This month I celebrate 30 years of ward attending.  I estimate that I have done over 100 months of ward attending during this time.  I find ward attending energizing, enjoyable and rewarding.  I hope my learners agree.

Here are some things I have learned:

1. Ward attending rounds should be enjoyable.  They can only be enjoyable if the attending sets a comfortable atmosphere.
2. Our job has two purposes – excellent patient care and learning for the students and residents.  The challenge of ward attending is that we must balance those two purposes.
3. Teaching does not equate to learning.  Our job is to induce learning.  We should not take it personally if we "teach" something and the student does not remember it the next day.  Repetition is good.  I often repeat questions to see if they remember.  When they do not remember I reassure them that learning comes from repetition.  When they do not remember the problem is mine not theirs!
4. Focus on the basics.  Learners at all levels need a firm understanding of the basics.  Never assume that residents know the basics as well as you think they do.  As a corollary we should work hard to know the basics.
5. Admit ignorance.  Few attending physicians know everything.  We all have holes in our knowledge.  When you do not know an answer, stop rounds and look it up.  If the question is important enough to pose, the answer is important enough to find.
6. In the patient's room, remember that the patient is the center of activity. We go to the bedside to interact with the patient.  Patients almost always are willing to have multiple examiners listen to lungs, heart, abdomen.  Patients do not mind some bedside teaching.  I always explain that I am going to teach the young physicians.  I often give the patient a bedside promotion to "assistant professor".
7. Accept graduated responsibility.  Do not dictate every detail of care to the resident.  Residents, interns and students need discussions of the plans.  What tests should we order and why?  How do we choose antibiotics?  What is the differential diagnosis?  How should we proceed today?  All of these questions allow for good patient care and learning without the learners feeling a sense of micromanagement. 
8. Praise good decision making.  Learners need encouragement.
9. Make expectations clear.  Students, interns and residents cannot read your mind.
10. Respect their time.  Time is their major currency.  Give the team enough time to do their work.

Related posts:

1. An old post – focus on basics
2. Teaching bedside manner
3. Can a 3rd year student influence his attending? @autolycos
4. Focus on pimping
5. Developing “set pieces” for ward-attending rounds

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