforehand.
Harvard Business School’s method of question, listen, and
has received wide recognition as an interactive
method for teaching and involving all members of the class
with a variety of questions. We have previously successfully
used this method to teach small groups in GI Pathophysiology
at Harvard Medical School.
The positive feedback from
medical students and medical school faculty to the use of the
question, listen, and respond method was the impetus for
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11606-018-4381-2) contains supplementary
material, which is available to authorized users.
Received October 5, 2017
Revised February 1, 2018
Accepted February 22, 2018
Published online March 27, 2018