All medical trainees and junior doctors have that moment of dread when the resident or attending physician focuses their gaze on them during ward rounds. Because what follows is an intense nerve-wracking bout of questioning regarding whatever comes to the physician’s mind regarding the patient. This practice is a time-honored practice in clinical medicine. In its ideal state, it is intended as a form of Socratic instruction. When the instructor asks questions using the Socratic method, the “answer” and the “goal” of instruction should be known. It is an unstructured form of teaching since the questions and follow-up questions depend upon the clinical scenarios as well as the replies. This creates unique opportunities which lead the student to solve the problem themselves by applying the basics to a clinical scenario. Subsequent teaching conducted along this line of questioning then, must focus on the level of the student’s knowledge level and teaching must be oriented towards to it. This would promote critical thinking and adaptability of the students when faced with challenges in their professional career.
The question then comes as to why this method is so dreaded by most students. The unstructured nature of interrogating trainees in ward rounds can lead to vastly different experiences based on the medical educator as well as the student. Designing the line of questioning based on the students’ knowledge and guiding them to reach the intended goals of teaching requires dedication and experience on the part of the teacher. Unfortunately, in some situations this cannot be seen. If the instructor is rigid, students would be afraid to explore alternative approaches to the questions asked and be hesitant to expand the discussion for fear of facing the wrath of the instructor.
Harassment and mistreatment of students have become topics of increasing concern in medical education; and fear-inducing interrogation of students has been seen as one of the main sources of bullying in medical school. While some students excel in handling these high-pressure situations, not everyone handles it so well. This may lead to students feeling embarrassed when they show a lack of knowledge in front of their peers and patients. Which in turn causes increased stress and anxiety leading to burnout.
To overcome these issues the medical educator needs to display empathy towards students and focus more on questioning principles and making connections to develop knowledge instead of focusing on minutiae. Identifying the level of knowledge of the students and teaching to that level must be done. This can be established by asking questions to assess the students’ baseline knowledge level. A significant proportion of the responsibility in making the ward round teaching effective, fall on the students too. Since the teaching cannot continue if they do not engage in the discussion properly.
A structured approach to ward rounds has been used to great success in some institutions. This requires a greater level of commitment and dedication on the part of the instructors and students but if designed properly it can lead to great results.
References available.
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Shakya Weeraratne is a final year medical student in Sri Lanka.
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Interrogating medical trainees in ward rounds: Fear and the Socratic method
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