Emergency ward rounds: an ethnographic study from communities of practice

Abstract

Introduction: Ward rounds constitute an essential practice in medical training, as they integrate clinical care with situated learning. In the emergency department, this activity gains particular relevance due to the need for collaboration, decision-making, and learning in high-demand contexts. However, in Latin America, there is limited empirical evidence regarding its formative dynamics.
Objective: To explore the dynamics and interactions of the teaching-learning process between students and instructors during ward rounds in the emergency department, using Lave and Wenger's theoretical framework of Communities of Practice (CoP).
Method: A qualitative study with an ethnographic approach was conducted in the emergency department of a teaching hospital of the Mexican Institute of Social Security, between July and November 2024. Observations and in-depth interviews were carried out. Data were analyzed using an abductive approach that combined inductive coding and theoretical deduction guided by the CoP framework. A reflexive stance was maintained, and participant confidentiality was ensured in accordance with the Declaration of Helsinki.
Results: The analysis revealed four dimensions of learning situated within CoPs: meaning (integration of theory and practice through guided reflection), practice (progressive participation and decision-making under pressure), community (cohesion and belonging through collaborative work), and identity (professional development through role modeling and shared norms). These dimensions illustrate how ward rounds in emergency care function as a dynamic and relational learning space.
Conclusions: Ward rounds in the emergency department represent a CoP in which residents construct knowledge, identity, and a sense of belonging through collaborative practice. The findings offer implications for designing educational strategies that strengthen clinical learning and participation in high-demand contexts.