Interprofessional bedside rounding improves quality of feedback to resident physicians

Abstract

Purpose

Obtaining high quality feedback in residency education is challenging, in part due to limited opportunities for faculty observation of authentic clinical work. This study reviewed the impact of interprofessional bedside rounds (‘iPACE™’) on the length and quality of faculty narrative evaluations of residents as compared to usual inpatient teaching rounds.

Methods

Narrative comments from faculty evaluations of Internal Medicine (IM) residents both on usual teaching service as well as the iPACE™ service (spanning 2017–2020) were reviewed and coded using a deductive content analysis approach.

Results

Six hundred ninety-two narrative evaluations by 63 attendings of 103 residents were included. Evaluations of iPACE™ residents were significantly longer than those of residents on usual teams (109 vs. 69 words, p < 0.001). iPACE™ evaluations contained a higher average occurrence of direct observations of patient/family interactions (0.72 vs. 0.32, p < 0.001), references to interprofessionalism (0.17 vs. 0.05, p < 0.001), as well as specific (3.21 vs. 2.26, p < 0.001), actionable (1.01 vs. 0.69, p < 0.001), and corrective feedback (1.2 vs. 0.88, p = 0.001) per evaluation.

Conclusions

This study suggests that the iPACE™ model, which prioritizes interprofessional bedside rounds, had a positive impact on the quantity and quality of feedback, as measured via narrative comments on weekly evaluations.

Keywords:

• Interprofessional bedside rounding
• internal medicine residency
• direct observations
• feedback and evaluation

Acknowledgments

Gabrielle Fogg, Olivia Whittaker, Haley Koukos, and Michael McCann were instrumental in the coding of the narrative evaluations.

MMC Center for Outcomes Research & Evaluation, Michael Kohut Ph.D., Lee Lucas RN, Ph.D.

MMC Institute for Teaching Excellence, Robert Bing-You, MD, MEd, MBA.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Interprofessional bedside rounds: Representatives of multiple professions (at minimum a nurse and a physician) meet at the patient's bedside to discuss a clinical care plan with the input of all members (Gonzalo et al. 2016).

Additional information

Funding

This work was supported by American Medical Association (AMA) under Grant AMA 35627.

Notes on contributors

Lesley B. Gordon

Lesley B. Gordon, MD, MS, Assistant Professor, Tufts University School of Medicine, serves as Associate Program Director for Maine Medical Center’s Internal Medicine Residency, where she is a Hospital Medicine attending. Her interests include graduate medical education and the intersection between human health and the environment.

Melissa Zelaya-Floyd

Melissa Zelaya-Floyd, Ph.D, is the Program Manager of the iPACE™ grant at Maine Medical Center. Dr. Zelaya-Floyd has 6 years of experience in quality improvement and project management in healthcare and is an experienced program manager. She combines her background in systems engineering, education research, and quality improvement to study and advance patient-centered outcomes of interprofessional team-based care and education.

Patricia White

Patricia White, AS, is Program Coordinator for the iPACE™ grant at Maine Medical Center. She has a background in medical education and healthcare administration, with roles including Practice Manager for an outpatient family medicine clinic and Program Coordinator for the Tufts University School of Medicine-MMC Maine Track program.

Sarah Hallen

Sarah Hallen, MD, FACP, Assistant Professor, Tufts University School of Medicine, currently serves as the Program Director for the Geriatric Medicine Fellowship at Maine Medical Center. Her research interests include the development and evaluation of interprofessional educational interventions to improve clinical care, especially for older adults.

Kalli Varaklis

Kalli Varaklis, MD, MSEd, is the Designated Institutional Official at Maine Medical Center and a practicing Ob/Gyn. Her primary research interests include promoting and studying inter-professional education in the GME setting and she is the PI on the AMA ‘Re-Imagining Residency’ grant.

Motahareh Tavakolikashi

Motahareh Tavakolikashi, MS, is a Quality Management Engineer at MaineHealth. She is a Ph.D. candidate in Industrial and Systems Engineering and holds a bachelor's and master's degree in the same major. She specializes in applying System Engineering approaches and Data Mining techniques to improve healthcare system processes.