Longer Internal Medicine Rounds Did Not Translate Into Higher Exam Scores
A nationwide Japanese study has drawn a sharp line between time spent on attending rounds and measurable performance on an in-training examination. Among 6,347 postgraduate year 1 and 2 residents who completed the 2023 General Medicine In-Training Examination and a post-examination survey, longer weekly round duration was not associated with better scores. In fact, residents reporting 6–10 hours of weekly internal medicine attending rounds had lower internal medicine domain scores than those reporting 1–2 hours, and the same pattern appeared in the group reporting 11 hours or more.
The finding challenges a common assumption in bedside teaching: more time at the patient’s side should automatically yield more learning. In this cohort, duration alone was a poor proxy for educational value.
Exam Performance Fell as Round Time Increased Beyond 2 Hours
Weekly internal medicine attending round time was grouped into none, 1–2, 3–5, 6–10, and at least 11 hours, with 1–2 hours serving as the reference category. Of the residents included, 44.1% reported that 1–2 hours of weekly attending rounds best matched their experience, making that the most common exposure level in the dataset. Mixed-effects linear regression models adjusted mean differences in both internal medicine domain scores and total GM-ITE scores.
Compared with 1–2 hours of attending rounds, 6–10 hours was associated with an adjusted mean difference of −0.47 in internal medicine scores, with a 95% CI of −0.77 to −0.17. The ≥11-hour group showed an even larger decrement, −0.70 with a 95% CI of −1.22 to −0.19. The same overall direction held for longer bedside attending round time during general internal medicine rotations, which was also associated with lower scores.
Longer rounds did not buy better test performance.
What the Pattern Suggests About Bedside Teaching
The result does not prove that attending rounds are unhelpful. It does suggest that simply extending time on rounds may not strengthen the kinds of knowledge measured by the GM-ITE. Internal medicine rounds are often expected to combine case-based reasoning, clinical exposure, feedback, and team supervision. Yet when duration expands without a clear structure, the educational yield may flatten or even fall if attention is dispersed, teaching points are diluted, or residents spend more time observing than actively reasoning through cases.
The biology of learning in clinical training is not measured in hours alone. Repetition matters, but so does cognitive engagement, the chance to retrieve information under pressure, and the quality of feedback delivered in real time. A long round can become a passive procession of cases, while a shorter, tightly focused round can force residents to synthesize differential diagnoses, management decisions, and evidence-based reasoning more efficiently. The study’s design cannot separate those mechanisms, but the association is consistent with a teaching environment in which time is not the same as instruction.
Why the Internal Medicine Domain May Be Sensitive to Round Structure
Internal medicine training depends heavily on apprenticeship. Residents are expected to absorb clinical reasoning while balancing workload, documentation, and service demands. When bedside rounds become lengthy, the educational signal may be obscured by fatigue, competing tasks, or decreased opportunity for residents to speak, present, and receive corrective feedback. Examination performance may then reflect not only knowledge acquisition but also the efficiency of the teaching environment.
This is especially relevant during postgraduate year 1 and 2, when residents are still consolidating the framework for common internal medicine problems. If round time increases without improving interaction, the added minutes may not translate into better schema formation or deeper retention. The study does not measure those intermediate processes directly, but the negative association with exam scores fits a plausible educational explanation: more exposure is not equivalent to more learning when the format is passive.
A Nationwide Snapshot of Japanese Residency Training
The investigation used a nationwide cross-sectional design, which gives the findings broad reach across Japanese residency training settings. Residents completed the 2023 GM-ITE and a post-examination survey, allowing investigators to compare reported round exposure with standardized exam performance. Because the analysis adjusted for other factors through mixed-effects linear regression, the association between attending round time and internal medicine scores was not a simple unadjusted comparison.
Still, the design has limits. A cross-sectional study cannot determine whether long rounds caused lower scores or whether residents in more demanding or lower-performing environments were simply assigned to more prolonged bedside teaching. Rotations with heavier service burdens, more complex patients, or different supervision styles could shape both round length and exam performance. The data also rely on self-reported weekly round time, which may not capture variation in teaching quality, resident participation, or the educational content delivered during those hours.
Bedside Teaching Needs More Than Minutes on the Clock
For program directors and attending physicians, the practical message is straightforward: protected time for rounds matters, but duration alone should not be treated as a surrogate for educational quality. The study points toward the need for better-defined bedside teaching rather than merely longer bedside teaching. If the goal is stronger resident performance in internal medicine, the structure of rounds, the frequency of active questioning, the quality of feedback, and the clarity of teaching objectives may matter more than a longer schedule.
The finding also raises a question for residency curricula elsewhere. Institutions often debate how to preserve bedside instruction in a crowded training day, but this analysis suggests that adding more hours without sharpening the teaching method may not improve what residents know when they sit for an in-training exam. In that sense, the study is less an argument against attending rounds than an argument for making every minute on rounds count.
The authors received support from JSPS KAKENHI, and the study was approved by the Ethical Review Committee of the Japan Institute for Advancement of Medical Education Program. Informed consent was obtained from all participants. The remaining question is not whether bedside teaching should continue, but which features of rounds actually drive learning and whether those features can be measured more accurately than duration alone.