The 7 habits of highly effective rounding.

In this issue of the Journal of Graduate Medical Education, Sandhu et al1 evaluate the differences between highly effective and low-yield family-centered bedside rounds. The “manager,” or rounds leader, must engage in a high level of planning and collaboration, and the leader's managerial skills were found to be crucial to creating a successful educational experience for the team. Where are these skills taught in a typical residency curriculum? They are not explicitly mentioned in the Accreditation Council for Graduate Medical Education core competencies, although it could be argued that practice-based learning, systems-based practice, and communication skills are all part of the skills set of an effective manager.2 Pilot projects have sought to prepare residents for the real world after residency,3 but they have not been systematically incorporated on a national level. In Canada, the site of this study, the 7 CanMEDS competencies are used to assess trainees, with 1 of these encompassing the role of manager.4 However, it is not clear that the importance of the manager's role is widely recognized in all settings. When asked to rate the importance of the CanMEDS' manager role, Danish residents ranked it lower for outpatient versus inpatient specialties.5 Managerial skills often are taught through an “informal curriculum,” the intentional or unintentional example set by the attending physician or senior resident leading rounds.6 Steven Covey's Seven Habits of Highly Effective People was the first of many best-selling management books offering self-management strategies.7 Covey's work has long been thought to have practical applications in systems improvement,8 including that in health care. We offer evidence from the literature in business management,9 as well as medicine, using Covey's 7 habits as a framework for conducting effective family-centered bedside rounds. The aim is to emphasize practices that likely will serve physicians well in the management of medicine as well as in their personal lives.