Fellow, Pediatric Hospital Medicine Children’s Hospital Los Angeles
Background: The ACGME Pediatrics Subspecialty Milestones emphasize fellows’ development as teachers. There are no published guidelines for teaching on pediatric inpatient rounds but literature review yields leadership, autonomy-promotion, and learner engagement as common themes of high-quality teaching. At our institution, audits revealed learner engagement as the least represented teaching behavior among fellows on rounds. Objective: Our Global Aim is to improve the teaching delivered by fellows on rounds through a series of interventions. Focused on learner engagement, our SMART Aims are to: 1. Improve the frequency of teaching points delivered by fellows on rounds from baseline 31% to 50% by February 2024. 2. Improve the frequency of fellows asking their learners questions on rounds from baseline 14% to 30% by February 2024. Design/Methods: This is an IRB-reviewed exempt quality improvement project with Plan-Do-Study-Act cycles. The sample is composed of subspecialty fellows who lead ward-level resident teams. A process map, fishbone, and key driver diagram were created. Planned interventions include: 1. A badge buddy quick-reference resource. 2. A presentation for first-year fellows. 3. Weekly email announcements containing teaching tactics for fellows to experiment with that week. 4. An evaluation tool that attendings can use to provide feedback to fellows about their teaching. Primary process measures include: 1. The frequency of teaching points delivered by fellows on rounds. 2. The frequency of fellows asking their learners questions on rounds. Balancing measures include rounds length and residents’ perceptions of excessive teaching. Measures will be collected via audits of morning rounds as well as pre-post surveys completed by fellows and residents that assess for fellows' leadership, autonomy-promotion, and learner engagement. Data will be analyzed via run charts and pre-post statistics. Baseline data was collected from June to September 2023. Interventions began September 2023 and will conclude January 2024. Follow up data will be collected from January to March 2024.
