This article examines the literature on medical rounds to inform the recent move toward instructional rounds as a practice of districtwide improvement and professional learning for superintendents and administrators. Based on the practice of medical rounds as a method for creating shared norms and understandings about medicine and patient care, instructional rounds is a process in which networks of superintendents (and, increasingly, principals and teachers) observe and analyze classroom teaching to develop shared norms and understandings about instruction. Research on the practice of medical rounds highlights potential challenges for the medical community that also might apply to education: challenges of purpose, worldview, pedagogy, content, expertise, voice, and power/status. Understanding and addressing these challenges can inform the development of instructional rounds.