“I’ve always felt that medicine—and especially medical teaching—is like an apprenticeship,” she explains. “There are many, many opportunities to teach while doing in an apprenticeship-like fashion. The demands of taking care of patients and [reduced] resident work hours have certainly decreased the ability to do more formal and didactic or classroom-type teaching. However, the opportunities for spontaneous or ‘teach as you go’ education still exist.”
Solutions to the Time Crunch
Dr. Schultz, a member of the Swedish Medical Center’s teaching service who leads a teaching team every month, admits she has no answers to the time crunch academic hospitalists experience. “There just isn’t enough manpower,” she says. “The hospital doesn’t get paid for people to teach, and to pay people to have dedicated time to pursue academic research or prepare lectures just isn’t feasible for most hospitals, as they are already struggling to make ends meet.”
Many hospitals employ both non-teaching and teaching services to ensure night and weekend coverage. But this can create other dilemmas for the academic hospitalist. For instance, Dr. Schultz says her teaching service gets the more complicated and critically ill patients who require more of her time, thus squeezing out, again, the opportunity to prepare lecture notes or conduct research.
At UNC Children’s Hospital, the pediatric hospitalist program is in its infancy, having launched in fall 2006, and the new service is mostly a non-teaching service. Dr. Bradford reports that the teaching and the hospitalist service are assigning patients on a case-by-case basis. “There is [teaching] value in all patients and all cases,” says Dr. Bradford, “but it’s really hard to say which ones have the most value: Should it be the patient who has a short stay with a common illness or a patient who has been chronically ill and in the hospital for 100 days? It’s hard to know.”
At Brigham and Women’s Hospital, Dr. McKean reports the hospitalist group did not want to institute a two-tiered [teaching and non-teaching] hospitalist program, so one of their hospitalists, Chris Roy, MD, created a Physician Assistant Clinician Educator (PACE) service, with a hospitalist supervising two PAs during daytime hours; it’s supplemented by moonlighters at night. Members of this service have teaching responsibilities and are involved in curriculum development for physician assistants and students. Additional research is needed to examine outcomes of educational efforts directed toward the multidisciplinary team in the core competency areas elaborated by the Accreditation Council for Graduate Medical Education, explains Dr. McKean.
Whatever strategies are used to address case workloads, effecting real change for academic hospitalists—ensuring protected time as well as rewards for educational and research pursuits—will require clear-sighted planning from hospitalist leaders. “The bottom line is to proactively manage the program’s direction and growth,” asserts Dr. McKean. “Instead of being everybody’s Band-Aid and being everything to everybody, it’s important to have a strategic plan. You can’t necessarily plan for five years, but you can plan for three, and you could do things in a step-wise manner to increase the academic and research presence.”
This is precisely where SHM’s emphasis on networking and mentoring can come in, believes SHM’s Education Committee Chair Preetha Basaviah, MD, clinical associate professor of medicine and associate course director, Practice of Medicine, at Stanford University School of Medicine, California. SHM has led many initiatives, such as the publication of the Core Competencies and the creation of Web-based quality improvement resource rooms, which help provide curriculum support.
“What we’ve done as an education committee is to help provide some of the resources, support, and advocacy that our members need so that they can go back to their programs and say, ‘These are the national standards and resources provided by an organization that advocates for us.’ ” says Dr. Basaviah.