Family-Centered Rounds Put a Twist on a Medical Student’s Patient Presentation

Recently, I completed my pediatric rotation at a busy, reputable children’s hospital. After spending three months on internal medicine wards, I was eager for a change of pace and curious to see whether the new patient population would spark any interest in a potential career path. I felt the 12 weeks of medicine training required of all third-year medical students at my institution had prepared me quite well for the six-week pediatric rotation which would involve time spent in not only the inpatient wards, but also the newborn nursery, outpatient clinic, and pediatric subspecialty offices.

Man, was I in for a surprise.

It wasn’t that I was blown away by a vast amount of unfamiliar academic material (let’s face it, as third year medical students, we all feel overwhelmed when adjusting to a new rotation); rather the information that I learned had to be put forth in an entirely different way.

During my medicine rotation, the attending physicians wanted to hear every detail about each and every single one of my patients. I recited my patients’ vital signs, study reports, and lab results in my head until they were committed to memory. I used words in casual conversation, which, to this day, I cannot spell. After I presented my patients, my preceptors and residents would correct my errors, teach, and quiz me. They used the same three- and four-syllable words, and expected me to respond to their questions with textbook answers.

During my first day on the pediatric ward service I was introduced to an entirely new type of rounds: family-centered rounds. Generally, the patients’ parents would stay overnight with them in the hospital. In the morning, we would invite them to speak with the team while we discussed their son or daughter. Initially, I was taken back by how awkward it must have been for those poor parents; they were woken from what little restful sleep they could get in the stress-filled hospital environment, and brought (while still in pajamas) in front of a team of 8-10 very awake people wearing white coats.

Now enter the third-year medical student, nervously reciting vital signs, using unfamiliar three- and four-syllable words, and making eye contact only with the distinguished-looking person wearing the longest white coat.

With all that said, my patient presentations underwent a massive facelift. I became a teacher instead of just a medical student. I used same the format that I had come to know so well during my medicine rotation, this time focusing more on explaining things like why certain tests become important in a child with such-and-such a condition, and why we worry about these lab results or those vital signs. Numbers were no longer important; a worried parent wants to know first and foremost if their child is well, not what his or her sodium level was this morning.  My assessment and plan, as well as their respective explanations, became far more important than my ability to memorize numbers.

Now don’t get me wrong: I don’t particularly think I have poor “people skills,” and I think I was able to explain my patients’ conditions, lab results, and discharge planning instructions fairly well during my medicine rotation. I received good evaluations, and have to admit that, at first, it seemed counter-intuitive that I was expected to not showcase my fund of medical knowledge. However; after my inpatient pediatric rotation ended, it became more clear. Patient-centered rounds actually pushed me to the limits of my education. I could record and report data – I learned that during medicine – but now I was taking that knowledge and summarizing it, applying it, explaining it. While I didn’t understand this phenomenon at  first, it now seems like a complete no-brainer, particularly from the patient’s perspective.

Not all of my classmates were assigned to the same rotation I was. I wonder how many of them, as well as other medical students, are still just reporting data and memorizing numbers. I wonder how many will urge their own medical students to do the same one day, and whether one of the two “rounding styles” will be proven to be more effective. Intuitively, I know they both have their own merits. However, in my own mind, I can honestly say that I have come out of my rotation for the better.

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One thought on “Family-Centered Rounds Put a Twist on a Medical Student’s Patient Presentation

  1. Love the perspective on FCR (as the cool kids call it, haha). I think you also summed up the overall mindset of Peds quite nicely. Our Hospitalist team only does FCR and I think it is great both for families and for residents/students and for faculty too. Studies have shown that residents and students are slightly less comfortable with it initially, but then seem to adjust to it. I won’t ever go back. Besides the obvious improvements for the family, I also like it because as the faculty I can actually get some direct observation of the skills of my learners, which does not occur nearly as much as I would hope overall in medicine.

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