Monday, June 13, 2016

A Quality Improvement Initiative to Modernize Teaching on Family-Centered Rounds

Aarti Patel
Cincinnati Children’s Hospital Medical Center
Background: Millennial trainees prefer innovative, multimodal education that includes physical exam (PE) topics on family-centered rounds (FCR); however, attending teaching techniques may not meet these needs. To address the gap, a multimedia PE website (PEToolkit) was created, but its use on FCR was infrequent. Our aim was to increase PEToolkit use from 2 to 5 page counts per week in a 7-month period.

Methods: This quality improvement project took place at a large academic center on one Hospital Medicine team. Key drivers informed our interventions, and an annotated run chart followed the impact over time. Secondary measures, attending’s change in perception of teaching skill and resident-observed method of PE teaching, were assessed via surveys and analyzed using Wilcoxon signed rank test for attending pre/post responses and Fisher’s Exact and Wilcoxon rank sum between resident intervention/non-intervention groups.

Results: Median page counts increased to 5 counts per week in 7 months. The most impactful interventions included training senior residents to teach with PEToolkit and feedback on website usage to the team mid-week. Survey results noted attendings in the heavy exposure group had increased perceived skill with PE teaching (median difference 1; p = 0.02). There was no statistically significant change in perceived skill of teaching with technology in any of the exposure groups. More residents observed use of video for PE teaching (52% vs 0%; p < 0.001) and frequency of PE teaching was ranked higher on the intervention team, compared to those on the non-intervention team (median 3 vs 2, p = 0.02).

Conclusion: We increased use of the PEToolkit website during FCR, thus increasing multimodal PE teaching for our millennial learners. Engagement of learners, frequent feedback, and educational coaching should be considered when incorporating technology in teaching.