1. Mary Ottolini MD, MPH Vice Chair of Medical Education
Medical Student Role on Family Centered Rounds (FCR) Part 1: How to Succeed
Mary Ottolini MD, MPH
Vice Chair of Medical Education

2. Overall Objectives For Successful Presentations During FCR:
Part 1 Objectives
Describe the purpose of FCR and your role.
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)
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)
To use discriminating features to analyze the differential diagnosis
Describe the difference in the presentation for a new vs. an old pt

3. Part 1 Objectives Describe the purpose of FCR and your role.
Use the ‘PBEAR’ format to give easy to follow, succinct oral presentations
including only pertinent positive and negative findings

4. What is the purpose of FCR?
Please click on the video below to play:
Play Video

5. The Purpose of Rounds Calibrate and Correct a Shared Mental Model
Create a Plan for the Day
Assign and Accomplish Tasks
Plan Transitions of Care
Educate Yourself and the Patient/Family

6. 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

7. 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

8. 3. Assign and Accomplish Tasks
Renew, refine or discontinue patient orders
Jot down tasks to complete after rounds

9. 4. Plan Transitions of Care
Assess discharge/transfer criteria
Estimate the Timeline
Identify specific transition needs
(wean O2, family teaching, referral to rehab)

10. 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

11. 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

12. Efficient Presentations are Crucial to Your Learning!!
Succinct, Clear Presentations
Changing the emphasis from:
Data delivery  Data synthesis
Thoroughness  Selectivity
All the data  The pivotal data
“Hx-heavy”  “DDx-heavy”
Entire presentation reflects critical thinking and gives selective data that shapes the differential diagnosis

13. 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

14. 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

15. 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.

16. Watch the Video and Assess: 1. Communication 2. Background Evidence
Please click on the video below to play:
Play Video

17. Communication Skills:X X X NA X
His speech was audible, but with a lot of “uhms”
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

18. Background Evidence: X X X
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.
Developmental Hx and Family History are irrelevant to the presenting problem
“NSVD- was discharged in 3 days…mother was unsure of GBS status”-
this is irrelevant and confusing

19. Background Evidence: Objective Data:X
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 X X
Comments:
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

20. In Summary… Be prepared to discuss the following questions:
Describe the 5 purposes of Family Centered Rounds?
Explain PBEAR format for presenting.
What are the key attributes of good Communication?     
How do you determine what Background Evidence is pertinent to present on FCR?