Pediatrics Residents' Perspectives on Family-Centered Rounds: A Qualitative Study at 2 Children's Hospitals

摘要

What was known Little is known about pediatrics residents' perspectives on the educational impact of FCRs.;What is new This is the first study, to our knowledge, to identify pediatrics residents' knowledge, attitudes, and beliefs about FCRs, including perceived benefits and barriers.;Limitations The single specialty limits generalizability; prior exposure to FCRs in medical school may have affected resident perceptions.;Bottom line Residents report that well-conducted FCRs improve education and quality of care, including parental satisfaction, communication, and patient length of stay.;Background Family-centered rounds (FCRs) are multidisciplinary rounds consisting of medical teams partnering with patients and families in medical decision making.1,2 Academic hospitals are more likely to conduct FCRs.2 Accreditation Council for Graduate Medical Education core competencies, such as professionalism and interpersonal and communication skills, ideally are taught at the bedside; FCRs allow residents to interact with patients and families under direct faculty supervision, and are valuable in teaching residents these competencies.3,4 Implementing FCRs can be challenging in a busy inpatient environment. Although FCRs have been widely adopted,2–7 the literature on their impact on patient care, discharge timeliness,3 teamwork, and staff and parental satisfaction is limited,2,5 and little is known about the educational impact of FCRs. Residents are a crucial part of FCRs; this makes it important to understand their perspectives. The study objectives were to identify pediatrics residents' perceptions of FCRs, including benefits of and barriers to successful FCRs.;Methods Study Design We conducted a collaborative qualitative study using focus groups8 at Children's Medical Center Dallas (CMC) and Children's National Medical Center (CNMC). The study was conducted from November 2008 to February 2010. The study protocol was approved by both institutions' Institutional Review Boards.;Results Participant Sociodemographics Of the 24 participants, 14 (9 interns and 5 senior residents) were from CMC, and 10 (5 interns and 5 senior residents) were from CNMC. Three-quarters (18 of 24) were female; the mean age was 27?years, 80% (19 of 24) were non-Hispanic white, and about two-thirds (16 of 24) were exposed to FCRs during medical school;Discussion The study findings suggest that, if conducted well, FCRs enhance resident education and the quality of patient care, including patient satisfaction, communication, and length of stay. Physical constraints, lack of rounding uniformity, and variability in attending rounding and teaching styles were key FCR barriers. Implication for FCRs Enhanced Patient Volume and Education. Programs strive to balance adequate numbers of patients across the spectrum of age and medical complexity to maximize educational experiences.11 FCRs expose residents to more patient encounters without increasing their workload. Therefore, it is not surprising that residents identified FCRs as a valuable experience, resulting in better understanding of the decision-making process, learning about communication, and opportunities to observe more physical exams.;Conclusions Our findings indicate that, if conducted well, residents perceive that FCRs improve education, quality of care, and outcomes, including parental satisfaction, communication, and length of stay. Educational benefits of FCRs include learning through increased patient encounters, attending role modeling, and direct observation and feedback. Physical constraints, lack of uniformity of rounds, and variability in attending rounding and teaching styles were reported as FCR barriers.