Acing rounds: Keys to success as a resident

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published April 1, 2022

Key Takeaways

  • Rounds are a challenging and critical part of a successful residency.

  • A few common strategies—such as nailing down the basics and prioritizing—can help you "ace" them, regardless of the specific form they take.

  • Learn by observing how the attending physician addresses the patient and their family, how they channel compassion, and how they interact with other staff.

It’s impossible to overstate the importance of rounds for residents. Conducting successful rounds—commonly defined as how physicians promenade the floors—is a crucial part of any residency.

The first rounds were introduced in the late 1800s by William Osler at the Johns Hopkins University Hospital. Ever since then, rounds have taken various iterations. Instead of the classic bedside presentations, some attending physicians (commonly referred to as “attendings”) prefer to meet outside a patient’s room or in a conference room.[]

Some rounds only include physicians, whereas others involve multidisciplinary teams of doctors, advanced practice providers, nurses, pharmacists, and more. Some attendings allow use of computers-on-wheels, while others eschew this practice.

Whatever specific form your rounds take, there are common ways to prepare for them. We’ve gleaned tips from various sources that can help you as an enterprising resident make the most of rounds.

 Tip #1: Nail the basics

A carpenter may carry a variety of tools such as a spud wrench or tailpipe cutter, but at the end of the day, few get used more than hammers and wrenches. Similarly, physicians should keep in mind the most basic diagnoses above all, and nail their knowledge of these concepts. 

Common concerns on a typical assessment and plan would include bowel regimens, pain control, atrial fibrillation, antibiotic regimens for pneumonia, and low urine output.

Good resources for brushing up on evidence-based management of common conditions include the Intern Night Float Survival Guide from SUNY Upstate Medical University and the Family Practice Notebook.

Tip #2: Keep a system 

A good schema is worth its weight in gold. Time saved from having a system in place can enable you to round more effectively, sign out earlier and facilitate the transfer of information more seamlessly. 

Although the schema you follow should be tailored to your personal preferences, some useful tools include colored pens, to-do checklists, Evernote, and common questions asked to new consults. 

To stoke your preparation efforts, try a resource like these pre-round notes from Stepwards. There are spaces on these crib sheets for information on patient conditions and details, as well as a “one-liner” that includes the patient’s name, length of hospital stay, and main clinical issue(s).

Tip #3: Prioritize

In real-estate, the buzzword is “location”; in medicine, it may as well be “prioritization.” Medical students, interns and residents are drilled with the notion that their approach to patients must be prioritized, including their history and physical exam, list of differential diagnoses and assessment and plan. Rounding needs to be prioritized, too.

Priorities on rounds include patients who need immediate action such as those up for discharge or needing immediate treatment, tests, or assessments. 

Prioritization is a feature of highly effective rounding, note the authors of an article published in the Journal of Graduate Medical Education explain, because it “allows team members to initiate important decisions sooner and thereby improve patient throughput and quality of care.[]

"Articulating why patients are being seen in a particular order also teaches learners how to prioritize patient care, a valuable skill for their future careers. "

Journal of Graduate Medical Education

Tip #4: Have a plan

Every physician on rounds should have a general plan for their patients without referring to any external notation or documentation. Physicians should keep in mind when patient visits should end and what should be accomplished in a timely fashion. 

On busy days, this plan can be streamlined to hit on everything important without compromising care. Perhaps an efficient approach would be to cut down pre-rounding and standardize approaches to each case.

A tight, focused, patient-centric approach not only boosts patient and staff satisfaction, but also enhances workflow while decreasing physician workload.

Tip #5: Observe

As an intern or resident, your role is not only to serve patients, but also to learn. Not all lessons are necessarily medical in nature; patient interaction skills can also be observed. Examples include how the attending physician addresses the patient and their family, how they channel compassion, and how they interact with other staff.

One resident did an about-face in his approach to rounds, as described to Thalamus: “I used to think that I had to ‘prove’ how much I knew to my attending. Oftentimes, this meant I was speaking more than I was listening. I was defending my proposal on rounds more than I was open to accepting new ideas. Then, a senior faculty member said—in a very caring and kind way—that on the spectrum of all interns, the smartest are the ones who shut up and listen.”[]

What this means for you

Acing rounds is a challenging but worthwhile goal. Fortunately, there are many steps you can take to bring your A game. Useful tips include: Knowing how and what to prioritize during rounds; perfecting your knowledge of common conditions; and keeping a system.

Read Next: Adopting a growth mindset during residency
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