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. A mobile version of this Task is available as part of the JDocs subscription and directly records results into your JDocs Portfolio.

  • 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

Related Competencies:

Collaboration and teamwork

Recognise the roles and responsibilities of other professionals within the healthcare team; respect and listen to their concerns about the patient

Collaboration and teamwork

Well prepared for ward rounds and patient management

Collaboration and teamwork

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

Communication

Comply with organisational policies regarding comprehensive and accurate documentation

Communication

Use electronic resources in patient care, e.g. to obtain results, populate discharge summaries, access medicines information and maintain health records

Communication

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

Health advocacy

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

Health advocacy

Show respect for patient treatment choices

Judgement and clinical decision making

Can explain indications, contraindications and risks involved in decision making regarding common procedures

Judgement and clinical decision making

Can differentiate between available investigations by identifying their risks and benefits

Judgement and clinical decision making

Use available evidence effectively and efficiently to inform clinical decision making

Leadership and management

Respond positively to direction

Leadership and management

Take responsibility for any task delegated

Leadership and management

Identify and follow patient care protocols, for example:

Medical expertise

Follow stages of a verification process and comply with the organisation’s procedures to ensure correct identification of a patient

Medical expertise

Understand the key features of antibiotic prophylaxis and appropriate therapeutic use, noting local protocols and the Therapeutic Guidelines (Antibiotics)

Professionalism

Maintain and respect patient privacy and confidentiality

Collaboration and teamwork

Recognise expertise and roles of other health team members and staff

Collaboration and teamwork

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

Communication

Can explain the common conditions of the unit effectively to patients and undertake informed consent for common elective and emergency conditions

Communication

Explain clinical reasoning to current health team using concise language and a structured approach

Communication

Keep patients and significant others informed of management plan progress

Communication

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

Health advocacy

Recognise vulnerable or marginalised populations who may have limited access to healthcare resources within the hospital community

Health advocacy

Consider how culture, beliefs and health literacy can affect patient understanding of their care and expectations

Health advocacy

Recognise own cultural values/biases that may impact on role as a doctor and in interactions with others

Health advocacy

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

Judgement and clinical decision making

Review patients on a regular basis and make decisions based on their response to treatment

Judgement and clinical decision making

Retrieve and use high-quality information from electronic sources for clinical decision making. Document decisions and reasons for same

Judgement and clinical decision making

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

Medical expertise

Perform a comprehensive examination of all systems

Medical expertise

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 products
  • 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
Medical expertise

Specify peri-operative management of anticoagulants and antiplatelet agents and recognise prescription and/or administration errors

Medical expertise

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

Professionalism

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

Collaboration and teamwork

Effectively prioritise patients with multiple medical conditions of varying disease severity

Collaboration and teamwork

Engage junior doctors, nursing and ancillary staff in ward rounds

Communication

Use effective strategies to deal with difficult or vulnerable patients

Communication

Set an appropriate tone for any communication with patients and their families, peers and colleagues

Communication

Communicate effectively with complex patients to take clinical history, identifying key comorbidities, e.g. use open and closed questions to elicit information

Communication

Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management

Communication

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

Health advocacy

Identify any gaps between management plan and patient wishes

Health advocacy

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

Judgement and clinical decision making

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

Leadership and management

Delegate appropriate tasks to junior members, ensuring supervision is maintained

Medical expertise

Present complex cases effectively to senior medical staff and other health professionals

Medical expertise

Evaluate outcomes of medication therapy. Monitor and review the patient’s response to treatment

Medical expertise

Provide appropriate aftercare and arrange follow-up for all procedures

Medical expertise

Audit own and team performance in relation to patient progress and outcome

Professionalism

Act as a role model of professional behaviour in the workplace

Scholarship and teaching

Use multi-disciplinary team meetings as teaching and educational opportunities

Scholarship and teaching

Adapt level of supervision to learner’s competence and confidence