Who Speaks First? Promoting Senior Resident Autonomy on Family-Centered Rounds: A QI Initiative.

Area of Science:

• Medical Education
• Quality Improvement
• Pediatric Residency Training

Background:

• Graduated autonomy is crucial for pediatric residents transitioning to independent practice.
• Family-centered rounds (FCR) offer a key opportunity for residents to develop leadership skills.
• Initial assessment showed senior residents (SRs) performed at a novice level in FCR autonomy.

Purpose of the Study:

• To increase the percentage of SREA-21 domains where SRs perform competently during FCR from 38% to 75% within six months.
• To enhance senior resident autonomy and leadership during pediatric inpatient rounds.

Main Methods:

• Utilized the model for improvement framework with plan-do-study-act cycles.
• Interventions included standardized expectations, pre-round huddles, interruption audits, and direct feedback.
• Assessed SR autonomy using the Senior Resident Empowerment Actions 21 (SREA-21) tool.

Main Results:

• Achieved a 100% competent score in SREA-21 domains, surpassing the 75% goal.
• Demonstrated special cause improvement in SR autonomy following intervention implementation.
• Run charts showed a significant upward trend in SR and hospitalist SREA-21 scores.

Conclusions:

• Quality improvement methodology effectively enhanced SR autonomy during FCR.
• The interventions successfully improved trainee competence in leading healthcare teams.
• The SREA-21 tool reliably measured improvements in resident autonomy.