Promoting Resident Autonomy During Family-Centered Rounds: A Qualitative Study of Resident, Hospitalist, and Subspecialty Physicians

Beck, Jimmy; Kind, Terry; Meyer, Rebecca; Bhansali, Priti

doi:10.4300/jgme-d-16-00231.1

Cited by 26 publications

(19 citation statements)

References 30 publications

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“…Indeed, as reported in one family‐centered rounds (FCR) study, senior residents often perceive decreased autonomy, and specific strategies can be employed to promote the autonomy of the resident physician in this team model. Setting clear expectations and defining responsibilities prior to the patient encounter are strategies that emerged from our results and are consistent with published FCR findings …”

Section: Discussionsupporting

confidence: 90%

“…This strategy begins with deductive coding, which integrates codes from relevant literature, followed by inductive coding, which involves the creation of de novo codes as the coder goes through the transcript line by line. For our purposes, an initial code list was derived from literature pertinent to swarming, including ED front‐end operations, ED process improvement, and FCR …”

Section: Methodsmentioning

confidence: 99%

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Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

Perniciaro

Schmidt

Pham

et al. 2019

AEM Education and Training

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Background: Academic emergency medicine is a constant balance between efficiency and education. We developed a new model called swarming, where the bedside nurse, resident, and attending/fellow simultaneously evaluate the patient, including initial vital signs, bedside triage, focused history and physical examination, and discussion of the treatment plan, thus creating a shared mental model. Objectives:To combine perceptions from trainee physicians, supervising physicians, nurses, and families with in vivo measurements of emergency department swarms to better conceptualize the swarming model.Methods: This mixed methods study was conducted using a convergent design. Qualitative data from focus groups with nurses, residents, and attendings/fellows were analyzed using directed content analysis. Swarming encounters were observed in real time; durations of key aspects and family satisfaction scores were analyzed using descriptive statistics. The qualitative and quantitative findings were integrated a posteriori.Results: From the focus group data, 54 unique codes were identified, which were grouped together into five larger themes. From 39 swarms, mean (AESD) time (minutes) spent in patient rooms: nurses = 6.8 (AE3.0), residents = 10.4 (AE4.1), and attendings/fellows = 9.4 (AE4.3). Electronic documentation was included in 67% of swarms, and 39% included orders initiated at the bedside. Mean (AESD) family satisfaction was 4.8 (AE0.7; Likert scale 1-5). Conclusions:Swarming is currently implemented with significant variability but results in high provider and family satisfaction. There is also consensus among physicians that swarming improves trainee education in the emergency setting. The benefits and barriers to swarming are underscored by the unpredictable nature of the ED and the observed variability in implementation. Our findings provide a critical foundation for our efforts to refine, standardize, and appraise our swarming model.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

Perniciaro

Schmidt

Pham

et al. 2019

AEM Education and Training

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“…Other strategies to promote autonomy as described by Beck et al [89] on Family-Centered Rounds (FCR) may be broken down to various phases of the FCR activity. Prior to the beginning of FCR, framing expectations and agreeing upon nonverbal signals were found to be helpful.…”

Section: Encouraging Autonomymentioning

confidence: 99%

“…After the FCR, promoting reflection and allowing the resident to reflect on how the rounds went is critical to improvement. Also allowing the resident to offer feedback to junior residents and medical students will promote the educational value of the FCR [89]. These steps outlined by Beck may be widely translatable to other activities within graduate medical education across specialties.…”

Section: Encouraging Autonomymentioning

confidence: 99%

Resident Autonomy

Cooper¹,

Allen²

2019

Contemporary Topics in Graduate Medical Education

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Autonomy in medical training is required to develop independent and competent physicians. The way in which this incremental level of independence is granted to a trainee must be thoughtful and deliberate to ensure appropriate supervision and patient safety. Theories that support the role of autonomy will be introduced and discussed in this chapter. Ethical considerations that describe the implications of balancing the necessary independence for trainees and an attending physician's responsibility to the patient and the patient's safety will also be considered. The level of autonomy that is granted is the responsibility of both the attending physician and trainee so that it is not only appropriate but also wellearned. There are multiple tools that may be used to objectively measure one's competence and necessary level of autonomy based on performance that will be discussed within this chapter. Finally we will demonstrate that encouraging and striking the balance of supervision and autonomy may be done safely with appropriate patient outcomes and trainee development into independent physicians. These outcomes will help to encourage autonomy amongst medical trainees, no matter one's specialty, to train and develop competent, independent physicians of the future.

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“…2016;8:731-738. 9 This interview-based study identified strategies used by attending physicians to promote resident autonomy during family centered rounds.…”

Section: Topic 3: Professionalism and Learnersmentioning

confidence: 99%

Top Medical Education Studies of 2016: A Narrative Review

Fromme

Ryan

Darden

et al. 2018

Academic Pediatrics

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Education, like clinical medicine, should be based on the most current evidence in the field. Unfortunately, medical educators can be overwhelmed by the sheer volume and range of resources for this literature. This article provides an overview of 15 articles from 2016 that the authors consider the top articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership and expertise across the continuum of pediatric medical education, used an iterative 3-stage process to review more than 6339 abstracts published in 2016. This process was designed to identify a small subset of articles that were most relevant to educational practices and most applicable to pediatric medical education. In the first 2 stages, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the articles that best met these criteria. In the final stage, all articles were discussed using a group consensus model to select the final articles included in this review. This article presents summaries of the 15 articles that were selected. The results revealed a cluster of studies related to observed standardized clinical encounters, self-assessment, professionalism, clinical teaching, competencies/milestones, and graduate medical education management strategies. We provide suggestions on how medical educators can apply the findings to their own practice and educational settings. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field.

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Promoting Resident Autonomy During Family-Centered Rounds: A Qualitative Study of Resident, Hospitalist, and Subspecialty Physicians

Abstract: Background Family-centered rounds (FCR) have become a leading model for pediatric inpatient rounding. Several studies have examined effective teaching strategies during FCR, but none have focused on promoting resident autonomy.

Cited by 26 publications

References 30 publications

Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

Resident Autonomy

Top Medical Education Studies of 2016: A Narrative Review

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