Beck Jimmy, Kind Terry, Meyer Rebecca, Bhansali Priti
J Grad Med Educ. 2016 Dec;8(5):731-738. doi: 10.4300/JGME-D-16-00231.1.
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.
The aim of this study was to identify strategies used by attending physicians to promote resident autonomy during FCR.
We conducted a qualitative study of attending physicians and residents between December 2012 and February 2013 at an academic children's hospital, where FCR is the standard model for inpatient rounds. Attending physicians participated in individual interviews, and residents participated in 1 of 2 focus groups separated by level of training. Focus group and interview transcripts were coded and themed using qualitative content analysis.
Ten attending physicians and 14 residents participated in interviews and focus groups. Attending physician behaviors that promoted resident autonomy included setting clear expectations, preforming a prerounds huddle, deliberate positioning, and delegating teaching responsibilities. These were further categorized as occurring during 1 of 4 distinct periods: (1) at the start of the rotation; (2) before daily FCR; (3) during daily FCR; and (4) after daily FCR.
Residents and attending physicians identified similar strategies to promote resident autonomy during FCR. These strategies occurred during several distinct periods that were not limited to rounds. The results suggest strategies for attending physicians to help balance appropriate and safe patient care with developing resident autonomy in the clinical setting.
以家庭为中心的查房（FCR）已成为儿科住院患者查房的主要模式。多项研究探讨了FCR期间的有效教学策略，但均未关注促进住院医师的自主性。
本研究旨在确定主治医师在FCR期间促进住院医师自主性的策略。
2012年12月至2013年2月，我们在一家学术儿童医院对主治医师和住院医师进行了一项定性研究，该医院以FCR作为住院患者查房的标准模式。主治医师参与个人访谈，住院医师按培训水平分为2个焦点小组之一参与访谈。焦点小组和访谈记录采用定性内容分析法进行编码和主题归纳。
10名主治医师和14名住院医师参与了访谈和焦点小组。促进住院医师自主性的主治医师行为包括明确期望、进行查房前碰头会、刻意定位和分配教学职责。这些行为进一步分为在4个不同阶段中的1个阶段发生：（1）轮转开始时；（2）每日FCR前；（3）每日FCR期间；（4）每日FCR后。
住院医师和主治医师确定了在FCR期间促进住院医师自主性的类似策略。这些策略发生在几个不同阶段，并不局限于查房期间。结果为主治医师提供了一些策略，有助于在临床环境中平衡适当且安全的患者护理与培养住院医师的自主性。
