The Flipped Ward Round

(For a quasi-related topic on making efficient use of teaching time, check out the Flipped Classroom here -Jonathan (@sherbino))

By Anthony Llewellyn (@hetimeddir)

I’d like to introduce to the world a prioritization technique or tip that I have used for some time.  I call it the “Flipped Ward Round.”

As a psychiatrist predominantly in administration or educational roles, my clinical time has often been limited.  I have over the years found it particularly helpful to briefly fill in for my colleagues during their periods of leave, rather than having a regular clinical load myself.  This has been highly popular for my colleagues with the added benefit of giving me greater exposure to a range of services.

In doing these intra-service locums I inherit established processes around the review of patients, whether a patient list or a ward round process.  In general these processes include a very static, linear, process (i.e. the format for a ward round discussion would generally start with a discussion of Mr Jones in Bed 1, then Mrs Smith in Bed 2 and so on and so forth down to Ms Brown in Bed 24.) For readers familiar with the pitfalls of meetings where time is not allotted to agenda items you are no doubt aware that the same problem can occur on ward rounds, there is an overgenerous discussion of cases at the top of the list and inadequate time allocated to patients at the bottom of the list.  This can of course lead to issues not being properly addressed for such patients, errors of omission and unnecessarily lengthy stay.

So, my approach to this problem is simple.  As the “intra-service locum” consultant I found it fairly easy to convince the rest of the team to indulge me in a simple experiment.  “What if we start at the bottom of the list this time?”  It would often lead to some interesting discussions about patient problems that had been overlooked up until that point.

I wonder if there is something in this for us as medical educators as well?  Do we get hooked on to do lists?  Do we tend to dwell too much at the top of these and neglect important issues at the bottom?  When we design new courses do we often find ourselves flagging for ideas toward the end?  Do the topics at the end of a seminar series get as well covered as those at the start?  Maybe we should #fliptheorder?