Division of Hospital Medicine (MJ Trost), Children's Hospital Los Angeles and the Keck School of Medicine (MJ Trost and MR Mamey), University of Southern California, Los Angeles, Calif; Department of Pediatrics (NM Potisek), Wake Forest Baptist Medical Center, Winston-Salem, NC.
Division of Pediatric Medicine (LB Seltz), Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
Acad Pediatr. 2019 Jul;19(5):549-554. doi: 10.1016/j.acap.2018.12.010. Epub 2019 Jan 11.
Pediatrics rotations may be medical students' only experience with patient- and family-centered rounding (PFCR). It is unclear how students participate in or are prepared for PFCR. We surveyed national pediatrics clerkships to determine the prevalence of PFCR and the proportion providing orientation in order to inform a needs assessment for PFCR orientation.
A 5-item peer-reviewed survey was distributed to the Council on Medical Student Education in Pediatrics (COMSEP) membership as part of a larger survey in 2017. Institutional differences among programs performing PFCR were compared using chi-square and t-tests. Responses to 1 open-ended question were coded and grouped into broad categories using content analysis.
The full COMSEP survey received answers from 190 participants representing 103 medical schools. Our questions received 174 responses representing 94 schools (98 training sites) and had an 85% (83/98) prevalence of student PFCR participation. Although most (n = 108; 85%) reported that their students received PFCR orientation, half (n = 62; 49%) considered orientation "informal," and only 2 reported using published curricula. After didactics, the most common orientation materials were handouts (n = 33; 26%), videos (n = 13; 10%), and role play (n = 7; 6%). Orientation was most commonly initiated at the start of clerkship (n = 62; 49%) by clerkship administration (n = 38; 30%), but 20% (n = 26) reported resident-led orientation. Qualitative responses (n = 98) were coded and organized into 4 themes; the greatest perceived challenges for medical students on PFCR were communication and anxiety.
Although most students participate in and receive orientation to PFCR, there is wide variability in the content, timing, and administration of orientation. A nationally disseminated, evidence-based orientation curriculum may reduce educational variability and better prepare students for PFCR.
儿科学实习可能是医学生唯一一次接触以患者和家庭为中心的查房（PFCR）的机会。目前尚不清楚学生如何参与或为 PFCR 做准备。我们调查了全国儿科学实习，以确定 PFCR 的普遍性以及提供定向培训的比例，以便为 PFCR 定向培训需求评估提供信息。
作为 2017 年更大规模调查的一部分，我们向儿科学学生教育理事会（COMSEP）成员分发了一份由 5 个项目组成的经过同行评审的调查。使用卡方检验和 t 检验比较了执行 PFCR 的项目之间的机构差异。使用内容分析将对 1 个开放式问题的回答编码并分为广泛的类别。
完整的 COMSEP 调查收到了来自代表 103 所医学院的 190 名参与者的回复。我们的问题收到了 174 名代表 94 所学校（98 个培训地点）的回复，学生参与 PFCR 的比例为 85%（83/98）。尽管大多数（n=108；85%）报告说他们的学生接受了 PFCR 定向培训，但有一半（n=62；49%）认为定向培训“非正式”，只有 2 所报告使用了已发表的课程。在讲座之后，最常见的定向培训材料是讲义（n=33；26%）、视频（n=13；10%）和角色扮演（n=7；6%）。定向培训最常在实习开始时（n=62；49%）由实习管理（n=38；30%）启动，但 20%（n=26）的报告说，居民领导定向培训。对 98 份定性回复进行了编码和组织，形成了 4 个主题；医学生在 PFCR 中面临的最大挑战是沟通和焦虑。
尽管大多数学生参与并接受了 PFCR 定向培训，但定向培训的内容、时间和管理方式存在很大差异。一个全国性的、基于证据的定向培训课程可能会减少教育的差异，并更好地为学生准备 PFCR。
