Priti Bhansali

The qualities and skills of exemplary pediatric hospitalist educators: a qualitative study.

Purpose To identify the qualities and skills of exemplary and ideal pediatric hospitalist educators. Method The authors conducted a prospective, multi-institutional qualitative study from November 2008 through January 2009 in which they interviewed pediatric hospitalists who were identified as exemplary educators at three academic pediatric residency programs. They then conducted focus groups with residents and medical students who had recently worked with these hospitalists. Qualitative analysis was used to identify themes. Results All six hospitalists identified as exemplary participated. Among invited learners, 14/18 residents (78%) and 16/18 medical students (89%) participated. Together, the participants contributed 266 comments, which the authors categorized into 36 themes within the four domains of teaching skills, personal qualities, patient care skills, and role modeling. New qualities and skills—including self-reflection/insight, encouraging autonomy, time management, knowledge acquisition, and systems knowledge—and differences in perceptions among hospitalists, residents, and students were identified. Differences between the qualities and skills of actual exemplary hospitalist educators and perceptions of those of an ideal hospitalist educator were also identified. Conclusions Pediatric hospitalists in academic residency programs have unique opportunities to significantly affect the education of medical students and residents. This study validates and expands on prior studies of the qualities and skills needed to be a successful hospitalist educator. Researchers and educators designing faculty development programs to train more successful hospitalist educators may wish to target these qualities and skills as well as the differences in medical student and resident needs.

A "Resident-as-Teacher" Curriculum Using a Flipped Classroom Approach: Can a Model Designed for Efficiency Also Be Effective?

PROBLEM The Accreditation Council for Graduate Medical Education requires training that enhances resident teaching skills. Despite this requirement, many residency training programs struggle to implement effective resident-as-teacher (RAT) curricula, particularly within the context of the 80-hour resident workweek. APPROACH In 2013, the authors developed and evaluated an intensive one-day RAT curriculum using a flipped classroom approach. Twenty-nine second-year residents participated in daylong RAT sessions. The curriculum included four 1-hour workshops focusing on adult learning principles, giving feedback, teaching a skill, and orienting a learner. Each workshop, preceded by independent reading, featured peer co-teaching, application, and feedback. The authors evaluated the curriculum using pre- and postworkshop objective structured teaching examinations (OSTEs) and attitudinal and self-efficacy teaching questionnaires. OUTCOMES Residents demonstrated statistically significant improvements in performance between pre- and postworkshop OSTEs on each of three core skills: giving feedback (P = .005), orienting a learner (P < .001), and teaching a skill (P < .001). Residents expressed positive attitudes surrounding teaching on the retrospective pre-post attitudinal instrument (P < .001) and rated themselves as more effective teachers (P < .001) after the training. NEXT STEPS The authors have demonstrated that the flipped classroom approach is an efficient and effective method for training residents to improve teaching skills, especially in an era of work hour restrictions. They have committed to the continuation of this curriculum and are planning to include assessment of its long-term effects on resident behavior change and educational outcomes.

Promoting Resident Autonomy During Family-Centered Rounds: A Qualitative Study of Resident, Hospitalist, and Subspecialty Physicians

BACKGROUND Family-centered rounds (FCR) have become a leading model for pediatric inpatient rounding. Several studies have examined effective teaching strategies during FCR, but none have focused on promoting resident autonomy. OBJECTIVE The aim of this study was to identify strategies used by attending physicians to promote resident autonomy during FCR. METHODS We conducted a qualitative study of attending physicians and residents between December 2012 and February 2013 at an academic childrens hospital, where FCR is the standard model for inpatient rounds. Attending physicians participated in individual interviews, and residents participated in 1 of 2 focus groups separated by level of training. Focus group and interview transcripts were coded and themed using qualitative content analysis. RESULTS Ten attending physicians and 14 residents participated in interviews and focus groups. Attending physician behaviors that promoted resident autonomy included setting clear expectations, preforming a prerounds huddle, deliberate positioning, and delegating teaching responsibilities. These were further categorized as occurring during 1 of 4 distinct periods: (1) at the start of the rotation; (2) before daily FCR; (3) during daily FCR; and (4) after daily FCR. CONCLUSIONS Residents and attending physicians identified similar strategies to promote resident autonomy during FCR. These strategies occurred during several distinct periods that were not limited to rounds. The results suggest strategies for attending physicians to help balance appropriate and safe patient care with developing resident autonomy in the clinical setting.

Parent understanding of the role of doctors and doctors in training on an inpatient pediatric ward.

Background: Many physician trainees care for patients in an academic hospital. We studied parent understanding of the roles of medical students, interns, residents, and attending physicians in the inpatient setting of a childrens hospital. Description: Surveys were given to parents during a hospital stay on a medical service asking about the responsibilities and education of physicians and trainees. Evaluation: The majority of respondents knew that medical students were not doctors, could not write prescriptions, or supervise residents or attendings. Most respondents did not know that an intern had completed medical school, was a doctor, or could write prescriptions. Most respondents knew that attendings had graduated from medical school, were doctors, and supervise interns and students. Factors affecting understanding of these roles included the parents level of education and race. Conclusion: Confusion exists about the different roles of physicians and trainees, particularly in parents without a college education, and who self-identify as non-White.

What's the Purpose of Rounds? A Qualitative Study Examining the Perceptions of Faculty and Students

BACKGROUND: Rounds are a critical activity on any inpatient service, but there is little literature describing the purpose of rounds from the perspective of faculty and trainees in teaching hospitals. OBJECTIVE: To evaluate and compare the perceptions of pediatric and internal medicine attendings and medical students regarding the purpose of inpatient attending rounds. METHODS: The authors conducted 10 semistructured focus groups with attendings and medical students in the spring of 2014 at 4 teaching hospitals. The protocol was approved by the institutional review boards at all institutions. The authors employed a grounded theory approach to data collection and analysis, and data were analyzed by using the constant‐comparative method. Two transcripts were read and coded independently by 2 authors to generate themes. RESULTS: Forty‐eight attendings and 31 medical students participated in the focus groups. We categorized 218 comments into 4 themes comprised of 16 codes representing what attendings and medical students believed to be the purpose of rounds. These themes included communication, medical education, patient care, and assessment. CONCLUSIONS: Our results highlight that rounds serve 4 purposes, including communication, medical education, patient care, and assessment. Importantly, both attendings and students agree on what they perceive to be the many purposes of rounds. Despite this, a disconnect appears to exist between what people believe are the purposes of rounds and what is happening during rounds.