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

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

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

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

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

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 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

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.

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

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

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

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

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?