The pediatrics milestones: initial evidence for their use as learning road maps for residents.

OBJECTIVE: As the next step in competency-based medical education, the Pediatrics Milestone Project seeks to provide a learner-centered approach to training and assessment. To help accomplish this goal, this study sought to determine how pediatric residents understand, interpret, and respond to the Pediatrics Milestones. METHODS: Cognitive interviews with 48 pediatric residents from all training levels at 2 training programs were conducted. Each participant reviewed one Pediatrics Milestone document (PMD). Eight total Pediatrics Milestones, chosen for their range of complexity, length, competency domain, and primary author, were included in this study. Six residents, 2 from each year of residency training, reviewed each PMD. Interviews were transcribed and coded using inductive methods, and codes were grouped into themes that emerged. RESULTS: Four major themes emerged through coding and analysis: 1) the participants' degree of understanding of the PMDs is sufficient, often deep; 2) the etiology of participants' understanding is rooted in their experiences; 3) there are qualities of the PMD that may contribute to or detract from understanding; and 4) participants apply their understanding by noting the PMD describes a developmental progression that can provide a road map for learning. Additionally, we learned that residents are generally comfortable being placed in the middle of a series of developmental milestones. Two minor themes focusing on interest and practicality were also identified. CONCLUSIONS: This study provides initial evidence for the Pediatrics Milestones as learner-centered documents that can be used for orientation, education, formative feedback, and, ultimately, assessment.

Medical student self-efficacy with family-centered care during bedside rounds.

PURPOSE: Factors that support self-efficacy in family-centered care (FCC) must be understood in order to foster FCC in trainees. Using social cognitive theory, the authors examined (1) how three supportive experiences (observing role models, practicing for mastery, and receiving feedback) influence self-efficacy with FCC during rounds and (2) whether the influence of these supportive experiences was mediated by self-efficacy with three key FCC tasks (relationship building, information exchange, and decision making). METHOD: Researchers surveyed third-year students during pediatric clerkship rotations during the 2008-2011 academic years. Surveys assessed supportive experiences and students' self-efficacy both with FCC during rounds and with key FCC tasks. Researchers constructed measurement models via exploratory and confirmatory factor analyses. Composite indicator structural equation models evaluated whether supportive experiences influenced self-efficacy with FCC during rounds and whether self-efficacy with key FCC tasks mediated any such influences. RESULTS: Of 184 eligible students, 172 (93%) completed preclerkship surveys. Observing role models and practicing for mastery supported self-efficacy with FCC during rounds (each P < .01), whereas receiving feedback did not. Self-efficacy with two specific FCC tasks-relationship building and decision making (each P < .05)-mediated the effects of these two supportive experiences on self-efficacy with FCC during rounds. CONCLUSIONS: Both observing role models and practicing for mastery foster students' self-efficacy with FCC during rounds, operating through self-efficacy with key FCC tasks. Results suggest the importance both of helping students gain self-efficacy in key FCC tasks before rounds and of helping educators implement supportive experiences during rounds.

Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care.

Over 8% of children have a chronic disease and many are unable to adhere to treatment. Satisfaction with chronic disease care can impact adherence. We examine how visit satisfaction is associated with physician communication style and ongoing physician-family relationships. We collected surveys and visit videos for 75 children ages 9-16 years visiting for asthma, diabetes, or sickle cell disease management. Raters assessed physician communication style (friendliness, interest, responsiveness, and dominance) from visit videos. Quality of the ongoing relationship was measured with four survey items (parent-physician relationship, child-physician relationship, comfort asking questions, and trust in the physician), while a single item assessed satisfaction. Correlations and chi square were used to assess association of satisfaction with communication style or quality of the ongoing relationship. Satisfaction was positively associated with physician to parent (p < 0.05) friendliness. Satisfaction was also associated with the quality of the ongoing parent-physician (p < 0.001) and child-physician relationships (p < 0.05), comfort asking questions (p < 0.001), and trust (p < 0.01). This shows that both the communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.

Medical student outcomes after family-centered bedside rounds.

OBJECTIVE: Family-centered bedside rounds (FCBRs) are recommended to improve trainee education, patient outcomes, and family satisfaction. However, bedside teaching has waned in recent years, potentially leading to less teaching and more concern for trainees. We examined medical students' concerns, teaching evaluations, and attitudes after experiencing FCBRs during the pediatric clerkship. METHODS: Data are both cross-sectional and pre-clerkship and post-clerkship surveys for 113 (89%) of 127 students. Students reported frequencies of post-clerkship concerns (14 items) and teaching experiences (17 items), with 5 response options (1 = never, 2 = rarely, 3 = occasionally, 4 = usually, 5 = always, dichotomized with "frequent" being usually or occasionally). Students reported pre-clerkship and post-clerkship attitudes for 4 items on a 7-point scale (1 = strongly disagree, 7 = strongly agree). Analyses included adjusted means or proportions. RESULTS: The most commonly endorsed concern was presenting information in a way that was understandable to patients and families, with 34.5% of students having this concern frequently. The majority of students frequently experienced 12 of 17 teaching items. Effective teaching of physical exam skills was the teaching item least often experienced frequently by students (20.3%). Student attitudes about the benefits of FCBRs for families were significantly more positive post-clerkship (mean change, 0.37 points; P < .001), but they remained neutral in their preference for FCBRs over traditional rounds without the family present (mean change, -0.14 points; P > .05). CONCLUSIONS: Although students demonstrate positive attitudes toward FCBRs and report frequent occurrence of inpatient teaching elements, findings suggest opportunities for easing student concerns and for using this venue to teach exam skills.