Lead a ward round

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to lead a ward round.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3. The doctor is encouraged to download the Key Clinical Task guidelines and seek the support of his/her supervisor for feedback on performance.

  • Is punctual, knows patients, aware of current issues and manages ward round allowing for patient workload
  • Demonstrates systematic approach to assessing patients
  • Develops good rapport with patients and relatives
  • Works well & communicates effectively with team members to provide clear instructions
  • Lead consultants, junior doctors, students
  • Discusses management plan effectively with consultant ; able to share this with patient
  • Teaches when appropriate (could be after ward round)
  • Delegates tasks, reviews notes
  • Supervises juniors including review of patients later in the day
  • PGY 1
  • PGY 2
  • PGY 3

  • Collaboration and teamwork

    • Recognise the roles and responsibilities of other professionals within the healthcare team; respect and listen to their concerns about the patient
    • Well prepared for ward rounds and patient management
    • Maintain accurate records and follow-up on investigation results
  • Communication
    • Provide updates to the current health team, e.g. new critical issues or changes in a patient’s condition
    • Comply with organisational policies regarding comprehensive and accurate documentation
    • Use electronic resources in patient care, e.g. to obtain results, populate discharge summaries, access medicines information and maintain health records
    • Gather information from a variety of sources and use it to ensure continuity of patient care, e.g. referral letters, case records, test results, electronic information
  • Health advocacy
    • Advocate for healthy lifestyle, and explain the environmental and lifestyle risks to health to patients, e.g. promote screening programs, vaccinations, cessation of smoking
    • Consider, and allow for, the impact of social, economic and political factors, as well as culture, ethnicity, sexuality, disability and spirituality, on patient illness and health
    • Show respect for patient treatment choices
  • Judgement and clinical decision making
    • Can explain indications, contraindications and risks involved in decision making regarding common procedures
    • Can differentiate between available investigations by identifying their risks and benefits
    • Use available evidence effectively and efficiently to inform clinical decision making
  • Medical expertise

     

  • Professionalism
    • Maintain and respect patient privacy and confidentiality
  • Collaboration and teamwork
    • Recognise expertise and roles of other health team members and staff
    • Support new unit (team) members
  • Communication
    • Use appropriate techniques and support when responding to patients and families in distress, and facilitate consultant involvement early in the process; to include participation in open disclosure discussions
    • Can explain the common conditions of the unit effectively to patients and undertake informed consent for common elective and emergency conditions
    • Explain clinical reasoning to current health team using concise language and a structured approach
    • Communicate effectively within multidisciplinary teams, reflecting an understanding of, and respect for, different health professional perspectives
  • Health Advocacy
    • Identify the common health issues relating to the clinical service and associated advocacy work undertaken by the hospital/health service
    • Recognise vulnerable or marginalised populations who may have limited access to healthcare resources within the hospital community
    • Recognise own cultural values/biases that may impact on role as a doctor and in interactions with others
    • Adhere to the limits of patient information that can be divulged in different settings, e.g. family and carers, ward rounds, handover
  • Judgement and clinical decision making
    • Identify and justify patient management options for common problems and conditions
    • Review patients on a regular basis and make decisions based on their response to treatment
    • Retrieve and use high-quality information from electronic sources for clinical decision making. Document decisions and reasons for same
    • Able to succinctly present the patient scenario and discuss management plan
  • Leadership and management
    • Contribute to multi-disciplinary team briefings about patients, e.g. ward meetings
  • Medical expertise
    • Present common cases effectively to senior medical staff and other health professionals
    • Perform a comprehensive examination of all systems
    • Work within unit-based protocols with regard to pre-operative assessment and care, operative procedures and post-operative care:
      • apply medical knowledge to clinical practice
      • implement and evaluate a management plan relevant to the patient following discussion with a senior clinician
      • identify when patient transfer is required, and manage risks prior to and during patient transfer
      • recognise indications for, and risks of, fluid and electrolyte therapy and blood product
      • provide appropriate aftercare and arrange follow up for common procedures 
      • safely manage anti-coagulant therapy and manage diabetes
      • recognise acute cardiac events and use relevant resuscitation/drug protocols
      • initiate resuscitation of the unwell patient. Recognise indicators for sepsis and implement clinically relevant plan
      • maintain a clinically relevant patient management plan of fluid, electrolyte and blood product use
      • recognise and manage fluid and electrolyte imbalances in a patient
      • effectively use semi-automatic and automatic defibrillators
      • provide appropriate aftercare and arrange follow up for more complex procedures
      • recognise when patients are ready for discharge and arrange referral to relevant members of the healthcare team to promote planning for safe discharge
    • Specify peri-operative management of anticoagulants and antiplatelet agents and recognise prescription and/or administration errors
    • Follow-up and interpret investigation results appropriately to guide patient management
  • Professionalism
    • Comply with legal requirements in patient care, e.g. Mental Health Act, death certification
    • Mindful of potential impact of resource constraint on patient care
  • Collaboration and teamwork
    • Collaborate effectively with other specialist teams involved in the patient’s care
    • Effectively prioritise patients with multiple medical conditions of varying disease severity
    • Engage junior doctors, nursing and ancillary staff in ward rounds
  • Communication
    • Use effective strategies to deal with difficult or vulnerable patients
    • Set an appropriate tone for any communication with patients and their families, peers and colleagues
    • Communicate effectively with complex patients to take clinical history, identifying key comorbidities, e.g. use open and closed questions to elicit information
    • Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management
    • Use graded assertiveness where appropriate
  • Health Advocacy
    • Acknowledge the potential impact of cultural differences in the acceptance of treatment for common conditions and work within those parameters
    • Identify any gaps between management plan and patient wishes
    • Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient
  • Judgement and clinical decision making
    • Use investigation findings to refine diagnoses for common conditions
    • Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan
  • Leadership and management
    • Demonstrate appropriate self-awareness and insight
    • Delegate appropriate tasks to junior members, ensuring supervision is maintained
  • Medical expertise
    • Present complex cases effectively to senior medical staff and other health professionals
    • Evaluate outcomes of medication therapy. Monitor and review the patient’s response to treatment
    • Provide appropriate aftercare and arrange follow-up for all procedures
    • Audit own and team performance in relation to patient progress and outcome
  • Professionalism
    • Act as a role model of professional behaviour in the workplace