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Medical Student Role on Family Centered Rounds (FCR)
Part 1:How to Succeed
Mary Ottolini MD, MPHVice Chair of Medical
Education
Overall Objectives For Successful
Presentations During FCR: Part 1 Objectives• Describe the purpose of FCR and your role.1. Use the ‘PBEAR’ format to give easy to follow, succinct oral
presentations • including only pertinent positive and negative findings
Part 2 Objectives (discussed in separate presentation)1. Begin a presentation on a new patient by representing the “Big
Picture” (Problem Representation)Identify the ‘defining features’
+ Use adjectives (‘semantic qualifiers’) to describe how you’re thinking= Combine into a ‘Problem Representation’
Part 3 Objectives (discussed in separate presentation)1. To use discriminating features to analyze the differential
diagnosis2. Describe the difference in the presentation for a new vs. an old
pt
Part 1 Objectives1. Describe the purpose of FCR and your role.
2. Use the ‘PBEAR’ format to give easy to follow, succinct oral presentations • including only pertinent positive and negative
findings
What is the purpose of FCR?
Please click on the video below to play:
Play Video
The Purpose of Rounds
1. Calibrate and Correct a Shared Mental Model
2. Create a Plan for the Day
3. Assign and Accomplish Tasks
4. Plan Transitions of Care
5. Educate Yourself and the Patient/Family
1. Calibrate and Correct a Shared Mental Model
Use (I) PBEAR (SS)• (I) Introductions and greeting
– Senior resident says hello- introduces team– Asks parent/patient what concerns them most today and
why?
• PBEAR– Use this structure for your case presentation – Communicate a clear thought process
• (S)olicit relevant input from staff/team members- – Senior Resident asks Nurse, Case Manager, patient and
parents
• (S)hare the team’s mental model with the family– Senior Resident Checks understanding – Asks about data that doesn’t fit
2. Create a Plan for the Day
• Based upon pertinent data (meds, studies, VS, overnight events)
• Assess progress and Anticipate likely problems
• Propose a Plan
• Validate and Verify the plan – Team members– Parents/patients
3. Assign and Accomplish Tasks
• Renew, refine or discontinue patient orders
• Jot down tasks to complete after rounds
4. Plan Transitions of Care
• Assess discharge/transfer criteria – Estimate the Timeline
• Identify specific transition needs – (wean O2, family teaching, referral to
rehab)
5. Educate Yourself and the Family
• Just-in-time and self directed learning:– Identify your gaps– Write down questions– Use your smart phone
to look up information
– Observe the Physical Exam
• Family integration and education: – Address concerns and confirm
comprehension
Learning During Family Centered Rounds
What makes it work?
Efficient Case Presentations
Don’t Repeat
See/Examine the Patient
Deliberately Multi-task: Look up information about the pt
during rounds
Efficient Presentations are Crucial to Your Learning!!Succinct, Clear Presentations
Changing the emphasis from:Data delivery -------- Data synthesisThoroughness-------- SelectivityAll the data ------ The pivotal data“Hx-heavy” ----------- “DDx-heavy”
Traditional Case Presentation
vs. PBEAR• CHIEF COMPLAINT
• HISTORY, PE; LAB
• ASSESSMENT
• PLAN
• P: PROBLEM– Represent the problem using
adjectives to communicate how you are thinking about the defining features of the problem
• B: BACKGROUND EVIDENCE– Report ONLY the key evidence
relating to the Dx/Rx of problem– Ask if more data is needed
• A: ANALYSIS– Analyze the differential-
Compare/contrast discriminating features/evidence to determine diagnosis
• R: RECOMMENDATION– Express uncertainty– Goals for management– The Plan– State what you are going to read
about
Communication Skills:
• Speak audibly/ clearly
• Avoid Digressing or Repeating
• Avoid Intermixing data where it doesn’t belong (i.e. PE findings during HPI)
• Use medical terms appropriately.
• Use notes appropriately
• Look parents in the eye-Be Sensitive to impact
Background Evidence:
• Background Evidence: Subjective (History) – Accurately synthesize the history
• Problem-focused with pertinent positives/ negatives.• Omit Irrelevant Data
– Logical progression of events- easy to follow
• Background Evidence: Objective Data: – Accurately synthesize the physical exam and lab
data. • Include problem-focused pertinent positives/ negatives
and pending data .
• Omit Irrelevant Data
Watch the Video and Assess: 1. Communication 2. Background Evidence
Please click on the video below to play:
Play Video
Communication Skills:
• Speaks audibly/ clearly • Uses medical terms appropriately. • Uses notes appropriately • Sensitive to impact on patient/ family.
Spoke inaudibly or unintelligible «------------------------------------------------------------» Spoke completely clearly and audibly.
Often digressed/ repeated. «------------------------------------------------------------» No repetition/ digression
Read or used notes inappropriately. «------------------------------------------------------------» Used notes completely appropriately.
Ignored patient/ family. «------------------------------------------------------------» Clearly Included patient/ family.
Intermixed data (ie history in PE) «------------------------------------------------------------» Presented all data in the correct category
X
X
X
His speech was audible, but with a lot of “uhms”
X
Notes should only be referred to for discrete data points- not read “Mom said she looked sick…No travel outside the country”-this is out of order/confusing
NA
Background Evidence:
Background Evidence: Subjective (History)
• Accurately synthesizes admitting/ interim history. • Problem-focused with pertinent positives/ negatives. • Logical progression of events.
Omitted most of the relevant data «------------------------------------------------------------» Included ALL the relevant data. Included irrelevant data. «------------------------------------------------------------» Omitted ALL the irrelevant data Confusing progression of events. «------------------------------------------------------------» Easy to follow progression of events.
•
XX
X
“NSVD- was discharged in 3 days…mother was unsure of GBS status”- this is irrelevant and confusing
Developmental Hx and Family History are irrelevant to the presenting problem
The cough should be described in more detail and in the HPI not ROS.The amount of intake and urine output should be described in greater detail to assess hydration.
Background Evidence: Objective Data:
Omitted most of the relevant data
«------------------------------------------------------» Included ALL the relevant data
Included irrelevant data «------------------------------------------------------» Omitted ALL the irrelevant data
Exam/ labs inaccurate/incorrect «----------------------- ------------------------------» Accurate/correct exam/ lab data
Comments:
X
No description of her overall appearance; no vital signs, inadequate pulmonary exam
Normal eye findings are irrelevant; get an Otoscope!
Don’t state details of normal and irrelevant lab values- ie U/A and Lytes
XX
In Summary…
Be prepared to discuss the following questions:1. Describe the 5 purposes of Family Centered
Rounds?
2. Explain PBEAR format for presenting.
3. What are the key attributes of good Communication?
4. How do you determine what Background Evidence is pertinent to present on FCR?