Behavioral Science Rounds: Identifying and Addressing the Challenging Issues That Residents Face on a Family Medicine Inpatient Service.

Abstract

Training residents in the care of hospitalized patients offers an opportunity to integrate behavioral science education with medical care and to foster professional growth, given the severity of coexisting medical and psychosocial problems and the formation of intense transient relationships. Rarely do residents have the time or guidance to reflect on how these experiences and relationships affect them. Weekly behavioral science rounds (BSR) provide dedicated time to reflect on and discuss challenging clinical and professional developmental issues arising during inpatient training. To understand the range of issues that learners experience, we analyzed facilitator notes of 45 consecutive BSR discussions. Through open coding analysis we identified the common topics and recurring themes raised by residents. The most common topics related to residents' emotional responses, clinical challenges, and interpersonal conflicts. We identified frequently recurring themes, including understanding the power and limitations of the physician, defining roles and responsibilities, and articulating personal beliefs and values. Early first-year residents had difficulty acclimating to increased responsibility and worried about competence; later, they experienced strong emotional reactions, feared becoming cynical, and were apprehensive about future leadership roles. Inpatient BSR can serve as an important educational intervention and professional development tool at a critical time in training. BSR requires a commitment of teaching resources, an assurance that they will occur regularly, and a culture of safety in which residents trust their discussions will be confidential and that they will be treated with respect and caring.