Effect Of Structured Learning Ward Rounds On Clinical Reasoning And Learner Engagement Among Postgraduates In Clinical Department. A Quasi-Experimental Study

Abstract

Background: Ward rounds are an integral component of postgraduate medical education, providing opportunities for bedside teaching, clinical reasoning, and professional skill development. However, conventional ward rounds often lack structure, limiting learner participation and educational effectiveness. Structured Learning Ward Rounds (SLWRs) have been proposed to enhance clinical learning through guided discussion, active engagement, and reflective practice.

Aim: To evaluate the effect of Structured Learning Ward Rounds on clinical reasoning and learner engagement among postgraduate residents in clinical departments.

Materials and Methods: A prospective quasi-experimental pre–post interventional study was conducted among 25 postgraduate residents from the Departments of General Medicine and Pediatrics at Government Thoothukudi Medical College, Tamil Nadu. Baseline clinical competency was assessed using the Mini Clinical Evaluation Exercise (Mini-CEX). Structured Learning Ward Rounds based on the SNAPPS model were implemented for 6–8 weeks. The intervention included structured case presentation, problem prioritization, differential diagnosis generation, faculty-guided clinical reasoning discussions, evidence-based management planning, bedside teaching pearls, and reflection. Post-intervention assessment included Mini-CEX evaluation and a perception questionnaire. Data were analyzed using the paired Student’s t-test.

Results: A total of 25 postgraduate learners participated in the intervention. Significant improvements were observed across all competency domains following implementation of structured learning ward rounds. Mean scores increased from 4.32 ± 0.85 to 7.20 ± 0.76 for history taking, 4.16 ± 1.11 to 7.32 ± 0.85 for clinical reasoning, 3.68 ± 1.18 to 7.16 ± 0.69 for counselling skills, and 3.20 ± 1.12 to 7.08 ± 0.64 for professionalism (all p < 0.001). Overall competence improved significantly from 4.44 ± 0.92 to 7.28 ± 0.74 (p < 0.001). Feedback from 13 participants indicated high levels of satisfaction, with 100% strongly agreeing that they were satisfied with the intervention. Most participants strongly agreed that structured ward rounds enhanced clinical reasoning (76.9%), improved learner engagement (76.9%), encouraged active participation (69.2%), and provided a positive learning environment (92.3%).

Conclusion: Structured learning ward rounds significantly improved postgraduate learners’ clinical competencies, including history taking, clinical reasoning, counselling skills, and professionalism. The intervention also enhanced learner engagement, participation, and satisfaction while fostering a positive educational environment. These findings support the integration of structured ward rounds into routine postgraduate clinical training as an effective strategy for strengthening workplace-based learning and improving overall clinical competence.