Teaching and learning in clinical rounds: a qualitative meta-analysis

Objective: Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main factors in the clinical environment are not identified. Methods: A systematic review of English articles using Web of Science, PubMed, Embase, Scopus and Cochrane library were conducted. Relevant keywords and their synonyms were used for the domains “medical students/clinical teachers/barriers and clinical round”. Additional studies were identified by searching reference lists of retrieved articles. All searches for English language articles were conducted within a 10-day period from 25 May to 3 June 2017. No time limit was considered for article searching. We contacted Kerman University of Medical Sciences to locate some studies due to access limitation. In this systematic review, studies on the subject of barriers to clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 600 articles. After title and abstract review, 43 of these were obtained and finally 20 were included in the study. All data were abstracted from the included studies. Two authors independently screened the studies. We used inductive content analysis and categories of barriers were derived from the data. MAXQDA software version 10 was used for data analysis. Results: A total of 20 articles were included and analyzed in depth. Content analysis yielded identification of 320 codes concerning barriers to clinical rounds in six categories classified as system-, climate-, teacher-, student-, patient-, and personnel-related factors. Conclusion: Our investigation depicts primarily main barriers in teaching on rounds. In this regard, effective teaching in clinical rounds is not obtained unless barriers concerning the learning triad and its environment are explored and necessary actions are adopted accordingly.