Using observed structured teaching exercises (OSTE) to enhance hospitalist teaching during family centered rounds

"Rounds" are the organizing structure for academic hospitalist-trainee teams. Family centered rounds (FCR) are endorsed by the Institute of Medicine and by the American Academy of Pediatrics, however, rounds are often conducted in the privacy of the conference room where patients and families are not privy to the decision-making process used to determine their diagnosis and management. Less than half of pediatric hospitalists reported conducting FCR, citing concerns about inefficiency and diminished teaching.

The aim of this study was to design and implement a faculty development program to address the need of hospitalists to efficiently teach during FCR.

Scoring templates were developed to measure evidence-based teaching behaviors to optimize orientation, feedback, clinical reasoning, assessing physical exam findings, and promoting resident leadership during FCR. Hospitalists were scored by Standardized Learners and Standardized Parents during 4 Observed Structured Teaching Exercises (OSTEs) before and after focused workshops.

Fourteen of 14 hospitalist participants had 17 months ± 14 months of experience; 71% were female; none had previous training in the areas proposed in the study. The differences between pre- and post-OSTEs for the 4 stations were statistically significant (P < .0001). Particular improvements were noted in the correction of incorrect clinical reasoning (new patient diagnosis) (56% pre, 86% post) and orientation (65% pre, 95% post).

We found incorporating OSTEs into a FCR faculty development program to be an effective strategy for improving faculty teaching behavior. Additional study is needed to determine if this strategy results in sustained improvements in conducting FCRs in real inpatient settings.