Medical Subinternship: Student Experience on a Resident Uncovered Hospitalist Service

Background:

Although studies demonstrate the positive impact of hospitalists on medical student education, all were performed in a traditional resident covered ward service (RCWS) setting. Our institution implemented a resident uncovered hospitalist service (RUHS) in June 2003 in an effort to comply with newly revised resident work hour requirements. Many teaching hospitals have developed similar services. A RUHS may provide an alternative learning experience for medical students.

Method:

During the 04‐05 academic year, 38 students spent 2 weeks of their subinternship on the RUHS. The remainder of their 6‐week subinternship was spent on the RCWS. We conducted a survey to find out how subinterns perceived their experiences on the two services. We asked “If you had to do your subinternship all over again, would you prefer to only be on?”, with available answers including the RCWS, the RUHS, or a combination of both. We assessed overall experience and knowledge learned using a 5‐point Likert scale. We also assessed characteristics of teaching practices, workload, and time spent at the hospital while on each service.

Summary of Results:

27 of 38 students completed the survey, for a response rate of 71 %. When asked, “If you had to do your subinternship all over again?”, 81% of students indicated a preference to rotate on both services, while 15% preferred the RCWS and 4% preferred the RUHS exclusively. 74% rated the knowledge learned on the RCWS service as very good or outstanding compared to 44% on the RUHS (p = 0.03). More students agreed that intellectual discussion and the exchange of ideas occurred frequently on the RCWS compared to the RUHS (88% vs. 58%, p = 0.02). The amount of time spent in work rounds with the attending was significantly different as well, with 76% of subinterns indicating ten or more hours per week on the RCWS compared to 21% on the RUHS (p < 0.001). 84% of students indicated that they spent 11 or more hours per day at the hospital while on the RCWS compared to 20% on the RUHS (p < 0.001).

Statement of Conclusions:

Although the knowledge learned was rated higher on the RCWS than the RUHS, students preferred a combination of services if they had to do their subinternship all over again. Although students valued the intellectual discussion and exchange of ideas that occur during work rounds on the RCWS, it seemed to result in longer hours at the hospital. This may help to explain the apparent paradox between students giving a higher rating of the learning experience on the RCWS yet preferring to combine the services if they had it to do over again. Finally, busy hospitalists on the RUHS may have had less time to dedicate to teaching during work rounds than attending physicians on the RCWS.

Author Disclosure Block:

K. O'Leary, None; V. Chadha, None; V. Fleming, None; D. Baker, None.