Christopher Sankey, MD, FACP, SFHM, associate professor of medicine (general medicine), Yale School of Medicine (YSM), and Northeast Medical Group’s Anisha Advani, MD, associate director, Yale New Haven Hospital’s Hospitalist Service and assistant clinical professor (YSM), were recently awarded the 2023 Northeast Group of Education Affairs Innovation in Medical Education Award for their proposal, “The Hospital Medicine Firm: A Novel Impatient Rotation in Hospital Medicine.” The recognition, given to two recipient teams, highlights trailblazing medical education curriculum within academic centers in the Northeast region. The award was presented at the organization’s 2023 Annual Conference.
The proposal outlines a new, redesigned inpatient medicine rotation implemented at Yale New Haven Hospital (YNHH) this past year. Instead of a traditional team structure with an attending, senior resident, junior resident, and medical student, the hospital medicine team pairs two hospitalist attendings and two senior residents in an “apprenticeship" model. This has allowed senior residents to hone their skills of preparing to be independent attendings and allows attending hospitalists to refocus their teachings specifically for senior residents.
Sankey states, “Previous research has demonstrated that new residency program graduates have knowledge and experience gaps noted when they begin hospital medicine positions. This rotation provides a structure and opportunities for experiential learning that more effectively prepare senior residents for the demands of inpatient attending roles and responsibilities.”
“This has been especially important because hospital medicine as a field is one of the fastest growing specialties in the last decade,” states Advani. “This is a real opportunity to use an apprenticeship model and non-traditional structure to better equip trainees for life as a hospitalist.”
All senior residents in the Department of Internal Medicine’s Traditional and Medicine-Pediatrics programs undergo this rotation. “This is an important rotation for all senior residents, even those who are even going into subspecialties,” adds Advani. “All trainees need to understand competencies like value-based care, the importance of inpatient versus outpatient care, and to flex the muscles of learning to care higher numbers of patients nimbly as they transition to fellowship or attending practice.”
A large focus of the new curriculum is on hospital medicine-specific competencies. While internal medicine trainees at YNHH are exposed to ample medical knowledge, they receive relatively less experience in procedural and systems-based competencies. The new hospital medicine rotation also features a different pattern of rounding and a sign-out system in the electronic medical record. The educational experience has also been redesigned. Once a week, trainees receive protected learning time for experiential learning, including point-of-care-ultrasound workshops, clinical deterioration simulation sessions, and clinical reasoning sessions. The attendings on service cover patient calls during these teaching sessions to ensure learners are not interrupted.
In all, the feedback has been superb. Sankey states, “Learners have been flexible and willing to give the new structure a chance, and the attendings have embraced the opportunity to supervise residents in a new way. We’re really excited to continue to refine and improve the rotation in the new academic year.”
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