It’s been a while since our January #JHMChat, but with a new class of interns, it seems like a good time to go back and review what we discussed! The chat focused on a Journal of Hospital Medicine Point/Counterpoint article by Samantha Wang, MD, Suchita Sata, MD, MHS, Andrew Olson, MD, and Julia Caton, MD, EdM, “Should Teaching Hospitalists be Required to Provide Direct Care?”. All authors, plus Bob Centor, MD (#UncleBob), were special guests for the chat. If you missed it, please look it up on X (formerly known as Twitter). We still want to hear your thoughts!
During the chat, we heard from people from multiple hospital systems, in various stages of their careers, and with different experiences of direct care time. Based on our (not very scientific) survey, 75% of participants spend at least some time doing direct patient care. #JHMChat attendees identified several positive aspects of direct care, including identifying pain points in the healthcare system, forming deeper relationships with patients, practicing bedside communication, and improving understanding of the logistical aspects of clinical care.
Participants who don’t do direct care noted that there are times residents ask questions they can’t answer – but they use it as an opportunity to model, saying, “I don’t know, but I’ll find out!” Dr. Wang has another approach, where she spends some time outside of rounds with her team so she can see how they approach triaging, documentation, and interacting with colleagues and then can give feedback based on these observations.
Given all the amazing educators we had gathered, we wanted to get some expert opinions on how to create a positive and productive learning environment for trainees. Drs. Tran and Trivedi provided concise, yet detailed, overviews of their approach to leading a teaching team.
Many educators emphasized the need to get to know learners as people, check in frequently, have honest discussions about parts of the job that are hard (and don’t forget parts that are good!), and model asking for help.
As someone who works either on a resident team or an advanced practice provider (APP) team, I was curious to learn how direct patient care contributes to other participants’ clinical practice and teaching styles. Discussions revolved around learning about the pain points in hospital systems (future QI projects/innovations corner ideas!), understanding the impediments to care, and thinking of ways to improve in the future.
These discussions made me realize that, while my patients are covered by an APP, I still do a lot of the direct care (writing notes, calling consults, updating families) with tasks split between attending and APP. Dr. Berger made a similar point and emphasized the importance of teamwork and that patients may be able to get more efficient care on a team using this model.
#UncleBob, who no longer provides direct care, noted that he has come to value conversations with learners as the most crucial part of teaching. He also emphasized that to make rounds efficient, you must prioritize what is discussed on rounds.
The discussion around approaches to teaching rounds was especially interesting and educational. We discussed how to emphasize thought processes and clinical reasoning on rounds, instead of presentations being a report-out of data available in the record. Others pointed out that not all teaching has to be done on rounds or through chalk talks, and utilizing an attending addendum as a teaching strategy can also be very effective.
A new class of interns has started – what can we do to be better teachers and provide better care for our patients? Is there anything you learned from this chat that you can use the next time you are on a teaching team? Let us know in the comments or by responding to the #JHMChat!