Division of Hospitalist Medicine, Children's National Medical Center, Washington, DC, USA.
J Hosp Med. 2011 Sep;6(7):423-7. doi: 10.1002/jhm.879.
"Rounds" are the organizing structure for academic hospitalist-trainee teams. Family centered rounds (FCR) are endorsed by the Institute of Medicine and by the American Academy of Pediatrics, however, rounds are often conducted in the privacy of the conference room where patients and families are not privy to the decision-making process used to determine their diagnosis and management. Less than half of pediatric hospitalists reported conducting FCR, citing concerns about inefficiency and diminished teaching.
The aim of this study was to design and implement a faculty development program to address the need of hospitalists to efficiently teach during FCR.
Scoring templates were developed to measure evidence-based teaching behaviors to optimize orientation, feedback, clinical reasoning, assessing physical exam findings, and promoting resident leadership during FCR. Hospitalists were scored by Standardized Learners and Standardized Parents during 4 Observed Structured Teaching Exercises (OSTEs) before and after focused workshops.
Fourteen of 14 hospitalist participants had 17 months ± 14 months of experience; 71% were female; none had previous training in the areas proposed in the study. The differences between pre- and post-OSTEs for the 4 stations were statistically significant (P < .0001). Particular improvements were noted in the correction of incorrect clinical reasoning (new patient diagnosis) (56% pre, 86% post) and orientation (65% pre, 95% post).
We found incorporating OSTEs into a FCR faculty development program to be an effective strategy for improving faculty teaching behavior. Additional study is needed to determine if this strategy results in sustained improvements in conducting FCRs in real inpatient settings.
“查房”是住院医师培训团队的组织架构。以家庭为中心的查房（FCR）得到了美国医学研究所和美国儿科学会的认可，然而，查房通常在会议室的私密环境中进行，患者及其家属无法参与决定其诊断和管理的过程。不到一半的儿科住院医师报告说进行了 FCR，他们援引效率低下和教学效果减弱的担忧。
本研究旨在设计和实施一项师资发展计划，以满足住院医师在 FCR 期间高效教学的需求。
开发了评分模板，以衡量基于证据的教学行为，以优化定向、反馈、临床推理、评估体检结果以及在 FCR 期间促进住院医师的领导力。住院医师在 4 次观察结构化教学练习（OSTE）之前和之后，由标准化学习者和标准化家长进行评分。
14 名住院医师参与者中的 14 名参与者有 17 个月±14 个月的经验；71%为女性；没有人接受过研究中提出的领域的先前培训。4 个站点的 OSTE 前后评分差异具有统计学意义（P<.0001）。特别注意到在纠正不正确的临床推理（新患者诊断）（56% 前，86% 后）和定向（65% 前，95% 后）方面有明显的改善。
我们发现，将 OSTE 纳入 FCR 师资发展计划是一种提高教师教学行为的有效策略。需要进一步研究以确定这种策略是否会导致在实际住院环境中进行 FCR 的持续改进。
