In 2002, ACGME required six general competencies to be incorporated into residency curriculum and evaluation: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Hospitalists, because their practice already incorporates many aspects of these competencies, may be more effective at teaching these concepts to residents.
In the formal capacity of teacher, hospitalists can participate in attending/teaching rounds and in didactic patient-specific sessions presented in a case-based format, which provides residents with basic knowledge. As teaching supervisors, they can oversee the full range of clinical processes and procedures from the admission stage to post-discharge. Hospitalist teachers can also serve as mentors, providing a role model to residents who may be searching for direction regarding future plans. Through career counseling, hospitalists may steer learners into appropriate areas of study and training. Table 1 summarizes a series of research studies that document the positive impact hospitalists have achieved as educators in the academic environment.
Hospitalists may also have formal responsibility for developing curricula for learners in the academic environment. Whether the focus is on teaching medical students, residents, or hospitalist fellows, there is a need to determine the topics and material to be covered, incorporate them into a cogent curriculum, and update regularly to reflect the changing standards of care.
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Table 1: Results of Research on Hospitalists as Educators
“Informal”
Informal education can be viewed as an exchange of information among stakeholders in the health care industry attempting to improve outcomes. Figure 1 depicts this as a two-way information exchange (solid arrows in both directions). As hospitalists impart knowledge to primary care physicians (PCPs), specialists/surgeons, other health care professionals (including nurses and pharmacists), patients, families, and hospital administrators, they reap benefits as well. These stakeholders stand to profit from the knowledge hospitalists can impart in daily interactions within the hospital and in less formal settings.
By working together with nurses, emergency room physicians, medical specialists, and PCPs, hospitalists can help achieve efficient and effective processes of care. The use of available software programs enables health care professionals to cooperatively exchange reliable information regarding patient management. Ongoing conversations regarding diagnoses, treatment, medications, and procedures serve to keep each member of the team educated and informed, thus ensuring more efficient delivery of care (12).
Alpesh Amin, MD, executive director of the hospitalist program at the University of California, Irvine, and chair of SHM’s Education Committee, points out that hospitalists frequently have opportunities to act as educators during case-by-case interactions with PCPs and other health care providers. “Every time you talk to a doctor about admitting or discharging a patient, it’s an opportunity to educate,” he says. In addition, “the hospitalist can apply and/or develop critical pathways and algorithms to educate others.” In the course of managing care, criteria can be developed for previously unaddressed medical issues.
This same opportunity for education extends to the hospital floor where team building serves to enlighten each member of the group providing patient care. In a reciprocal environment, both hospitalists and their medical professional “teammates” benefit from each other’s knowledge. Amin points out that specialists typically focus on one condition, while hospitalists consider the entire patient. By openly receiving the specialist’s input and advice, processing it, and then applying it to the patient, the hospitalist can develop a comprehensive approach to disease management. By considering co-morbidities and long-term care, the health care team should base decisions on “patient-centered education (13).”
Hospitalists can initiate informal in-house educational outreach, such as informational programs about medical breakthroughs, new medications, explanations of existing medical legislation, and other relevant topics. These programs can enlighten nurses, case managers, pharmacists, and other health care professionals about issues important to managing patients and/or achieving quality outcomes. The format for these programs may be one-on-one interactions (either in-person or by telephone) relating to one specific patient; formal in-service lectures; “Lunch and Learns”; pharmaceutically funded drug- or-disease-management seminars; committee or departmental meetings, and/or random written communications (sent electronically or by interoffice mail) that incorporate history and physical findings, consultations, discharge summaries, or hard-copy articles (12).