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

Abstract

Background Many academic hospitals have incorporated family-centered rounds, yet little is known about pediatrics residents' perspectives on the educational impact of these rounds. Objective To identify pediatrics residents' knowledge, attitudes, and beliefs about family-centered rounds, including perceived benefits and barriers. Methods We conducted focus groups of residents exposed to family-centered rounds at 2 university-affiliated, freestanding children's hospitals. Focus group data were analyzed using grounded theory. Results A total of 24 residents participated in 4 focus groups. Residents reported that family-centered rounds enhance education by increasing patient encounters and improving physical exam skills, direct observation, real-time feedback, and attending role modeling; improve parent satisfaction, interpersonal and communication skills, and safety; and reduce length of stay. Physical constraints (large teams and small rooms), lack of uniform approaches to family-centered rounds, variable attending teaching styles, and specific conditions (child abuse, patients on isolation) were cited barriers. Conclusions Pediatrics residents report that well-conducted family-centered rounds improve their education and the quality of patient care, including parent satisfaction, communication with families, and patients' length of stay. Standardizing family-centered rounds and reducing attending variability in teaching style might further enhance residents' educational experiences.

Increasing Parental Participation During Rounds in a Pediatric Cardiac Intensive Care Unit

“…13 Parental participation during rounds offers a venue to meet the Accreditation Council for Graduate Medical Education's core competencies of professionalism, interpersonal and communication skills, direct observation, and feedback. 1,[14][15][16] Physician trainees reported that family-centered rounds enhanced their medical education by increasing the number of encounters with patients and observations of direct patient care, providing an opportunity for real-time feedback and role modeling by attending physicians, and enhancing communication and interpersonal skills. 16 Parental participation during rounds has been embraced as a measure of quality and as standard practice recommended by the American Academy of Pediatrics.…”

“…1,[14][15][16] Physician trainees reported that family-centered rounds enhanced their medical education by increasing the number of encounters with patients and observations of direct patient care, providing an opportunity for real-time feedback and role modeling by attending physicians, and enhancing communication and interpersonal skills. 16 Parental participation during rounds has been embraced as a measure of quality and as standard practice recommended by the American Academy of Pediatrics. 3 The purpose of this quality improvement project was to increase the percentage of invitations to participate in morning rounds on the pediatric cardiothoracic intensive care unit (CTICU) that were extended to the parents available.…”

Improving Trainee Education During Family-Centered Rounds: A Resident’s Perspective

“…2,3 In addition, fear of sharing sensitive patient information on FCR also serves as a barrier because trainees attempt to balance the emotional needs of patients and families with the need for frank clinical discussion. 2,4 Anecdotally, this is particularly true when it comes to discussion of appropriate differential diagnoses, especially when a difficult diagnosis such as malignancy is possible. These fears often lead to a modified presentation of the patient's clinical picture, with more emphasis placed on patient and family comfort than trainee education.…”

“…Although resident discomfort and time constraints are consistently recognized as the greatest barriers to teaching, studies have cited attending style as the key factor in determining residents' satisfaction with their educational experience. [2][3][4]6 Although it would be difficult to standardize rounding, further study to identify specific skills that promote educationally effective FCR could allow for training in these areas. We believe that skills such as bedside physical examination teaching, effective communication, and encouragement of trainee autonomy would be viewed by residents as strengths of educationally stimulating attending physicians.…”

“…2,4 One of the strengths of FCR is the forum it provides for direct communication with patients and families, a time-consuming but critical aspect of patient care that should not be sacrificed. Although families should not be denied the opportunity to participate in rounds, recent literature demonstrates that individual patient and family expectations of FCR vary dramatically.…”