Clinical vs. education
The changing hospital environment has led to tensions between the clinical and educational roles of the hospitalist.
It used to be that the educational role of an academic hospitalist was filled by traditional ward teaching opportunities with house staff that aligned with their clinical responsibilities. However, the landscape for hospital medicine at academic medical centers has been changing rapidly in recent years due to mergers, acquisitions, and growing partnerships. And this change, as a recent study uncovered, has reportedly led to a growing tension between the clinical and educational missions of the hospitalist.
Catherine Callister, MD, assistant professor of hospital medicine at the University of Colorado Anschutz Medical School, is one of the lead researchers on the study, “Impact of Clinical Demands on the Educational Mission in Hospital Medicine at 17 Academic Medical Centers.”
The study conducted 17 interviews with hospital medicine leaders from 17 different academic medical centers, including division heads, section heads and other leaders.
Dr. Callister said researchers found that the growth of academic medical centers has increased the clinical footprint of academic hospitalist groups, while leaving opportunities for traditional teaching teams relatively stable.
“Disproportionate clinical growth has resulted in tension between the hospitalist clinical and educational missions, including a mismatch in supply and demand for traditional teaching opportunities,” she said. “Hospital medicine groups are adapting to this mismatch by adopting different recruitment strategies, working creatively to find novel educational opportunities, and trying to reimagine the role and identity of an academic hospitalist.”
Dr. Callister will be leading a discussion about that study and ways the mismatch can be addressed in Saturday’s session, “Clinical Gains, Education Pains: Academic Hospitalists’ Journey Amidst Rapid Clinical Growth.”
One tactic for addressing the disparity between clinical growth and educational stagnation involves expanding the teaching footprint at medical centers.
“This can include hospitals developing their own fellowships and tracks in medical education, QI, and informatics,” Dr. Callister said. “Hospitalist faculty are increasingly leadership positions in the medical school residency programs. Hospitals can also expand learners onto specialty service including substance use, procedures, ultrasound, and transplant.”
Hospitals should also look to expanding their available learners from other areas such as PAs, NP students, pharmacy, dental, and nursing students, Dr. Callister said.
“They can also look at things like peer-to-peer coaching and mentoring as well as externships for international medical graduates,” she said.
There are also potential solutions in non-clinical teaching opportunities such as student lectures, team-based learning in small groups, teaching ethics or narrative medicine courses, and nonclinical rotations.
Looking to the future, Dr. Callister said hospitalists need to redefine their current thinking in terms of educational opportunities.
“There is a need to rethink and broaden the definition and benefits of academic work for hospitalists,” she said. “Diversifying trainee exposure to a wide variety of career paths and opportunities within academic medicine (including research, QI, and administration) in addition to education is also key.”
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