Practice Teaching Rounds

Teaching on a ward round

BMJ 2008; 337 doi: (Published 02 December 2008) Cite this as: BMJ 2008;337:a1930
  1. Jean Ker, director of clinical skills1,
  2. Peter Cantillon, senior lecturer2,
  3. Lucy Ambrose, clinical lecturer in medical education1
  1. 1Clinical Skills Centre, University of Dundee, Ninewells Hospital, Dundee DD1 9SY
  2. 2Department of General Practice, National University of Ireland, Galway [email protected]
  1. Correspondence to: J Kerj.s.ker{at}

    A deliberate and planned approach to bedside teaching will make learning more effective

    Teaching on a ward round has been compared to walking a tightrope. A clinical teacher has to balance the differing needs of undergraduate and graduate learners while providing a comprehensive and safe clinical service. Teaching in the presence of patients is an additional tension because the patient plays a central role and also is the most attentive member of the audience. Ward round teaching remains a powerful teaching context in medicine as it provides an authentic experience of the complexity of patient care and professional practice.1 2 The enduring value of the ward round lies in its potential to model professionalism, enhance clinical reasoning,3 and demonstrate the cultural norms of medical practice.4 5

    We have developed six questions that can routinely be used to plan and deliver effective bedside teaching on ward rounds (fig 1). The questions are derived from empirically based theories of experiential and situated learning.6 7 8

    Fig 1 Six questions for planning a teaching ward round

    What is the plan (for teaching and learning)?

    Most clinical teaching is done on the hoof, but ward based teaching is more effective if it is planned. This can be difficult on a busy ward. When the senior clinician arrives for a ward round, there is usually a brief conference with team members and then “off we go.” However, taking five minutes at the start to think about the learners, the teaching opportunities, the teaching goals, and the tasks will increase the efficiency and effectiveness of teaching enormously.

    It is important to consider what sort of ward round it is. For example, a ward round that follows a night when team members were on call (a post-take ward round) will be longer than usual but may offer more teaching opportunities. …

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