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.

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.

Facilities and equipment for the care of pediatric patients in a community hospital.

Many children who require hospitalization are admitted to community hospitals that are more accessible for families and their primary care physicians but vary substantially in their pediatric resources. The intent of this clinical report is to provide basic guidelines for furnishing and equipping a pediatric area in a community hospital.