Background:
Hospitalists’ favorable impact on student education is well described. There is an emerging mandate to equip health care professionals with skills in navigating complex systems, interprofessional teamwork, and quality improvement. Surgical teams are ideal settings for demonstrating such concepts, and hospitalists in the co-management role are uniquely positioned to facilitate education in these areas.
Purpose:
Medical schools have placed a high priority on health care systems learning and are calling for early immersion in the workplace where students serve as contributing team members. Identifying quality sites to accommodate learners is of utmost importance. While surgical teams are rich microsystems in which students can experience principles of systems and teamwork, only ~20% of medical schools offer pre-clerkship surgery learning opportunities. We describe a model in which a co-management hospitalist relationship with an orthopedics team was leveraged to create an early immersion experience for interprofessional learners. By combining the valuable surgical team setting with embedded hospitalist educators, previously untapped learning opportunities can be harnessed.
Description:
An inpatient orthopedic-medicine co-management team was a pilot immersion site for first year medical students (MS1s) and second year pharmacy students (P2s). In this care model, hospitalists partner with orthopedic nurse practitioners, physician assistants, physical therapists, pharmacists, and surgeons to care for medically complicated patients peri-operatively.
Two MS1s and two P2s joined the team for 22 half-days throughout 2014-15. Medical students practiced clinical skills, rounded with clinicians in the hospital, assisted in clinics and operating rooms, and participated in process improvement projects. Students examined interprofessional roles, performed medication reconciliation and assessed hospitalized patients’ delirium risk. Pre-post knowledge tests on interprofessional education and geriatrics, weekly reflections, and focus groups were completed.
Following the longitudinal experience, student scores on geriatrics knowledge and interprofessional learning readiness surveys improved. Student reflections included themes on the value of working with and learning from different professions, the critical nature of teamwork, identification of systems issues that could be addressed to improve patient experience, and on recognition of the complexities of the medical system. After hearing a patient’s story about extended wait time for a shoulder surgery, one student committed her quality project to explore and address process efficiency in preoperative patient flow. Following successful incorporation or early learners on the team, orthopedics leadership approached hospitalists to co-develop a similar rotation for surgical interns.
Conclusions:
We demonstrate successful integration of early learners into the surgical setting as a powerful means of facilitating early command of complex clinical systems and patient-centered care. Clinical relationships between hospitalists and surgical providers can be extended into educational partnerships that capitalize on existing workplace structure to teach these critical concepts. Early learners in the surgical workplace can in turn be valuable assets to the system and patients.