Background: Career exploration and professional identity formation (PIF) are critical in undergraduate medical education (UME). With its focus on management of acutely ill, hospitalized patients, Hospital Medicine (HM) is an opportune environment for pre-clinical students to gain valuable, diverse clinical experiences. While widely utilized in UME, shadowing on HM direct-care services (HM-DCS) (i.e., those without other learners) is not well-described. Understanding shadowing in this domain is important as there are few examined strategies for incorporating learners on HM-DCS, which are highly clinically demanding for hospitalists. Pritzker School of Medicine (PSOM) students have traditionally lacked formal, structured opportunities to shadow in HM, thus, Hospital Medicine Shadowing Experience (HMSE) for pre-clinical students was developed and piloted in Spring 2021.
Purpose: 1) Develop HMSE to allow pre-clinical students exposure to HM-DCS, and to promote PIF through knowledge acquisition and positive role modeling 2) Evaluate HMSE for student and hospitalist satisfaction, feasibility, and perceived clinical workflow disruption for hospitalists
Description: HMSE was developed in February 2021 with the University of Chicago Section of Hospital Medicine in conjunction with PSOM. HMSE was scheduled on inpatient HM-DCS on Sundays. All pre-clinical students were invited; participation was optional. Attending hospitalist physicians were recruited as preceptors and paired 1:1 with students for minimum 2 hours. HMSE was evaluated via 2 anonymous, optional surveys. The student survey assessed: 1) self-reported knowledge and interest in HM prior to HMSE; 2) self-reported exposure to HM core elements during HMSE; 3) self-reported change in understanding and interest in HM following HMSE; and 4) overall satisfaction with HMSE, teaching, and role modeling received. The hospitalist survey assessed: 1) self-reported HM-DCS workflow disruption; and 2) satisfaction with HMSE. Evaluation was approved by PSOM and granted IRB exemption.10 students and 7 hospitalists participated in the pilot (April-July 2021). Response rate was 100%. Students reported shadowing for mean 3.6 ± 1.0 hours and seeing mean 10.8 ± 3.7 patients, and encountering mean 4.4 ± 2.2 categories of acute medical and 2.8 ± 1.3 categories of psychosocial issues; 40% reported direct clinical skills engagement (e.g., taking history). 70% reported discussing non-clinical opportunities in HM. All students reported better understanding HM clinical practice, and 90% better understanding non-clinical HM opportunities after HMSE. 40% were more interested in pursuing an HM career. Students were extremely satisfied with teaching and role-modeling, and many reported having direct participation in patient care, although students desired more (Figure 1). Hospitalists did perceive universal disruption of HM-DCS workflow, and occasionally patient care (Figure 2). Despite this, HMSE was positive for both students and hospitalists (Figure 1).
Conclusions: HMSE on direct-care services had very high student and hospitalist satisfaction, and improved student self-reported understanding of clinical and non-clinical elements of HM. This pilot showed potential for both educating students about HM, as well as facilitating PIF, and enhancing career satisfaction for hospitalist educators. Next steps include additional data collection, more objective measurements of HM-DCS workflow disruption, and honing guidelines to improve HMSE.
