Impact of Bedside Rounding on Attending Teaching Evaluations.

OBJECTIVE: To examine associations between bedside rounding (BSR) and other rounding strategies (ORS) with resident evaluations of teaching attendings and self-reported attending characteristics. METHODS: Faculty from three academic medical centers who attended resident teaching services for ≥4 weeks during the 2018-2019 academic year were invited to complete a survey about personal and rounding characteristics. The survey instrument was iteratively developed to assess rounding strategy as well as factors that could affect choosing one rounding strategy over another. Survey results and teaching evaluation scores were linked, then deidentified and analyzed in aggregate. Included evaluation items assessed resident perceptions of autonomy, time management, professionalism, and teaching effectiveness, as well as a composite score (the numeric average of each attending's scores for all of the items at his or her institution). BSR was defined as spending >50% of rounding time in patients' rooms with the team. Hallway rounding and conference room rounding were combined into the ORS category and defined as >50% of rounding time in these settings. All of the scores were normalized to a 10-point scale to allow aggregation across sites. RESULTS: A total of 105 attendings were invited to participate, and 65 (62%) completed the survey. None of the resident evaluation scores significantly differed based on rounding strategy. Composite scores were similar for BSR and ORS (difference of <0.1 on a 10-point scale). Spearman correlation coefficients identified no statistically significant correlation between rounding strategy and evaluation scores. An exploratory analysis of variance model identified no single factor that was significantly associated with composite teaching scores (P > 0.45 for all) or the domains of teaching efficacy, professionalism, or autonomy (P > 0.13 for all). Having a formal educational role was significantly associated with better evaluation scores for time management, and the number of lectures delivered per year approached statistical significance for the same domain. CONCLUSIONS: Conducting BSR did not significantly affect resident evaluations of teaching attendings. Resident perception of teaching effectiveness based on rounding strategy should be neither a motivator nor a barrier to widespread institution of BSR.

Patient-Centered Bedside Rounds and the Clinical Examination.

Bedside hospital rounds promote patient-centered care in teaching and nonteaching settings. Patients and families prefer bedside rounds and provider acceptance is increasing. Efficient bedside rounds with an interprofessional team or with learners requires preparation of the patient and the rounding team. Bedside "choreography" provides structure and sets expectations for time spent in the room. By using relationship-centered communication, rounds can be both patient proximate and patient centered. The clinical examination can be integrated into the flow of the presentation and case discussion. Patient and provider experience can be enhanced through investing time at the bedside.

Acute Cytomegalovirus (CMV) Infection Associated with Hemophagocytic Lymphohistiocytosis (HLH) in an Immunocompetent Host Meeting All Eight HLH 2004 Diagnostic Criteria.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and often deadly syndrome characterized by severe inflammation and cytokine dysregulation. The disease is defined by the HLH-2004 criteria, requiring five of eight findings, and is further differentiated into either primary or secondary causes. Primary HLH tends to be of genetic etiology, while secondary HLH results from other insults such as infection. Secondary HLH is most commonly associated with viral infections in immunocompromised patients. Acute cytomegalovirus (CMV) associated HLH in the immunocompetent host is exceedingly rare and only documented in four case reports to date. We describe the fifth documented case of CMV-associated HLH in an immunocompetent patient, and furthermore, we demonstrate that this patient is the first published case of its type to satisfy all eight of HLH-2004 criteria.

Returning to the Bedside: Notes From a Clinical Educator.

Over the past 3 decades, teaching rounds have drifted away from the bedside in favor of management discussions in a conference room or hallway. As a result, patients and families--2 of the most valuable resources in health care--are being left out of the loop. This trend is now being reversed by bedside presentations of newly admitted patients and structured interdisciplinary bedside rounds.

The impact of a faculty learning community on professional and personal development: the facilitator training program of the American Academy on Communication in Healthcare.

PURPOSE: Relationship-centered care attends to the entire network of human relationships essential to patient care. Few faculty development programs prepare faculty to teach principles and skills in relationship-centered care. One exception is the Facilitator Training Program (FTP), a 25-year-old training program of the American Academy on Communication in Healthcare. The authors surveyed FTP graduates to determine the efficacy of its curriculum and the most important elements for participants' learning. METHOD: In 2007, surveys containing quantitative and narrative elements were distributed to 51 FTP graduates. Quantitative data were analyzed using descriptive statistics. The authors analyzed narratives using Burke's dramatistic pentad as a qualitative framework to delineate how interrelated themes interacted in the FTP. RESULTS: Forty-seven respondents (92%) identified two essential acts that happened in the program: an iterative learning process, leading to heightened personal awareness and group facilitation skills; and longevity of learning and effect on career. The structure of the program's learning community provided the scene, and the agents were the participants, who provided support and contributed to mutual success. Methods of developing skills in personal awareness, group facilitation, teaching, and feedback constituted agency. The purpose was to learn skills and to join a community to share common values. CONCLUSIONS: The FTP is a learning community that provided faculty with skills in principles of relationship-centered care. Four further features that describe elements of this successful faculty-based learning community are achievement of self-identified goals, distance learning modalities, opportunities to safely discuss workplace issues outside the workplace, and self-renewing membership.

Does health care provider screening for domestic violence vary by race and income?

Domestic violence (DV) affects approximately 25% of women in the United States with approximately 5.3 million incidents each year. DV advocates and national medical associations encourage health care providers (HCPs) to screen patients. To determine DV screening rates by race and income, patient race/ethnicity, income, and receipt of and receptiveness toward screening were measured. Patient preference for screening did not vary by race and varied little by income, but experience with screening did. Practices serving predominantly African American and lower income patients screened at higher rates. These findings seem driven by practice factors rather than differential treatment of individuals. Future research should focus on why certain types of practices screen more than others.

Patient attitudes toward screening.

BACKGROUND: Physician organizations recommend screening for health care behaviors. Despite these recommendations, health care providers worry that questions on sensitive topics may not be accepted by their patients. To determine if there is a relationship between health care screening by providers and acceptance of that screening by patients, a survey of female patients was analyzed. METHOD: Two telephone surveys were conducted two years apart. Each was a cross-sectional sample of female patients over the age of 18 years who had been seen by their primary care provider (PCP) in the previous 12 months. Patients were asked if they had been screened for eight different health behaviors (exercise, smoking, use of alcohol or drugs, excessive stress, sexual functioning concerns, safety or violence in the home, guns in the home) in the past year. They were also asked about their attitudes toward screening for those behaviors by health care providers. Odds ratios were calculated for patients who both agreed that screening should occur and reported having been screened in the last year. RESULTS: 3,175 women were surveyed. There was high acceptance of routine screening for exercise (75%), smoking (72%), alcohol/drugs (68%), and stress (62%), but less for sexual functioning (40%), safety/violence (40%), or guns (23%). There was a higher likelihood of agreeing with routine screening if the patient reported having been screened in the past year: exercise (OR 2.3, 95% CI 1.8-2.9), smoking (OR 1.6, 95% CI 1.3-1.9), alcohol/drugs (OR 2.3, 95% CI 1.9-2.7), stress (OR 1.7, 95% CI 1.4-1.9), sexual functioning (OR 2.7, 95% CI 2.2-3.4), safety/violence (OR 3.4, 95% CI 2.8-4.2), and guns (OR 4.4, 95% CI 3.4-5.8). LIMITATIONS: Only women in established relationships with primary care providers were surveyed. The cross-sectional nature of the survey prevents determination of the causality of the relationship. CONCLUSION: Women who had been screened for a health behavior had greater acceptance of routine screening for that behavior. Although further research is needed to determine the casual relationship, providers should not worry about offending their patients when screening for sensitive health behaviors.

A practice-centered intervention to increase screening for domestic violence in primary care practices.

BACKGROUND: Interventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices. METHODS: A multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice. RESULTS: Seventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%). After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43-2.23). CONCLUSION: An intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.

It's in the cards: a practice-friendly, real-time data collection strategy for quality improvement.

The heart of the Card Response Project, a six-step data collection strategy, is the clinician, armed with a pocket-sized card for rapid completion during clinic visits.

Patient complaints about physician behaviors: a qualitative study.

PURPOSE: Health care institutions are required to routinely collect and address formal patient complaints. Despite the availability of this feedback, no published efforts explore such data to improve physician behavior. The authors sought to determine the usefulness of patient complaints by establishing meaningful categories and exploring their epidemiology. METHOD: A register of formal, unsolicited patient complaints collected routinely at the Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina was used to categorize complaints using qualitative research strategies. After eliminating complaints unrelated to physician behavior, complaints from March 1999 were analyzed (60) to identify complaint categories that were then validated using complaints from January 2000 (122). Subsequently, all 1,746 complaints for the year 2000 were examined. Those unrelated to physician behavior (1,342) and with inadequate detail (182) were excluded, leaving 222 complaints further analysis. RESULTS: Complaints were most commonly lodged by patient (111), followed by a patient's spouse (33), (52), parent (50), relative/friend (15), or health professional (2). The most commonly identified category was disrespect (36%), followed by disagreement about expectations of care (23%), inadequate information (20%), distrust (18%), perceived unavailability (15%), interdisciplinary miscommunication (4%), and misinformation (4%). Multiple categories were identified in (19%) complaints. Examples from each category provide adequate detail to develop instructional modules. CONCLUSION: The seven complaint categories of physician behaviors should be useful in developing curricula related to professionalism, communication skills, practice-based learning.