Family-centered rounds and medical student education: a qualitative examination of students' perceptions.

BACKGROUND: Although current literature supports the benefits of family-centered rounds on medical education, few studies have explored students' perceptions of family-centered rounds. PURPOSE: The aim of this study was to provide a better and broader understanding of the effect of family-centered rounds on medical student education. METHODS: During the inpatient portion of the third-year pediatric clerkship at a southeastern United States 4-year medical school, students were exposed to family-centered and conference room work rounds and completed a post-hoc reflective open-ended questionnaire. The study was conducted from July to December 2007 and the inpatient experience was at one of two large academic medical centers. Using a constant comparative approach, the qualitative content of 45 of the 63 potential students' responses was analyzed. RESULTS: Family-centered rounds served as an opportunity for medical students to build their practice-based knowledge through direct and simultaneous interaction with the medical team, patients, and families. Family member communication, medical team communication, and increased exposure to patients allowed for unique learning opportunities such as augmentation of communication skills, practice with use of lay terms, legitimate peripheral participation, and humanizing cognitive understanding of diseases. Areas of concern noted by the students included space limitations, length of rounds, potential anxiety provoked in the patient, and faculty and resident comfort with teaching certain topics. CONCLUSIONS: Our qualitative analysis of medical student perceptions on family-centered rounds suggests that pediatric medical student education may benefit by improving knowledge and practice with communication and humanizing disease processes. However, perceived barriers, such as concerns about space or instructor comfort with teaching certain topics, existed. Further studies are warranted to gain a better understanding of the educational impact of conducting this type of rounds.

Improving developmental screening in pediatric resident education.

OBJECTIVE: Given that pediatricians cite low competency in developmental screening, this study aims to effectively teach screening to residents. DESIGN: Using a quasi-experimental design, residents received an educational module and one-on-one teaching of 3 validated developmental screeners (Denver II, ASQ [Ages and Stages Questionnaire], and PEDS [Parents' Evaluation of Developmental Status]), with subsequent independent use with all 3 screeners with their own continuity patients. Outcome measures included changes in knowledge, skills, and preferences. RESULTS: All residents achieved significantly increased skills with all screeners. They strongly preferred the ASQ (70%), citing that this taught them normal (30.2%) and pathological (27.9%) development while negatively noting time (72.1%), scheduling issues (30.2%), and difficulties with child cooperation (20.9%). Knowledge specifics did not significantly increase. CONCLUSIONS: In-depth developmental screening education revealed marked improvement in skills and preferences. These evaluations led to full adoption of the ASQ in resident clinics. Future research must test if effective development teaching in residency leads to increased routine screenings in practice.

The use of virtual patients to teach medical students history taking and communication skills.

BACKGROUND: At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills. METHODS: In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user's head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of students' performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment). RESULTS: All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student's questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 +/- 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 +/- 1.76 for version 2.0 (4 months later) reflecting enhanced voice recognition and other technological improvements. These overall ratings compare favorably to a 7.47 +/- 1.16 student rating for real SPs. CONCLUSIONS: Despite current technological limitations, virtual clinical scenarios could provide students a controllable, secure, and safe learning environment with the opportunity for extensive repetitive practice with feedback without consequence to a real or SP.