Family-Centered Rounds: Family Satisfaction and Resident Comfort
Journal: Hospital Pediatrics (IF 2.4)
Year: 2025
Psychological safety (PS) is paramount to maximizing learning, as learners who expend cognitive energy on external stressors will learn less. Bhatia et al. note that residents may fear “not appearing smart” during family-centered rounds (FCR)—a common component of hospitalist rotations—which in turn creates suboptimal PS. To address this potential phenomenon, Bhatia et al. aim to describe pediatric residents’ perspectives on PS during FCR and compare these perspectives with families’ views on the relationship between trainee learning and trustworthiness in patient care.
To capture both parties’ perspectives on the matter, Bhatia et al used the grounded theory methodology for qualitative analysis. (Read our summary of the pros and cons to this study technique.) The resident cohort consisted of 25 residents. PGY-1s and PGY-3s had nearly equal representation, and participants were predominantly female (n=23) and white (n=22). The family cohort was a convenience sample of 15 participants who were also predominantly female (n=13) and white (n=11), with most (n=12) having acquired at least a partial college degree.
The study's application of grounded theory was par for the course: three coders analyzed transcripts after each interview using a continuously updated codebook, resolved disagreements through consensus discussion, and practiced reflexivity via group reflection among the primary investigators.
The findings revealed that resident concerns revolved around themes consistent with self-determination theory: residents hoped for reasonable autonomy, wanted to appear and feel confident for families, and desired a strong sense of team belonging. When these facets experienced infractions, learners risked withdrawing and taking a less active role in patient care. Critically, family members did not view residents being wrong negatively; rather, they perceived the sequelae of this withdrawal most negatively. Families reported that residents who did not ask questions risked being perceived as “a know-it-all,” and they especially valued learners who displayed empathetic interpersonal skills. Families also appreciated observing the medical team's troubleshooting process during FCR. As one family member stated:
“I like to see the conversation between them all, even if it’s a little bit back and forth. I like to see them coming at it from different angles. That makes me feel better when there’s a couple of different opinions and options and they settle together on one. It makes me feel good about everything”
The Spin: Studies use grounded theory methodology to study poorly described phenomena—PS on FCR is a strong example of this. The study’s connection of FCR to the well-described self-determination theory provides a valuable framework for medical educators as they train residents and students in any setting, but especially during inpatient rounding where learning often occurs in a socially stressful environment.
A key strength of this study is the investigators' use of reflexivity, a critical component of rigorous grounded theory methodology.
Regarding limitations, the study does not differentiate between responses gathered immediately post-rotation and those submitted months later. This introduces a potential fading affect bias (a type of recall bias) as the passage of time may have masked or intensified prior feelings of discomfort, impacting how residents described threats to PS. That being said, residents did not seem to have trouble identifying these instances in themselves or other learners (i.e., medical students).
Furthermore, the use of a convenience sample for the family cohort presents a significant selection bias. One may hypothesize that this sample—likely parents most frequently at the bedside—consequently possesses higher health literacy and holds more favorable opinions of residents and medical education than families who could not or did not participate. This is a potential confounder, especially given that the surveyed family members had high educational backgrounds, with none possessing less than a high school diploma.
Finally, studies show that caregivers of color are less likely to experience inclusion in FCR, and this convenience sample was predominantly white. Future studies may target this disparity and attempt to capture a more generalizable population.
To Read More: Bhatia, S., Yan, G., & Seltz, L. B. (2025). Pediatric Resident Psychological Safety, Learning, and Family Trust During Family-Centered Rounds. Hospital pediatrics, 15(11), 886–893. https://doi.org/10.1542/hpeds.2025-008516