Whether or not you round in the hospital with trainees, I believe you will find their resident perspective intriguing: their article opens the door to discussions about communication with families, teaching, and time efficiency, all through the pragmatic lens of those who are in the trenches.
We have come to expect Family Centered Rounds, considered the standard of care since 2003, as “the” way of conducting inpatient rounds. While many of us learned through “fanny rounds,” in which we sat around a table in the conference room “running the patient list.” Frankly we were always behind the curve, since nurses and other staff and (most of all) families and patients were either not able to contribute or had to “interrupt” to provide needed clinical information.
Now, over a decade later, the nuances are still being worked out. During Family Centered Rounds the medical team must balance discussion of the full differential diagnosis including worrisome diseases, as well as sharing medically critical but sensitive personal information, with each family’s unique expectations – how does this dance impact the education of trainees? The authors make an excellent case for good planning and preparatory work, both with the family to clarify their wishes, and with the trainees to facilitate full discussion and questioning before or after the family centered moments.
Is bedside teaching improved by Family Centered Rounds? While Family Centered Rounds would seem to offer multiple “golden moments” for teaching both physical exam and communication skills, Drs. Stanski and Patel point out that the educational value of this opportunity is heavily attending dependent. Rather than just relying on the endless Likert-scale driven feedback forms that are solicited, completed and compiled, they appropriately ask us to consider what qualities or approaches of attending physicians will be most effectively facilitate the learning experience. This presents an interesting potential focus for educational research and I hope the authors will consider expanding on their thoughts and initiating a trainee-attending collaboration to identify “best practices” of teachers during Family Centered Rounds.
Finally, what is the role of the trainees themselves in improving education during Family Centered Rounds? This is a great question, and even better that the authors have asked it! Mechanisms for trainee feedback and open discussion, and quality improvement initiatives that improve efficiency without negatively impacting medical care or education are noted. Residents at the authors’ training program began a project to increase accessibility of protective gear to speed up the endless “gown-glove-masking” that accompanies entering and exiting patient rooms.
What a simple and great potential time-saver for all providers, mining out precious minutes that can be spent at the bedside teaching and learning, not just waiting in line for a gown. Taking responsibility for one’s own education is a lifetime pursuit, and it is a pleasure to see current trainees like Drs. Stanski and Patel who are willing to think long and hard about their learning in real time. I also compliment Drs. Sisk and Schwarz, Editor and Deputy Editor of this monthly feature, who worked with the authors to bring their writing and thoughts to publication. Kudos to all.