At many academic institutions, hospitalists are increasingly acting as the teaching attendings on inpatient general medicine rotations. There have been multiple studies demonstrating perceived benefits of hospitalist faculty on housestaff education in academic and community hospitals (1-6). Measured benefits have included improved trainee satisfaction with the educational experience, improved teaching, and higher quality of attending rounds (3,4). There is growing evidence that hospitalist physicians attending on medicine wards provide educational advantages for medical students as well (5-7).
The majority of published studies thus far have focused on trainee education on a traditional medicine ward rotation, with a team including housestaff and medical students. A few medical centers have developed a resident or medical student rotation on a primary hospitalist service (8). With recent restrictions on resident work hours, many more academic programs are developing a “non-covered” hospitalist service similar to the community model (9). While the outcomes of many such programs are not yet entirely clear, this type of service may provide opportunities for an alternative learning experience for medical students. The author is not aware of any published accounts of the medical student experience on such rotations.
Barnes-Jewish Hospital is an urban, 904-bed academic center. The hospitalist program at our institution was initiated as a community model in 2000, with a private service managing patients independent of the internal medicine teaching service. Since then, members of the group have become integrally involved in multiple other teaching roles throughout the institution. The private inpatient service has remained a portion of the practice. During this time period, fourth-year medical students have had the opportunity to participate in a 4-week clinical elective on our primary hospitalist service as a substitute for, or in addition to, the traditional internal medicine sub-internship.
This rotation differs from the traditional medicine rotation in that students have the opportunity to be exposed to more patients, as multiple patients are admitted each day, rather than on a rotating call schedule. Students work directly with hospitalists on the service without the involvement of housestaff. They are not assigned to a specific attending, and therefore work with several attendings over the course of the rotation. A single student rotates on any given 4-week block. There are no other support staff involved in patient care, such as physician assistants or nurse practitioners. Over the last 4 years, over 30 students have participated in this rotation.
In 4 years, students have enrolled in approximately 75% of the elective block rotations available. Overall, written feedback has been obtained from 21 students. Students have been asked to rate the quality of teaching, meaningful participation in patient care, and overall satisfaction with the rotation, as well as to provide additional comments on their experience. Ratings were on a five-point scale, ranging from poor to excellent. Review of student evaluations of this rotation over the past 4 years reveals a majority rating of excellent or very good in all three categories (17/21).
In the students’ narrative comments, several themes were predominant. Positive feedback included the opportunity for one-on-one interactions with several attendings. Students valued the exposure to multiple role models with unique patient care styles. In addition, many students appreciated the opportunity to see a larger number of patients, given the multiple daily admissions. Students see an average of 16 new admissions during the rotation compared to an average of 10 patients on the traditional sub-internship over the course of 4 weeks.
Students also commented on the diversity of patients seen. Given the high patient census on the service (an average of 30 each day), we are able to be selective and choose learning cases with interesting and varied diagnoses. Several students appreciated the opportunity to perform more procedures, which may be preferentially performed by the housestaff on a traditional medicine rotation.