Medical Student Role on Family Centered Rounds (FCR) Part 1: How to Succeed

1. Medical Student Role on Family Centered Rounds (FCR) Part 1:How to Succeed Mary Ottolini MD, MPH Vice Chair of Medical Education

2. Overall Objectives For SuccessfulPresentations During FCR: Part 1 Objectives • Describe the purpose of FCR and your role. • Use the ‘PBEAR’ format to give easy to follow, succinct oral presentations • including only pertinent positive and negative findings Part 2 Objectives (discussed in separate presentation) • Begin a presentation on a new patient by representing the “Big Picture” (Problem Representation) Identify the ‘defining features’ + Use adjectives (‘semantic qualifiers’) to describe how you’re thinking = Combine into a ‘Problem Representation’ Part 3 Objectives (discussed in separate presentation) • To use discriminating features to analyze the differential diagnosis • Describe the difference in the presentation for a new vs. an old pt

3. Part 1 Objectives • Describe the purpose of FCR and your role. • Use the ‘PBEAR’ format to give easy to follow, succinct oral presentations • including only pertinent positive and negative findings

4. Play Video What is the purpose of FCR? Please click on the video below to play:

5. The Purpose of Rounds • Calibrate and Correct a Shared Mental Model • Create a Plan for the Day • Assign and Accomplish Tasks • Plan Transitions of Care • Educate Yourself and the Patient/Family

6. 1. Calibrate and Correct a Shared Mental Model Use (I) PBEAR (SS) • (I) Introductions and greeting • Senior resident says hello- introduces team • Asks parent/patient what concerns them most today and why? • PBEAR • Use this structure for your case presentation • Communicate a clear thought process • (S)olicit relevant input from staff/team members- • Senior Resident asks Nurse, Case Manager, patient and parents • (S)hare the team’s mental model with the family • Senior Resident Checks understanding • Asks about data that doesn’t fit

7. 2. Create a Plan for the Day • Based upon pertinent data (meds, studies, VS, overnight events) • Assess progress and Anticipate likely problems • Propose a Plan • Validate and Verify the plan • Team members • Parents/patients

8. 3. Assign and Accomplish Tasks • Renew, refine or discontinue patient orders • Jot down tasks to complete after rounds

9. 4. Plan Transitions of Care • Assess discharge/transfer criteria • Estimate the Timeline • Identify specific transition needs • (wean O2, family teaching, referral to rehab)

10. 5. Educate Yourself and the Family • Just-in-time and self directed learning: • Identify your gaps • Write down questions • Use your smart phone to look up information • Observe the Physical Exam • Family integration and education: • Address concerns and confirm comprehension

11. Learning During Family Centered RoundsWhat makes it work? Efficient Case Presentations Don’t Repeat See/Examine the Patient Deliberately Multi-task: Look up information about the pt during rounds

12. Efficient Presentations are Crucial to Your Learning!! Succinct, Clear Presentations Changing the emphasis from: Data delivery -------- Data synthesis Thoroughness-------- Selectivity All the data ------ Thepivotal data “Hx-heavy” ----------- “DDx-heavy”

13. CHIEF COMPLAINT HISTORY, PE; LAB ASSESSMENT PLAN P: PROBLEM Represent the problem using adjectives to communicate how you are thinking about the defining features of the problem B: BACKGROUND EVIDENCE Report ONLY the key evidence relating to the Dx/Rx of problem Ask if more data is needed A: ANALYSIS Analyze the differential- Compare/contrast discriminating features/evidence to determine diagnosis R: RECOMMENDATION Express uncertainty Goals for management The Plan State what you are going to read about Traditional Case Presentation vs. PBEAR

14. Communication Skills: • Speak audibly/ clearly • Avoid Digressing or Repeating • Avoid Intermixing data where it doesn’t belong (i.e. PE findings during HPI) • Use medical terms appropriately. • Use notes appropriately • Look parents in the eye-Be Sensitive to impact

15. Background Evidence: • Background Evidence: Subjective (History) • Accurately synthesize the history • Problem-focused with pertinent positives/ negatives. • Omit Irrelevant Data • Logical progression of events- easy to follow • Background Evidence: Objective Data: • Accurately synthesize the physical exam and lab data. • Include problem-focused pertinent positives/ negatives and pending data. • Omit Irrelevant Data

16. Play Video Watch the Video and Assess: 1. Communication 2. Background Evidence Please click on the video below to play:

17. Communication Skills: X X X NA X His speech was audible, but with a lot of “uhms” Notes should only be referred to for discrete data points- not read “Mom said she looked sick…No travel outside the country”-this is out of order/confusing

18. Background Evidence: X X X The cough should be described in more detail and in the HPI not ROS. The amount of intake and urine output should be described in greater detail to assess hydration. Developmental Hx and Family History are irrelevant to the presenting problem “NSVD- was discharged in 3 days…mother was unsure of GBS status”- this is irrelevant and confusing

19. Background Evidence: Objective Data: X X X Comments: No description of her overall appearance; no vital signs, inadequate pulmonary exam Normal eye findings are irrelevant; get an Otoscope! Don’t state details of normal and irrelevant lab values- ie U/A and Lytes

20. In Summary… Be prepared to discuss the following questions: • Describe the 5 purposes of Family Centered Rounds? • Explain PBEAR format for presenting. • What are the key attributes of good Communication? • How do you determine what Background Evidence is pertinent to present on FCR?