Setting and Problem
Patient-centered care focuses on the individual patient's needs and concerns, rather than on those of the physician. This shift in approaching patient care has challenged residency programs to create training experiences in which residents are asked to consider social, economic, and organizational challenges that their patients regularly face. Collaborative care is an essential element for delivering high-quality, patient-centered care. Adapting residency curricula to provide interprofessional training related to the patient experience remains an area in which best practices are not known.
Intervention
We created a 2-week patient experience rotation for our 12 categorical second-year pediatrics residents that utilized experiential learning, simulation, and didactics focused on patient-centered care. The primary learning objectives were to (1) observe interprofessional collaboration across hospital units; (2) provide communication skills training; and (3) understand patient and family perspectives. A sample schedule is provided (Table).
Table.
Sample Resident Patient Experience Schedule
Experiential learning was accomplished by pairing residents with nurses in the inpatient or outpatient setting. Residents also were assigned to a specialty clinic as their core clinical environment and asked to reflect on interprofessional relationships and individual patient experiences. During a night shift, each resident completed a 360-degree patient shadowing experience based on the Institute for Healthcare Improvement framework for observing patient care. Residents were required to follow a patient through every step of his or her admission, from the emergency department to the inpatient unit. Residents were then asked to answer satisfaction of care questions by completing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as if they were the patient.
Themed patient-centered didactics took place during the standard noon conference time frame. Topics included (1) pain management; (2) the Language of Caring, a nationally recognized communication skills program; (3) a palliative care patient panel; (4) a patient disabilities simulation; and (5) child life. In addition to interactions with our pain team, palliative care team, patients, and child life experts, residents role played disability scenarios to experience first-hand their potential challenges. The rotation culminated in a 1-hour small group structured debrief with 2 core faculty facilitators.
Outcome to Date
This 2-week interprofessional experience influenced trainees' attitudes about the patient experience. This rotation was feasible by scheduling second-year residents on a 2-week flexible elective to allow for patient experience educational activities. In postrotation feedback, more than 90% of residents reported that the patient experience rotation was a positive addition to their educational curriculum.
Resident perceptions of a physician's impact in care decreased as a result of the experience. One resident commented:
“Physicians are only 1 part of an interprofessional team . . . nurses are an integral part of the team and we need to communicate better with them regarding plan of care and ensure they are part of the overall plan discussion.”
Residents gained a better understanding of the importance of communication during the admission process. One resident reported:
“. . . Communication of admission process expectations to family are at times lost . . . There needs to be delineated ownership between nursing and physicians during this transition time; we need to improve time frame estimation for families.”
Residents identified areas of personal growth, including the need to provide more explicit medical team introductions, to address patient and family expectations regarding the admissions process, and to better anticipate any delays in transitions of care.
Responses from HCAHPS revealed that the majority of residents felt that nurses usually listened to patients, always/usually explained things in a way that patients would understand, and always/usually would explain medications prior to administration.
Although we utilized a 2-week rotation, we feel the educational activities offered could be readily incorporated longitudinally to make it more generalizable to other programs.