Medical Student Outcomes after Family-Centered Bedside Rounds: Cox ED, Schumacher JB, Young HN, Evans MD, Moreno MA, Sigrest TD. AcadPediatr. 2011; 11(5): 403-408.
Reviewed by Tricia McBurney and Sherron Jackson
What was the study question?
What are student' concerns, teaching evaluations, and attitudes after experiencing Family-Centered Bedside Rounds (FCBR) on the pediatric clerkship?
How was the study done?
The setting was a free-standing children's hospital with 88 beds in mid-western USA. During a 3-week inpatient experience (8-week clerkship), 4 students round at the beside with 1 attending (7 hospitalists), a senior resident, two interns, the patient's nurse, and any other team members who chose to join rounds .Pre-clerkship and post-clerkship surveys were obtained for 113 of the 127 (89%) medical students for the 2008-2010 academic years. Attitudes about FCBR were assessed on both the pre-survey and post-survey. The post-survey assessed student concerns about FCBR and also student evaluations of teaching during FCBR. Student attitudes were measured by 4 items on a 7 point scale. Student concerns were measured by 14 items and teaching experiences were measured by 11 items; both concerns and teaching experiences were on a 5-point scale.
What were the results?
Post- clerkship, the students were significantly more positive about the benefits of FCBR for patients/families (mean change .37 points, p< .001). Interestingly, the students were neutral about preferring FCBR over "sit down" rounds (no significant change after the clerkship). The top 2 concerns of students were presenting information in a way that was understandable to the patients and families on rounds (34.5% of students reported as a frequent concern) and presenting in front of patients and families (25.1%). Only 20.3% of the students reported that effective teaching of physical exam skills was frequent on FCBR. Less than 40% of the students reported as frequent the following: allowing students the opportunity to answer patient and family questions and helping students develop relationship-building skills with families.
What are the implications of these findings?
The American Academy of Pediatrics, the Residency Review Committee for Pediatrics, and the Joint Commission all endorse FCBR. It is critical to consider how we can maximize learning for the medical students on FCBR. The students apparently recognize that the FCBR are better for patients and families, so why do the students not prefer these rounds over "sit down" rounds? This article points out many teaching opportunities on FCBR that can be done well. Maybe, all patient encounters at the bedside do not lead to certain teaching items or opportunities. For instance, which bedside encounters are most appropriate for PE?
Editor's note: This study is important because it reminds us that even though most stakeholders think Family-Centred Bedside Rounds are fantastic, we may not be optimally serving the medical students with this model. We need to carefully determine how we can best optimize learning for all trainees with this model.