By: Jimmy Beck, MD, MEd, acting assistant professor of pediatrics, University of Washington School of Medicine, Division of Pediatric Hospital Medicine, Seattle Children’s Hospital
Note: At the time of the study mentioned in this blog post, the author was a pediatric hospital medicine fellow at Children’s National Medical Center, Washington, DC.
Despite the fact that a policy statement from the American Academy of Pediatrics published in 2003 asserted that “conducting attending physician rounds in patients’ rooms with the family present should be standard practice,” I had not experienced family-centered rounds (FCR) until I began my hospitalist fellowship in 2011. The task of leading FCR presented a distinct challenge for me. I had to simultaneously balance the informational needs of family members with the educational needs of my trainees. I struggled with facilitating effective learning at the bedside while managing an interdisciplinary medical team that still focused on patient-centered care. Is FCR at odds with bedside teaching? Is teaching my students about our patient’s murmur truly family centered? How would a family or patient benefit from that? Or if I were to talk about my approach to a patient with hyponatremia with the family and patient present is that really centered around the family’s needs? Additionally, although I had always used questions to stimulate reflection and learning in clinical settings, I wondered if I needed to alter the way I taught during FCR knowing that trainees are concerned about being “pimped” by their attendings for fear of losing credibility with a family.
While I knew I could eventually become more proficient at teaching by watching and emulating attendings who had more experience with FCR, I was eager to fast track this process. I performed a literature review that yielded several studies describing effective FCR teaching behaviors, but the vast majority of these studies focused upon the perspectives of attendings and/or trainees and had not captured the perspectives of other relevant stakeholders, including nurses and families, who I believe hold important perspectives on the teaching that occurs during FCR. Seeing the gap in the literature, I decided to focus my fellowship research project on teaching strategies that facilitated learning during FCR, addressing the input of multidisciplinary team members, specifically bedside nurses, as they provide invaluable education and support to families, and parents of hospitalized children, who bring perspective and knowledge about their children.
While the results of our qualitative study mirrored previous studies regarding bedside teaching during FCR, we discovered novel and concrete suggestions for improving both family and trainee education. The overarching finding from our study was that the attending’s ability to maintain situational awareness during FCR was critical for improving both family and trainee education. Like a quarterback who must process the constantly changing position of the other team’s defense in regards to the upcoming play, attending physicians are required to process changing information during FCR, such as the nonverbal cues of family members and trainees, their emotional states, and the amount of time spent in a room. Just as a quarterback often calls an “audible”—a play change that is made at the line of scrimmage to adjust to a changing defense—so too do successful attending physicians make adjustments during FCR in order to ensure everyone is learning.
The strategies outlined in our report not only helped me become a better teacher, but hopefully will provide insight to guide education during FCR in a manner that is able to be concurrently learner centered and family centered.