Residents also need to learn that information needs to be meticulously transmitted when there is a transition of care from hospital to nursing facility or from hospital to home. “Residents may view life in the academic center as a vacuum from the outside primary care world,” says Dr. Epstein. “The residents may see the care as what they did in the hospital, but the care is part of a continuum from the primary care, the person’s doctor,” he says.
Team Approach
For hospitalist Julia Wright, MD, associate clinical professor of medicine and director of hospital medicine at the University of Wisconsin School of Medicine and Public Health in Madison, teamwork coupled with redundancy has proven an effective method of teaching residents while delivering first-rate patient care.
“I structure the learning environment so that each person knows what level of responsibility he has within the healthcare team,” she says.
Dr. Wright requires that medical students learn how wards work, that interns learn more about diagnosis and management, and that residents learn how to assign responsibility to the patient team while taking responsibility for patient care. Meanwhile, the attending makes sure the proper diagnosis has been made, and the treatment plan has been carried out.
This arrangement she finds helps her teach and helps prevent errors. “What happens is that there’s some duplication of effort within the medical team,” says Dr. Wright. “But you want more than one person checking to make sure things are getting done, and that way it’s not only excellent care for the patient, but it’s a learning environment.”
The Bottom Line
Dr. Wright says she favors training residents by teaching them about each patient being cared for and that patient’s particular manifestation of a disease. “This method fits in very well with the whole idea of how each one of us is working to help this patient with this condition. I like to pool information and actually take care of the patient as we talk about a condition: helping that patient improve, helping make the diagnosis, helping decide on a treatment. The bottom line is the patient, getting the patient excellent care,” says Dr. Wright.
“As teachers, we try to teach with emotions,” says Dr. Li. “When we teach trainees to care for patients we try to think about how to make it memorable for them—and you remember something that’s emotional,” “So, despite some of the challenges we face, I think we’re at a better place than we were 10 years ago, having hospitalists on the wards. And I think 10 years from now, we’re going to be in an even better place. We’ll have the luxury of 10 more years of clinical experience and emotional experience to impart to trainees.” TH
Robin Tricoles is a medical writer based in New Jersey.
Reference
- Singh H, Thomas EJ, Peterson LA, et al. Medical errors involving trainees. A study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007 Oct;167(19):2030-2036.