Jared P. Austin, MD, Tracy Bumsted, MD, MPH, Carrie Phillipi, MD, PhD, Megan Aylor, MD, Tamara Wagner, MD, Windy Stevenson, MD, Jennifer Schroeder, MD, Sarah Green, MD, Oregon Health and Science University, Portland, OR; Chad Brands, MD, Mayo Clinic, Rochester, MN
Background: Oral presentations on rounds provide a critical forum for information exchange, clinical decision-making, and teaching and learning at the bedside. Presentations are also a primary means by which medical students and residents are evaluated by attending physicians. Currently, pediatric residency programs are transitioning from the traditional model of “sit-down” rounds, and embracing family-centered rounds (FCR) at the bedside. However, the structure for oral presentations on FCR remains specific to each attending physician and typically is not formalized in a structured fashion. Objective: The goal of this project was to develop and implement a consistent and easily-remembered structure and mnemonic for oral presentations on FCR. Methods: Multiple members of the medical team (including attending hospitalists, chief residents, residents and interns) met and decided which elements are most important to include in FCR oral presentations, and in which order these elements should be presented. Once elements and sequence were determined, an acronym was developed incorporating these elements. Results: The acronym we developed for FCR on established patients is FREE TIPSS, where F=Family and team introductions, R=Recap of clinical history, E=Events overnight or since last rounds, E=Exam pertinents, including vital signs and fluid balance, T=Tests, I=Impression, P=Problem-based plan, S=Staff input, particularly from nursing staff, and S=Summary for parents with opportunity to ask questions. For new patients, the acronym was modified by adding an extra “E” for Extra information, including pertinent past medical, family or social history, to make FREEE TIPSS. We created two-sided laminated cards, and provided these to medical students and residents on the first day of their ward rotations. Feedback from medical students, residents and staff has been positive, and several other inpatient services within our facility have shown interest in adopting this FCR model. Conclusions: The FREE TIPSS acronym provides a structured, easily-remembered mnemonic for oral presentations on FCR. We believe standardizing oral presentations on FCR will lead to 1) improved presentation skills by learners, 2) more efficient rounds, and 3) better patient care. Further studies evaluating these parameters with use of this mnemonic are needed.