Engaging resident physicians in the design, implementation, and assessment of bedside interdisciplinary rounds.

Bedside interdisciplinary rounds (IDR) improve teamwork, communication, and collaborative culture in inpatient settings. Implementation of bedside IDR in academic settings depends on engagement from resident physicians; however, little is known about their knowledge and preferences related to bedside IDR. The goal of this program was to identify medical resident perceptions about bedside IDR and to engage resident physicians in the design, implementation, and assessment of bedside IDR in an academic setting. This is a pre-post mixed methods survey assessing resident physicians' perceptions surrounding a stakeholder-informed bedside IDR quality improvement project. Resident physicians in the University of Colorado Internal Medicine Residency Program (n = 77 pre-implementation survey responses from 179 eligible participants - response rate 43%) were recruited via e-mail to participate in surveys assessing perceptions surrounding the inclusion of interprofessional team members, timing, and preferred structure of bedside IDR. A bedside IDR structure was created based on input from resident and attending physicians, patients, nurses, care coordinators, pharmacists, social workers, and rehabilitation specialists. This rounding structure was implemented on acute care wards in June 2019 at a large academic regional VA hospital in Aurora, CO. Resident physicians were surveyed post implementation (n = 58 post-implementation responses from 141 eligible participants - response rate 41%) about interprofessional input, timing, and satisfaction with bedside IDR. The pre-implementation survey revealed several important resident needs during bedside IDR. Post-implementation survey results revealed high overall satisfaction with bedside IDR among residents, improved perceived efficiency of rounds, preserved quality of education, and value added by interprofessional input. Results also suggested areas for future improvement including timeliness of rounds and enhanced systems-based teaching. This project successfully engaged residents as stakeholders in system-level interprofessional change by incorporating their values and preferences into a bedside IDR framework.

Maximising learning on ward rounds.

This study considers different ways of maximising learning opportunities during ward rounds, with particular emphasis on the strengths and challenges of the paediatric environment. The focus is on the most common types of ward round - in acute units involving predominantly trainees - but we hope there will also be much that will interest those who work in other settings such as community clinics. Alongside a review of the best available evidence from the literature, and underpinned by educational theory, suggestions for maximising learning on ward rounds are presented. Many of these ideas were generated from working in small groups with over 90 experienced paediatricians, each with particular experience and interest in medical education, as part of the Royal College of Paediatrics and Child Health's Paediatric Educators' Programme, the PEP.

Forum to help staff deal with day-to-day stress.

Schwartz Center rounds were piloted by the King's Fund in 2009 and other hospital trusts have now taken up the concept. The rounds provide a forum for staff to discuss social and emotional issues surrounding patient care, and lead to changes in the workplace.

Things We Do for No Reason™: Card Flipping Rounds.

Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

Righting the Autonomy-Supervision Pendulum: Understanding the Impact of Independent Rounds on Medical Students, Residents, and Faculty.

PURPOSE: To explore trainee and faculty perspectives on an independent rounding intervention on general pediatrics wards at 2 institutions. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

Using Forum Theater as a Teaching Tool to Combat Patient Bias Directed Toward Health Care Professionals.

Introduction: Health care professionals who identify as members of underrepresented and racial minority groups may experience bias from patients and patient families. These occurrences disrupt the educational and therapeutic environments, distress the targeted individuals and allies, and create potential legal liability. Yet there are few educational opportunities for individuals to brainstorm and implement strategies for responding professionally during such instances. Methods: Presented first as a grand rounds, then an invited workshop, and finally an invited series, this educational activity was developed in a stepwise manner over the course of a year. Each format was sequentially modified based on feedback from participants-more than 200 physicians and other health care professionals-using evaluation forms that were voluntary and anonymous. The educational activity used an adaptation of forum theater, in which participants role-played an instance of oppression with a goal of altering the ultimate outcome. This approach provided participants with the opportunity to develop and rehearse responses to workplace bias in a way that preserved the provider-patient relationship. Results: Feedback for these educational sessions was overwhelmingly positive. Participants noted the importance of acknowledging and addressing bias in the workplace and encouraged facilitators to expand the sessions in length, frequency, and scope. Discussion: Forum theater is a methodology that can be employed in health care to teach appropriate and authentic responses to expressed patient bias while maintaining the therapeutic relationship. The positive reception from participants in our preliminary sessions established a strong foundation for future improvements to this work.

Observing bedside rounds for faculty development.

BACKGROUND: Bedside rounds are an ideal opportunity for clinical teaching. We previously offered faculty development on balancing learner autonomy, patient care and teaching. We noticed that participants often asked whether attending physicians and learners shared the same perceptions of the key elements (patient-centredness, efficiency and educational value) of bedside rounds. Understanding these perceptions and identifying areas of discordance would inform faculty development for optimal bedside rounds. METHODS: At a university hospital we observed 16 attending physicians and 47 learners over 112 patient encounters. We noted the length of rounds and the number of interruptions. Participants were surveyed on their perception of the attending physicians' efficacy in preparing the team for rounds, and the efficiency and educational value of the rounds. Bedside rounds are an ideal opportunity for clinical teaching FINDINGS: After the same rounds, compared with the attending physicians, learners perceived the patient-centredness, efficiency and educational value of the rounds to be significantly higher. Learners rated attending physicians higher than attending physicians did themselves on learner autonomy, appropriate supervision, conferring responsibility for the care plan to learners and not interrupting. There was no correlation between interruptions and length of the rounds, or learner or attending physician perception of key elements of the rounds. Learners tended to attribute greater efficacy to attending physicians for team preparation than attending physicians did themselves. CONCLUSION: We identified salient beliefs and practices on bedside teaching. Our findings suggest that identifying shared goals and expectations, and creating metrics to define successful rounds, may help attending physicians to better synergize with learners. Interruptions need not be eschewed completely for the purpose of achieving efficient rounds. Integrating these measures into faculty development may bolster the quality of bedside rounds.

A Nurse-Led Innovation in Education: Implementing a Collaborative Multidisciplinary Grand Rounds.

Multidisciplinary grand rounds provides an opportunity to promote excellence in patient care through scholarly presentations and interdisciplinary collaboration with an innovative approach. In addition, multidisciplinary grand rounds serves to recognize expertise of staff, mentor and support professional development, and provide a collaborative environment across all clinical disciplines and support services. This article describes a process model developed by nurse educators for implementing a multidisciplinary grand rounds program. The components of the process model include topic submissions, coaching presenters, presentations, evaluations, and spreading the work. This model can be easily implemented at any organization. J Contin Educ Nurs. 2017;48(8):353-357.

Project More Doctors for Brazil in remote areas of the state of Roraima: relationship between doctors and the Special Supervision Group / Projeto Mais Médicos para o Brasil em áreas remotas de Roraima, Brasil: relações entre médicos e Grupo Especial de Supervisão / Proyecto Más Médicos para Brasil en áreas remotas de Roraima, Brasil: relaciones entre los médicos y el Grupo Especial de Supervisión

ABSTRACT This article aims at discussing aspects of the Project More Doctors for Brazil's Special Supervision Group in areas of difficult access in the Brazilian state of Roraima. It is focused on the relationships between supervisors and doctors, identifying potentialities and difficulties, and highlighting strategies to overcome them. This is an experience report from a thematic content analysis of documents produced by supervisors in 2015 and 2016. Three key categories emerged: potentialities, challenges of the process and constructions based on supervision. Based on the analysis, this is an innovative relationship in healthcare, where academia and services hardly ever come together. It is a complex relationship with structural, cultural and educational limitations. It requires creativity and planning to play all different roles under construction.

RESUMO O artigo busca discutir aspectos da experiência de atuação do Grupo Especial de Supervisão do Projeto Mais Médicos para o Brasil (PMMB) em áreas de difícil acesso no estado de Roraima, Brasil, com foco nas relações entre supervisores e médicos, identificando potencialidades e dificuldades e destacando estratégias utilizadas para superá-las. Trata-se de um relato de experiência oriundo de uma análise de conteúdo temática de documentos produzidos pelos supervisores nos anos de 2015 e 2016, com o surgimento de três categorias-chave: potencialidades, desafios do processo e construções a partir da supervisão. Na análise, percebeu-se que essa relação se apresenta como inovadora, em um espaço de cuidado em saúde no qual dificilmente há aproximação entre academia e serviço, revelando-se complexa, com limites estruturais, culturais e de formação, necessitando de inventividade e planejamento para que cumpra sua variedade de papéis em construção.

Resumen El objetivo del artículo es discutir aspectos de la experiencia de actuación del Grupo Especial de Supervisión del Proyecto Más Médicos para Brasil en áreas de difícil acceso en el Estado de Roraima, Brasil, enfocándose en las relaciones entre supervisores y médicos, identificando potencialidades, dificultades y subrayando las estrategias utilizadas para superarlas. Se trata de un relato de experiencia proveniente de un análisis de contenido temático de documentos producidos por los supervisores en los años 2015 y 2016, con el surgimiento de tres categorías clave: potencialidades, desafíos del proceso y construcciones a partir de la supervisión. En el análisis se percibió que esa relación se presenta como innovadora en un espacio de cuidado de salud en donde difícilmente hay aproximación entre academia y servicio, revelándose compleja, con límites estructurales, culturales y de formación, necesitando capacidad de invención y planificación para que cumpla su variedad de papeles en construcción.

The management of academic supervision in the More Doctors for Brazil Project by higher education institutions / A gestão da supervisão acadêmica no Projeto Mais Médicos para o Brasil por instituições de educação superior / La gestión de la supervisión académica en el Proyecto Más Médicos para Brasil por las instituciones de educación superior

ABSTRACT The More Doctors Program is a strategic set of actions for the Brazilian National Health System (SUS) aiming at improvements in medical education, professional qualification and retention of doctors in unassisted areas. Among these actions, we highlight the Project More Doctors for Brazil (PMMB), responsible for the emergency supply of doctors. It was conceived as a response to the shortage of professionals in primary care across the country, an extremely important aspect in this set of strategies for SUS. The professional improvement proposed by PMMB has mobilized public higher education institutions to participate as supervisory institutions. They are responsible for supervising the activities developed by doctors and for strengthening the continuing education policy through teaching-service integration actions. This article aims to report on the experience of managing academic supervision in light of the challenge of the implementation of PMMB.

RESUMO O Programa Mais Médicos (PMM) consagra-se como um conjunto estratégico de ações para o Sistema Único de Saúde (SUS), visando ao aprimoramento da formação médica, à qualificação profissional e à fixação de médicos em regiões desassistidas. Destacamos, dentre essas ações do programa, o Projeto Mais Médicos para o Brasil (PMMB), responsável pelo provimento emergencial de médicos. Este foi concebido como resposta à carência de profissionais na Atenção Básica em Saúde do país, aspecto de destaque nesse conjunto de estratégias para o SUS. O aperfeiçoamento proposto pelo PMMB mobilizou as instituições públicas de educação superior a atuar como instituições supervisoras (IS). Essas instituições atuam na supervisão das atividades desenvolvidas pelos médicos e no fortalecimento da política de educação permanente com ações de integração ensino-serviço. Este estudo objetiva relatar a experiência na gestão da supervisão acadêmica diante do desafio de implantação do PMMB.

RESUMEN El Programa Más Médicos se consagra como un conjunto estratégico de acciones para el Sistema Único de Salud (SUS) teniendo como objetivo el perfeccionamiento de la formación médica, de la calificación profesional y el establecimiento de médicos en regiones no asistidas. Entre esas acciones del Programa, subrayamos el Proyecto Más Médicos para Brasil (PMMB), responsable por la provisión de médicos en situación de emergencia. El mismo fue concebido como respuesta a la carencia de profesionales en la Atención Básica de Salud del país, aspecto de destaque en ese conjunto de estrategias para el SUS. El perfeccionamiento propuesto por el PMMB movilizó a las instituciones públicas de educación superior para que actuaran como Instituciones Supervisoras (IS). Estas instituciones actúan en la supervisión de las actividades desarrolladas por los médicos y en el fortalecimiento de la política de educación permanente con acciones de integración enseñanza-servicio. Este estudio tiene el objetivo de relatar la experiencia en la gestión de la Supervisión Académica ante el desafío de implantación del PMMB.

The More Doctors Program in remote areas: the experience of the Special Supervision Group in Pará, Brazil / O Programa Mais Médicos em áreas remotas: a experiência do Grupo Especial de Supervisão no Pará, Brasil / El Programa Más Médicos en áreas remotas: la experiencia del Grupo Especial de Supervisión en el estado de Pará, Brasil

The More Doctors Program encompasses an academic supervision carried out by supervisory institutions that have signed an agreement with the Ministry of Education (MEC). Academic supervision is part of the educational offers and implies periodic and regular visits to participant doctors. However, due to the difficulties of some institutions in the North region to fulfill their responsibilities under the Project More Doctors for Brazil, MEC created the Special Supervision Group (GES), which has been operating since 2014 in that region. This article records the GES experience in the state of Pará from January 2015 to May 2017. Its main contribution is to enable the provision of care for the population that inhabits a vast region where there is shortage of doctors, as the supervision of the professionals is mandatory and if it did not occur, the Program would not be allowed in Pará.(AU)

O Programa Mais Médicos (PMM) abrange, no eixo provimento, a supervisão acadêmica, realizada por instituições supervisoras (IS) que firmaram termo de adesão com o Ministério da Educação (MEC). A supervisão é parte das ofertas educacionais e implica visita periódica e regular aos médicos participantes do PMM. Entretanto, devido às dificuldades de algumas IS da região Norte cumprirem o que lhes cabe no âmbito do Projeto Mais Médicos para o Brasil (PMMB), o MEC criou o Grupo Especial de Supervisão (GES), que atua desde 2014 nessa região. Este artigo registra a experiência do GES no estado do Pará no período de janeiro de 2015 a maio de 2017. Sua principal contribuição é possibilitar o atendimento à população habitante de uma região vasta e com notória escassez de médicos, uma vez que a supervisão dos profissionais é obrigatória e, caso ausente, inviabilizaria o programa no Pará.(AU)

El Programa Más Médicos (PMM) abarca la supervisión académica realizada por las Instituciones Supervisoras (IS) que hayan firmado documento de adhesión con el Ministerio de la Educación (MEC). La supervisión académica es parte de las ofertas educativas e implica una visita periódica y regular a los médicos del PMM. Sin embargo, debido a las dificultades de algunas IS de la región Norte para cumplir sus responsabilidades en el ámbito del PMMB, el MEC creó el Grupo Especial de Supervisión (GES), que actúa desde 2014 en la región. Este artículo registra la experiencia del GES en el estado de Pará en el período de enero de 2015 a mayo de 2017. Su contribución es hacer posible la asistencia a una población que habita una vasta región con notable escasez de médicos, una vez que la supervisión de los profesionales es obligatoria y si no la hubiera inviabilizaría el Programa en el Estado de Pará.(AU)

An up-front guide to getting promoted: slow and steady.

For many years there has been a debate about the explanation for the common observation that faculty who sit nearer the front of the conference room at departmental grand rounds are more likely to have higher academic rank. There is an obvious correlation between rank and age, so that the natural tendency of older faculty to be closer to the front in order to hear and see better poses one confounding variable. But the underlying questions ­ whether faculty who sit closer to the front get promoted because they sit closer or choose to sit closer in order to get promoted or sit closer because they feel more engaged and want to participate rather than be more passive, or nap ­ has never been addressed. It is akin to a nature/nurture question, but the truth of the observation has never been supported by data. The following study, financed by the Academy, was intended to answer this contentious question and provide a path forward. Fifteen years ago the Academy funded a large study to investigate this question via a long-term, multi-center trial. The following is an analysis of the results.