Hospitalist involvement in internal medicine residencies

Abstract

Disclosure: Nothing to report. CONTEXT:The ways hospitalists interact with and contribute to internal medicine residencies in the United States have been described locally, but have not been documented on a national level. OBJECTIVES:To describe the penetration of hospitalists into medicine residency faculty nationally, and document their contributions to teaching activities. MEASUREMENTS: Number of teaching hospitals utilizing hospitalists, number of programs utilizing hospitalists to teach, hospitalist teaching duties, and number with hospitalist tracks. RESULTS:In 2005, program directors recalled 54% of teaching hospitals employed hospitalists before and 73% after implementation of work-hour limitations. Of those employing hospitalists, 92% of programs in the Northeast and West used them to teach. Two years later, the Midwest (78%) and South (76%) continued to lag behind in the proportion of teaching hospitalists. Specific teaching activities of hospitalists included: attending on teaching service (92%), conducting rounds (81%), observation of clinical skills (67%), lectures (68%), and morning report (52%). Seven percent of program directors reported other duties of hospitalists, including: supervising procedures, reviewing night float patients, serving as associate program directors, and writing curricula. Eleven percent of training programs had hospitalist tracks. CONCLUSIONS:As hospitalists have become prevalent and have become efficient clinicians in community and university hospitals, the majority of internal medicine residencies have enlisted them to provide rounds, lectures, and bedside teaching. A small number of residencies are beginning to develop tracks to facilitate this new career option for graduates.

Effects of increased overnight supervision on resident education, decision‐making, and autonomy

“…The presence of overnight hospitalists (also known as ''nocturnists'') is growing within the academic setting, yet their role in relation to trainees is either poorly defined 13 or independent of housestaff. 14 To better understand the impact of increasing levels of supervision on residency training, we investigated housestaff perceptions of education, autonomy, and clinical decision-making before and after implementation of an in-hospital, overnight attending physician (nocturnist).…”

Faculty development for hospitalists: Structured peer observation of teaching

“…Hospitalists are increasingly responsible for educating students and housestaff in internal medicine. 1 Because the quality of teaching is an important factor in learning, [2][3][4] leaders in medical education have expressed concern over the rapid shift of teaching responsibilities to this new group of educators. [5][6][7][8] Moreover, recent changes in duty hour restrictions have strained both student and resident education, 9,10 necessitating the optimization of inpatient teaching.…”

Productivity vs. production capacity: Hospitalists as medical educators

“…What is the role of hospitalists in medical education? The article by Beasley et al,2 confirms what has long been suspected: the growth of hospitalists in medical education has paralleled the growth of the movement as a whole. The meta‐analysis by Natarajan et al3 further suggests that hospitalists are at the very least no worse in medical education than other specialists, and in some domains, may be superior.…”

“…What does it mean to “change the educational system?” Taiichi Ohno,6 Toyota's Chief Engineer, provides “Seven Organizational Wastes,” a framework for identifying areas of improvement in the educational work environment. Consider, for example, the following selected opportunities for improving the efficiency of the inpatient medical education system: (1) excessive testing or consultation leading to delayed discharge and more resident work effort (Overproduction); (2) the resident team waiting for the attending to arrive from a procedure or clinic (Waiting); (3) inadequate teaching about the principles of transitions of care, resulting in more readmissions to the teaching service (Transporting); (4) failure to have quality improvement conferences to discuss the appropriateness of admissions (Inappropriate processing); (5) failure to teach residents how to work with social work/placement services to facilitate early discharge (Unnecessary inventory); (6) failure to construct a training program that limits fragmentation, with residents moving from 1 task to the next and back again (Unnecessary motion); and (7) medical errors resulting in prolonged lengths of stay and resident work effort (Defects). There is no shortage of opportunities for improving the efficiency of the inpatient educational environment, but it requires that the systems architect is sufficiently familiar with the system to design interventions that are meaningful and effective.…”

“…As experience is accumulated, more hospitalists have to actively seek out leadership positions in graduate medical education, aligning our strengths, in patient safety, efficiency, and systems change, with the goals and objectives of the residency and student programs. The fact that 73% of residency training programs utilize hospitalists is exciting; the fact that there are only 15 hospitalists as program directors is disappointing 2. As was the case in the clinical care environment, leadership will be just as important in the education environment, as it is important for enacting the changes that will transform the inpatient education environment to a system that is efficient, safe, and patient‐centered.…”