146: Leading educationally effective family centered rounds: it takes a good manager!

Abstract

Family centered rounds (FCR) are the most common rounding format in North American pediatric hospitals. If conducted with a clear understanding of the settings, goals, and teaching strategies, FCR permit explicit teaching of CanMEDS competencies. If not done effectively, learners and teachers run the risk of being led room to room with suboptimal participation, minimal educational value and very poor efficiency. The purpose of this study was to describe the dimensions of FCR within the Canadian CanMEDS context in order to develop recommendations for effective teaching and learning earning in thi this e environment. Data were collected from focus group meetings of pediatric residents and attending paediatricians on the clinical teaching unit at a tertiary care academic children's hospital. Data were analyzed using grounded theory methodology. Rounds were described along a spectrum from successful and highly educational to unsuccessful and of low educational value. Three dimensions impacted the rounds experience; the environment, education, and competing priorities. The physical aspects of the hospital learning environment and the fact that the environment was both family centred and team based impacted educational success. Both the content and the process (or how teaching was done) affected the experience. Last, preceptors and senior residents faced competing priorities between patient care, learners (and the range of learners) and the need to maximize efficiency and patient numbers. Attending paediatrician and resident perceptions of educational effectiveness were influenced by how well these dimensions were managed. The ability to manage the rounds was the core variable for successful rounds being led by individuals who were able to maximize predictability in the environment and minimize learner vulnerability. Specific strategies for leading educationally effective FCR were also discussed. The CanMEDS Manager Role was central to creating an educationally effective FCR experience and this is an ideal environment for the teaching and evaluation of this core competency. A framework and tool for leading successful FCR based on the CanMEDS Manager role was developed based on study findings. The importance of the Manager Role needs to be made explicit for trainees and attending staff.