Promoting Resident Autonomy During Family-Centered Rounds: A Qualitative Study of Resident, Hospitalist, and Subspecialty Physicians

Abstract

BACKGROUND: Family-centered rounds (FCR) have become a leading model for pediatric inpatient rounding. Several studies have examined effective teaching strategies during FCR, but none have focused on promoting resident autonomy. OBJECTIVE: The aim of this study was to identify strategies used by attending physicians to promote resident autonomy during FCR. METHODS: We conducted a qualitative study of attending physicians and residents between December 2012 and February 2013 at an academic children's hospital, where FCR is the standard model for inpatient rounds. Attending physicians participated in individual interviews, and residents participated in 1 of 2 focus groups separated by level of training. Focus group and interview transcripts were coded and themed using qualitative content analysis. RESULTS: Ten attending physicians and 14 residents participated in interviews and focus groups. Attending physician behaviors that promoted resident autonomy included setting clear expectations, preforming a prerounds huddle, deliberate positioning, and delegating teaching responsibilities. These were further categorized as occurring during 1 of 4 distinct periods: (1) at the start of the rotation; (2) before daily FCR; (3) during daily FCR; and (4) after daily FCR. CONCLUSIONS: Residents and attending physicians identified similar strategies to promote resident autonomy during FCR. These strategies occurred during several distinct periods that were not limited to rounds. The results suggest strategies for attending physicians to help balance appropriate and safe patient care with developing resident autonomy in the clinical setting.