Gray Amy Z, Modak Maitreyi, Connell Tom, Enright Helen
Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
Clin Teach. 2020 Jun;17(3):286-291. doi: 10.1111/tct.13086. Epub 2019 Aug 26.
Ward rounds are a fundamental part of hospital culture and teaching on rounds has a long tradition. Yet evidence points towards increasing difficulties in delivering ward round education in complex heath care settings. Drawing on the literature and gaps identified in our own hospital setting we hypothesised that a tool for structuring ward rounds could improve the educational experience on rounds without adding a time burden to already busy consultants.
We used a developmental evaluation approach to develop a framework and evaluate a tool for improving ward round education. The ward round framework STIC (Set, Target, Inspect and Close) and ward round tool was developed through an iterative process of reviewing and piloting in a clinical department and was evaluated against Moore's outcome levels drawing on quantitative and qualitative data. Surveys of consultants were used to quantify uptake, acceptability and usefulness of the ward round tool. Focus groups of trainee doctors evaluated their experience of ward round education.
The majority of consultants used the ward round tool and found it accessible, and useful to enhance education, without extending ward round time. Trainee doctors had seen the ward round tool in use and reflected that it provided structure, focused their learning opportunities, gave clarity to the agenda and provided closure. Unintended benefits were seen for enhanced team work.
We present a structured framework STIC and tool for ward rounds that incorporates education, which is acceptable to consultants and is perceived to enhance education for trainees and to strengthen team work. Understanding our framework STIC and our ward round tool's applicability in other settings, scalability and impact and the perspective of patients, would be valuable extensions of this work. We present a structured framework STIC and tool for ward rounds that incorporates education, which is acceptable to consultants and is perceived to enhance education for trainees and to strengthen team work.
查房是医院文化的基本组成部分，教学查房有着悠久的传统。然而，有证据表明，在复杂的医疗环境中开展查房教育面临越来越多的困难。借鉴文献以及我们自己医院环境中发现的差距，我们假设一种用于构建查房的工具可以改善查房的教育体验，而不会给本就忙碌的顾问增加时间负担。
我们采用发展性评估方法来开发一个框架并评估一种改善查房教育的工具。查房框架STIC（设定、目标、检查和结束）和查房工具是通过在一个临床科室进行审查和试点的迭代过程开发的，并根据摩尔的成果水平，利用定量和定性数据进行评估。对顾问的调查用于量化查房工具的采用情况、可接受性和有用性。实习医生焦点小组评估了他们的查房教育体验。
大多数顾问使用了查房工具，发现它易于使用，有助于加强教育，且不会延长查房时间。实习医生看到了查房工具的使用情况，并反映它提供了结构，集中了他们的学习机会，明确了议程，并实现了收尾。还发现了对加强团队合作的意外好处。
我们提出了一个结构化框架STIC和一种用于查房的工具，该工具融入了教育元素，顾问们可以接受，并且被认为可以增强对实习医生的教育并加强团队合作。了解我们的框架STIC以及我们的查房工具在其他环境中的适用性、可扩展性和影响以及患者的观点，将是这项工作有价值的延伸。我们提出了一个结构化框架STIC和一种用于查房的工具，该工具融入了教育元素，顾问们可以接受，并且被认为可以增强对实习医生的教育并加强团队合作。
