Where Medicine Happened: What Bedside Rounds Taught

Bedside rounds used to be where medicine happened. Then medicine became too big.

The bedside round — the attending and residents and students gathering around the patient's bed, examining the patient, discussing the case in the patient's presence — was the standard format for clinical teaching in American medicine for approximately one hundred and fifty years, from the late nineteenth century through the 1970s and 1980s. In the last thirty to forty years, bedside rounds have been progressively replaced by hallway rounds, conference table rounds, and virtual rounds conducted from a workstation or conference room. The shift was driven by practical constraints: more patients, more data, more complexity, more efficiency pressures. The pedagogical and relational consequences of the shift have been less visible.

This essay is about what bedside rounds were built to teach, and what the teaching looks like when the bedside is no longer the site where teaching happens.

The Structure and Its History

William Osler, the founding physician of Johns Hopkins Hospital (1893), established bedside teaching as the standard format for medical education in the United States. The model was European — Osler had trained in Vienna and London — but he systematized it and made it the anchor of American medical teaching. The attending and trainees would spend hours at the bedside. The patient was the case; the patient's body was the text; the patient's response to treatment was the experiment.

The structure served multiple functions simultaneously. It was clinical work — the team was seeing patients, making diagnoses, adjusting treatments. It was teaching — the senior physicians were demonstrating how to think about clinical problems by thinking about them aloud while examining the patient. It was research — the cases seen became the basis for clinical observation and publication. It was social — the team was a unit organized around the shared work of caring for the patient.

The format persisted for most of the twentieth century because it worked. It produced physicians who could examine patients thoroughly, who could reason about cases at depth, who could communicate with patients, and who understood the work of medicine as fundamentally relational. The format also had constraints: it was time-intensive, it could not scale to large numbers of patients, and it required the patient's tolerance for multiple clinicians examining and discussing them.

The Shift

The shift away from bedside rounds accelerated in the 1980s and 1990s, driven by several converging factors.

The growth in medical data. Bedside rounds conducted in the patient's presence were limited in how much data could be discussed. You could not spend three hours reviewing a patient's imaging and lab results while standing at the bedside. The shift to workstation-based rounds and table rounds allowed clinicians to incorporate more data more efficiently.

The growth in patient volume. Attending physicians in academic medical centers went from managing fifteen to twenty patients to managing thirty to forty or more. Bedside rounds at even thirty minutes per patient per day would consume the entire workday. Hallway rounds, conducted in fifteen minutes per patient, made it possible to round on more patients.

The professionalization of nursing. As nursing professionalized and developed its own expertise, bedside rounds organized around the attending's examination and the residents' learning became less compatible with the nursing staff's role. The bedside round was structured around the physician's teaching; the nurse was present but not centered. As nursing's clinical role expanded, the format became awkward.

The growth of technology. The ability to remotely access patient data, imaging, and test results meant that clinicians could no longer claim that the bedside was the site where all the relevant clinical information was available. The most important information was increasingly in the computer, not on the patient.

The expansion of critical care. ICU patients could not tolerate multiple clinicians examining them repeatedly. The ICU round became more efficient when conducted outside the patient's room, checking in for brief observations rather than spending time at the bedside.

What Bedside Rounds Taught

A bedside round organized the learning differently than hallway or table rounds do.

It made the patient visible. The residents were not discussing an abstract case. They were discussing the person in the bed, whose facial expression, whose tone of voice, whose body language, whose response to the examination was part of the clinical data. The patient's presence changed the reasoning. The resident who had to explain the diagnosis to the patient present learned to translate medical reasoning into language the patient could understand. The resident who observed the patient's emotional response to the plan learned to incorporate the patient's perspective into the assessment.

It embedded clinical reasoning in embodied practice. The attending who examined the patient while discussing the case was not just talking about how to examine for heart murmurs; she was demonstrating it with her hands, her stethoscope, her questions to the patient. The resident who watched and then performed the examination and reported the findings was learning a practice that was visual and tactile, not just verbal.

It made the hierarchies visible. In a bedside round, the attending is in charge, the residents are learning, the students are observing, and the patient is the reason everyone is there. The hierarchy is clear because everyone is in the same space doing the same work. In a hallway round or table round, the hierarchy is still there, but it is less visible because the patient is absent.

It organized rounds as a teaching ritual. The bedside round was not just the most efficient way to see patients; it was a form of ritual that did pedagogical and professional formation work. The gathering at the bedside, the examination, the discussion, the resolution — this sequence was repeated daily and constituted a professional practice that residents internalized as "how medicine is done."

It required accountability to the patient. The resident presenting a case at the bedside had to be prepared to answer questions not just from the attending, but from the patient. The attending had to be prepared to explain clinical reasoning to the patient. The presentation had to be rigorous because it was being given in the patient's presence.

What Hallway and Table Rounds Gained and Lost

Hallway rounds allowed more efficiency and more data review. A team could now see more patients and discuss more complex information. The teaching became more focused on clinical reasoning about the data rather than on bedside examination skills or communication with patients.

Table rounds, conducted in conference rooms, added even more efficiency and structured the discussion around imaging, laboratory data, and case presentations rather than around the patient. The patient became a data point — a name on a slide, a set of vital signs and test results — rather than a person in a bed.

Virtual rounds, conducted from a workstation or conference room with video access to the patient, added the capacity to do rounds without being physically present at the hospital. The efficiency gains were substantial. The relational and pedagogical losses were harder to quantify but arguably as substantial.

The gains were real. Modern medicine's complexity — the data volume, the imaging sophistication, the pharmacology depth — could not be managed through bedside rounds alone. The losses were also real: residents learned less about examining patients, learned less about communicating with patients, learned less about the relational aspects of clinical practice.

What Nursing Knows About Bedside Presence

Nursing has maintained bedside presence in a way medicine has not. Nursing rounds are still organized around the patient. The nurse is at the bedside managing patient care throughout the day. The nursing assessment is conducted at the bedside and is not delegated to technology or to distance.

This is not incidental to nursing's practice. It is central. Nursing's epistemic standpoint (as Issue 001 and Issue 012 argued) is grounded in bedside presence. The nurse who is continuously at the bedside sees what the physician who rounds briefly does not see. The nurse who knows the patient's baseline function, mood, trajectory, and response to treatment across hours has information the physician who sees a snapshot does not have.

Medicine could learn from this. The bedside is still a site where clinical information is available. The shift away from bedside rounds was justified by efficiency and data management, but it was also an epistemological loss: the loss of the patient as a person and as a site of clinical knowledge.

Recovering Bedside Rounds

This is not a proposal to eliminate hallway or table rounds. The efficiency and data access they provide are real necessities in modern medicine. This is a proposal to restore bedside rounds as a regular practice, even if not the sole format for teaching rounds.

A medical program that built bedside rounds back in — even if less frequently than the daily rounds of the mid-twentieth century — would produce residents who had practiced examining patients, communicating with patients, and incorporating the patient's presence into clinical reasoning. A program that kept bedside rounds central to the weekly teaching schedule, even while maintaining hallway rounds for daily efficiency, would be teaching the bedside as a site where clinical knowledge is produced.

The patient who is examined and discussed in her presence learns something different than the patient who is discussed in her absence. The resident who conducts rounds at the bedside learns something different than the resident who conducts rounds at a distance. The attending who teaches at the bedside models a practice of medicine that centers the patient.

The bedside is still there. The information is still there. The patient is still there. What changed is that medicine stopped organizing its teaching around the bedside as the primary site where medicine is practiced and taught. Recovering that practice would not mean abandoning modern medicine's data and efficiency. It would mean remembering that the bedside is also a site of clinical knowledge and professional formation.

About the author

Peter Schindler, MD, PhD is an Assistant Professor of Medicine and Associate Program Director of the Community Health Center Family Medicine Residency Program at the University of Nebraska Medical Center. He practices at Winnebago Comprehensive Health System, OneWorld Community Health Center, and Nebraska Medicine. He completed a Primary Care Research Fellowship at McGill University and holds a BSN from the University of Wisconsin-Oshkosh, an MS and PhD in nursing from Emory University's Laney Graduate School, a Diploma in Tropical Medicine from the Liverpool School of Tropical Medicine, and an MD from the Medical College of Wisconsin-Green Bay. He is board certified by the American Board of Family Medicine. The Interprofessional publishes new essays every week at the intersection of medicine, nursing, and the clinical knowledge that lives between them.

Disclaimer. The views in The Interprofessional are Peter Schindler's own and do not represent the official positions of the University of Nebraska Medical Center, Winnebago Comprehensive Health System, OneWorld Community Health Center, Nebraska Medicine, or any other affiliated institution.