Child Abuse Pediatrics Fellow Maimonides Infants and Children's Hospital of Brooklyn Brooklyn, New York, United States
Background: Family-centered rounds are standard practice in children's hospitals. Hospitalizations for child maltreatment can pose a barrier to this rounding approach due to the sensitive nature of these cases.
Objective: To explore attitudes of pediatric residents and attendings toward use of family-centered rounds for child maltreatment cases and identify implications for resident education on child abuse topics.
Design/Methods: A qualitative study incorporating 24 semi-structured individual interviews of pediatric residents, hospitalists, and intensivists was conducted at a single children’s hospital in NYC. Ten attendings and fourteen residents participated in interviews exploring rounding habits and attitudes toward family-centered rounds for suspected or confirmed child maltreatment cases. Data from interviews was analyzed using modified grounded theory.
Results: All participants endorsed family-centered rounds as best practice but cited difficulty when child abuse and neglect is included in the differential. Most reported preferring hallway rounds with limited caregiver participation and avoidance of teaching on child abuse topics at the bedside. Residents reported discomfort with family-centered rounds if child maltreatment was of concern, especially if presenting on rounds. Attendings reported feeling confident in this context, but lamented that trainees may divulge information on rounds that could compromise trust in the medical team or derail the child maltreatment investigation. Most participants suggested that these pitfalls could be mitigated by pre-rounding team huddles. Attendings and residents likened child maltreatment to a “psychosocial” issue better suited for discussion by the hospital child protection team rather than on daily academic rounds. Conclusion(s): Pediatric residents and attendings reported many challenges with the use of family-centered rounds for inpatient child maltreatment cases such that academic rounds are often truncated in this context. As a result, trainees may not become skilled in speaking with caregivers or gain sufficient experience through role modeling of their attendings during these encounters. Attendings and residents commonly split “medical” from “psychosocial” concerns for these cases, suggesting that they interpret child maltreatment as a non-medical problem. Hospital child protection teams can provide guidance on how to navigate family-centered rounds such that caregiver participation is satisfied while balancing resident education on child maltreatment topics.
Authors/Institutions: Gillian A. Hopgood, Maimonides Medical Center, Brooklyn, New York, United States; Thalia Porteny, Tufts University, Medford, Massachusetts, United States; Lori Legano, NYU Langone Health, New York, New York, United States; Ingrid Walker-Descartes, Maimonides Medical Center, Brooklyn, New York, United States