Medical Student Teaching on a “Non-Teaching” Service

Many students noted an increased level of independence experienced on this rotation compared with traditional teaching rotations. In other studies, concerns have been voiced regarding resident lack of autonomy while working with a hospitalist attending, who tends to have a more visible presence on the inpatient medicine floors (1,4). These concerns have not been validated by resident or medical student feedback of actual experiences (1,4). At the training level of a third- or fourth-year medical student, not having a resident intermediary may lead to more perceived autonomy, adding to the overall learning experience.

The main reservation expressed by students pertained to the challenge of scheduling dedicated teaching time while attending physicians are busy with patient care. Serving as the primary inpatient caregiver for patients can often lead to an unpredictable daily schedule. This year our hospital has instituted a designated floor for patients on the< hospitalist service. This has allowed centralization of most patient care, providing more time for teaching and more visibility of attending physicians to medical students on the rotation. Another solution may involve the increased use of non-physician practitioners, as are being incorporated into many hospital medicine practices. This could allow the physicians to focus on teaching and on patients with more complex medical issues.

From the physician perspective, having medical students rotate on the service is consistent with our mission as clinician educators. Hospitalists choose a position at an academic institution in part because teaching is a priority. For community hospitalists, working with medical students may offer an option to incorporate teaching into clinical patient care. For academic hospitalists facing more “nonteaching” duties, a similar rotation may allow physicians to incorporate an additional teaching role into such duties. Based on the limited experience at this institution, a hospitalist rotation appears to offer a distinct and positive learning experience for medical students compared with a traditional medicine rotation. More extensive experience in the future may support this as a viable option at more centers. Further study will be necessary to identify an optimal curriculum for such a rotation and to evaluate the impact on students’ career choices and perceptions of the field of internal medicine.

Dr. Quartarolo can be contacted at [email protected].

References

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