Council on Medical Student Education in Pediatrics


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COMSEP 2010 Albuquerque Meeting


Heather M. McLauchlan, MD, Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Il

Background: The patient case presentation is a well-known instrument used in medical settings to communicate information between healthcare providers. In addition, case presentations provide a critical opportunity to assess the knowledge of a student learner. The impact of family-centered bedside rounds, a hot topic in pediatrics, on medical student learning and professional development is unknown.  Specifically, it is unknown how family involvement in rounds affects how students articulate uncertainties in case presentations. Objectives: The purpose of this study is to investigate: 1. The number and type of uncertainties expressed by medical students on bedside rounds 2. How medical students feel about expressing uncertainties in front of patients on bedside rounds   3. How parents perceive and respond to uncertainties expressed on bedside rounds   Methods: Family-centered bedside rounds were audio taped for four patients admitted to the Children’s Hospital of Illinois.  Student presenters and  patient’s parents were each asked to respond to a four-question written survey about their experience with bedside rounds. Transcripts of bedside rounds underwent qualitative analysis using the constant comparative method to identify uncertainties expressed by students.  Surveys from students and parents were also analyzed for themes. Results: Preliminary results indicate that students’ uncertainties fell into three categories: historical factors, plan of care, and knowledge of pathophysiology.  The majority (80%) of uncertainties expressed related to the plan of care for patients.  Both students and parents expressed a high degree of comfort with bedside rounds.  Anecdotally, many additional uncertainties were expressed by students either before rounds began or after rounds were completed. Discussion: The ability for a physician to realize when their knowledge base is deficient is an important aspect of becoming a competent care provider.  However, asking questions on bedside rounds can be intimidating for new learners.   This preliminary study indicates that while students seem willing to ask certain questions on bedside rounds, there may be additional uncertainties that are not expressed in this setting.  Although this study has many limitations which will be discussed elsewhere, it highlights the need for further exploration of team dynamics and teaching methods on bedside rounds.