Gray Amy, Enright Helen
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2018 Sep;54(9):1011-1015. doi: 10.1111/jpc.14056. Epub 2018 May 22.
Ward rounds are complex activities in which education must be balanced against service. Limited evidence exists regarding how to optimise ward round education. In order to improve the educational experience, we aimed to understand the teaching and learning interactions on ward rounds with a particular focus on the experience of paediatric trainees.
We conducted an initial quantitative survey as a needs assessment regarding learning and teaching in clinical settings using a structured survey of 21 trainees. This was followed by an observational study using focused ethnography of 20 consultant ward rounds in a general medical department of tertiary paediatric hospital. We used a structured observation form to document ward round characteristics and educational interactions. Data were analysed using inductive content analysis to understand key influences on teaching and learning interactions.
Trainees reported a discrepancy between the actual educational value of ward rounds (mean rating 2.7/5) and what they desired (mean 4.3/5). Ward round ethnography revealed examples of excellent education and practice alongside missed opportunities. Explicit education on rounds was dominated by technical content with little focus on other aspects of professionalism. Major influences on educational interactions were the ward round model - consultant-as-expert versus learner-centred - and the hidden curriculum.
There are many examples of excellence in ward round education, yet there remains substantial scope to better harness the education potential of rounds. This requires us to challenge assumptions, enable feedback and reflection and make learning explicit - while putting the learner at the centre of educational opportunities.
病房查房是复杂的活动，其中教育必须与服务相平衡。关于如何优化病房查房教育的证据有限。为了改善教育体验，我们旨在了解病房查房中的教学互动，特别关注儿科实习医生的体验。
我们进行了一项初步的定量调查，作为对临床环境中学习和教学的需求评估，对21名实习医生进行了结构化调查。随后进行了一项观察性研究，采用聚焦人种志方法，观察了一家三级儿科医院普通内科的20次顾问查房。我们使用结构化观察表记录查房特点和教育互动情况。通过归纳性内容分析对数据进行分析，以了解对教学互动的关键影响因素。
实习医生报告称，病房查房的实际教育价值（平均评分为2.7/5）与他们的期望（平均为4.3/5）之间存在差异。病房查房人种志揭示了既有优秀教育和实践的例子，也有错失机会的情况。查房中的显性教育主要以技术内容为主，很少关注专业精神的其他方面。对教育互动的主要影响因素是查房模式——以顾问为专家型与以学习者为中心型——以及隐性课程。
病房查房教育中有许多优秀的例子，但仍有很大空间可以更好地发挥查房的教育潜力。这要求我们挑战固有观念，促进反馈和反思，使学习变得明确——同时将学习者置于教育机会的中心。
