Ward Rounds as Sociotechnical Learning Environments in Medical Education: A Scoping Review (Preprint)

BACKGROUND Ward rounds are central to clinical care and medical education, serving as primary settings for developing clinical reasoning and professional identity. While traditionally viewed as isolated teaching events, they are increasingly recognized as complex sociotechnical learning environments where digital tools, workflows, and hierarchies are not external constraints but constitutive components of the learning process. As digital health and artificial intelligence (AI) become more embedded in clinical practice, understanding how these elements interact to shape education is essential. OBJECTIVE The objective of this scoping review is to map the existing literature on ward rounds as sociotechnical learning environments in undergraduate and postgraduate medical education, exploring how digital technologies, organizational structures, and sociocultural dynamics influence learner participation and clinical reasoning. METHODS A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Joanna Briggs Institute (JBI) methodologies. The PCC (Population, Concept, Context) framework was used to define eligibility: population included medical students and residents; the concept focused on sociotechnical interactions (human actors, digital tools, and organizational factors); and the context included all inpatient settings. Comprehensive searches were performed in MEDLINE (PubMed), Scopus, Web of Science, ERIC, and LILACS from inception to the final search date. RESULTS A total of 26 studies were included in the final synthesis. Findings indicate that digital technologies, such as EHR integrated checklists and dashboards, structure inter-professional communication but can also shift attention toward the interface rather than the patient. Learning is consistently negotiated between clinical service demands and educational goals. Rigid hierarchies and frequent interruptions (averaging 12.6 per round in some studies) were found to limit junior learners' participation in diagnostic reasoning. Geographic variations showed that high income settings focus on efficiency and digital safety, whereas literature from low- and middle-income countries emphasizes the clinical method and professional values. CONCLUSIONS Ward rounds are workplace learning episodes co-produced by the interaction of people, tools, and routines. To improve educational quality, design efforts should focus on "designing participation" and making clinical reasoning audible within the natural workflow, rather than focusing on isolated teaching behaviors.