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Internal medicine residents and interns prefer inpatient rotations that are supervised by hospitalists

Residents, interns, and medical students consider internal medicine rotations supervised by hospitalists to be more effective and satisfying than those supervised by traditional attending physicians, according to a study supported by the Agency for Healthcare Research and Quality (HS11416). Hospitalists, who in the study spent substantially more time in the hospital compared with traditional attending physicians, may have more specific inpatient knowledge and teaching skills that distinguish them from non-hospitalists, suggest the researchers who conducted the study.

For the study, the researchers analyzed data from a Web-based evaluation system containing all house staff and student evaluations of their attending physicians and internal medicine ward rotations at two university-affiliated teaching hospitals over a 2-year period (1999-2001). A total of 1,587 trainees working with 17 hospitalists and 52 traditional attending physicians completed the evaluation. Trainees reported significantly more overall satisfaction with hospitalists than with traditional attendings (8.3 vs. 8.0 on a 9-point scale), and they rated hospitalists' overall teaching effectiveness as superior (4.8 vs. 4.5 on a 5-point scale). The trainees also rated the overall educational value of rotations higher with hospitalists (3.9 vs. 3.7 on a 5-point scale).

Trainees rated hospitalists' knowledge of relevant subject matter, discussion of pathophysiology, teaching effectiveness, emphasis on cost-effectiveness, and provision of appropriate and effective feedback as superior to that of traditional attendings. The items for which hospitalists received higher ratings describe a specific skill set that they either brought to their position or developed via frequent ward duty and do not reflect a difference in commitment toward or enjoyment of teaching, note the researchers.

Details are in "Effects of hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations," by Karen E. Hauer, M.D., Robert M. Wachter, M.D., Charles E. McCulloch, Ph.D., and others, in the September 27, 2004 Archives of Internal Medicine 164, pp. 1866-1871.

Editor's Note: Another AHRQ-supported study on a related topic focuses on professional liability issues pertinent to resident physicians, attending physicians, and graduate medical education institutions. For instance, attending physicians overseeing resident physicians face personal malpractice risk for the care they personally deliver as well as the care they direct (that is completed by residents they supervise) and for improper supervision that leads to mistakes.

See Kachalia, A., and Studdert, D.M. (2004, September). "Professional liability issues in graduate medical education." (AHRQ grant HS11285). Journal of the American Medical Association 292(9), pp. 1051-1056.

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