Lindsay Koressel
Ann & Robert H. Lurie Children's Hospital
Introduction: Patient and family-centered care is the backbone to pediatric health care. Family-centered rounds (FCR) have been endorsed by the AAP and have been implemented around the country in pediatric hospitals. While significant research has shown some improved experiences, improved relationships, and potentially earlier discharges, the extent to what impact FCR has had on teaching has been inconclusive. There has been no direct observational study of the how teaching occurs and what has potentially changed as we have moved away from table rounds to bedside rounds.
Aims: The goal of this direct observational qualitative study was to investigate the specific nature of teaching that occurs during FCR at a single institution.
Methods: A direct observational study was performed at the Ann & Robert H. Lurie Children’s Hospital of Chicago on the general pediatric inpatient teams between October 2018 and February 2019. Five unbiased observers observed FCR and took field notes on the teaching that was observed. By using previous categories and themes identified in a study of exemplary teachers as well as identified themes from monthly meetings with observers, the field notes were coded and analyzed.
Results: 17 discrete family-centered rounding experiences were observed, including 207 individual patient encounters. Families and nurses were present for 60% and 70% of encounters respectively, with only 10.6% physically taking place at the bedside in the patient room. The broad, overlapping themes identified in the qualitative analysis included: collaboration and coaching, developing clinical reasoning, family centered teaching, fostering positive relationships, learner independence, and physical exam teaching.
Conclusion: The majority of teaching that occurred was more implicit and subtle in nature, involving modeling of communication and professionalism skills when speaking both with the team and the families. The majority of clinical teaching was the development of clinical reasoning skills that was both facilitated by as well as modeled by the teacher. These skills are not only required of exemplary physicians, but also much more relevant and conducive to retaining information when learned at the bedside or in a relevant patient encounter. While the didactic and passive teaching may be a thing of the past when it comes to patient care rounds, the new information learned from our learners is valuable and extremely relevant to their future practice.
