J.A. Moriarty is a pediatric hospital medicine fellow, Stanford School of Medicine, Palo Alto, California.
S. Vellanki is a pediatric gastroenterology fellow, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Acad Med. 2020 Nov;95(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 59th Annual Research in Medical Education Presentations):S28-S36. doi: 10.1097/ACM.0000000000003645.
To explore trainee and faculty perspectives on an independent rounding intervention on general pediatrics wards at 2 institutions.
In July 2018, the authors introduced independent rounds 1 to 2 times a week at 2 training sites. In this qualitative study, the authors conducted semistructured focus groups with a purposive sample of junior trainees (clerkship medical students and postgraduate year [PGY] 1 residents), senior trainees (PGY-2 and PGY 3-5 residents), and hospital medicine faculty between October 2018 and May 2019. Focus groups were audio-recorded, transcribed verbatim, and analyzed for themes using the constant comparative approach associated with grounded theory.
Focus groups included 27 junior trainees, 20 senior trainees, and 18 faculty. Six themes emerged: (1) Independent rounds contributed to all trainees' development; (2) Senior residents described increased motivation to take full ownership of their patients and educational needs of the team; (3) Faculty expressed concerns about decreased opportunities for teaching and feedback; however, all trainees reported unique learning from having faculty both present and absent from rounds; (4) No significant patient safety events were reported; (5) All participants identified communication and patient progression concerns; and (6) A tension emerged between decreased faculty and enhanced trainee career satisfaction. Participants identified solutions to identified barriers to further improve this educational intervention.
As a result of independent rounding, trainees described increased motivation to take ownership of their patients and team. Both rounding experiences contributed to their development as physicians in different ways. Further studies should explore patient and caregiver perspectives and concerns about communication and patient care progression when designing future interventions to promote resident autonomy.
探讨 2 家机构普通儿科病房实习生和教师对独立查房干预的看法。
2018 年 7 月，作者在 2 个培训点每周进行 1 到 2 次独立查房。在这项定性研究中，作者对实习医生（实习医学生和住院医师第 1 年）、高年资实习生（住院医师第 2 年至第 5 年）和医院内科教员进行了半结构式焦点小组讨论，使用扎根理论的常规定量方法分析主题。
焦点小组包括 27 名实习医生、20 名高年资实习生和 18 名教员。出现了 6 个主题：（1）独立查房有助于所有实习生的发展；（2）高年资住院医师表示更有动力全面负责自己的病人和团队的教育需求；（3）教员表示担心教学和反馈机会减少，但所有实习生报告说，从有教员和没有教员查房中都有独特的学习机会；（4）未报告重大患者安全事件；（5）所有参与者都认识到沟通和患者进展方面的问题；（6）教员减少与增强实习生职业满意度之间存在紧张关系。参与者确定了解决已识别障碍的方法，以进一步改进这一教育干预。
通过独立查房，实习生表示更有动力全面负责自己的病人和团队。查房经历以不同的方式促进了他们作为医生的发展。进一步的研究应该探索患者和护理人员对沟通和患者护理进展的看法和担忧，以便在设计促进住院医师自主权的未来干预措施时。
