Background: With increasing numbers of hospitalist attending as well as demands of documentation and supervision, the # of days an attending physician remains with a team has been reduced at many academic medical centers. This reduction in attending physician continuity may impact the learners (teaching, receiving effective feedback) while potentially improving faculty experience (reduced burnout and fatigue).At Emory University Hospital Midtown, attending faculty have limited opportunities to participate on teaching services due to finite number of teaching blocks available. In order to increase the number of available teaching blocks, the duration of teaching service was changed from 14 days to average 10 days. . Our hypothesis was that a 10day rotation would decrease fatigue and burnout in attending faculty, would increase teaching effectiveness, and improve ability to observe learners (direct or indirect) without negatively affecting the resident perception of teaching and/or value to their education.
Methods: An IRB-exempted survey was sent to EUHM hospital faculty who participated in teaching service during FY19. This survey included questions over perception of teaching experience, teaching effectiveness, and impact on learner and patients. As a counterbalance, the experience of the learners was used based on the rotation evaluation for EUHM by the residents as completed on New Innovations TM .
Results: The number of teaching blocks for faculty increased from 52 to 70 with the change from 14 days to 10 day blocks. More individual faculty were able to attend on teaching service in the study period compared to the prior year (28 vs 25). In the period of 14 day blocks, on 4 hospitalists were able to serve on teaching teams more than twice during the year. During the 10 day block period, 14 hospitalists were able to be on teaching more than twice.Of the 28 faculty who served on teaching service in study period, only 17 had served the prior year and were eligible for study. 10/17 (58%) hospitalists eligible for this study completed the survey. All faculty surveyed had attended at least three years and 50% had greater than 7 years experience as teaching faculty. Of survey respondents, the majority (70%) preferred the shorter duration of teaching service. There were no difference in hospitalists attitudes towards feeling more effective as educators. There was less direct observation reported in the 10 day block. All faculty surveyed felt less exhausted after 10 day block compared to the 14 days block. Qualitative responses indicated advantages of 10day block were decreased exhaustion/fatigue and appreciation for increased opportunity to participate on teaching service. Disadvantages reported were difficult in connecting with learners, assessing learners and following up on feedback provided. There was no difference in the ratings of overall quality of education (p=0.48) or the adequacy of attending supervision (p=0.39) with 14 day vs 10 day model.
Conclusions: A 10 day teaching model allows increased participation of faculty on teaching service and does not appear to negatively affect the resident experience. Faculty based factors such as morale and burnout as well as ability to recruit and retain faculty may influence the duration of time on service. The majority of hospitalists surveyed (70%) preferred the shorter duration of teaching service. Challenges with new model included ability to assess and to connect with the learners.