Background: As the volume of inpatient clinical support tasks (non-direct patient care tasks) has increased, there has been increasing frustration amongst the internal medicine residents at our institution with the efficiency and educational value of their inpatient internal medicine ward experience. This is consistent with similar frustrations amongst trainees and hospitalists across the country. “You don’t need an MD to complete these tasks,” became a common refrain. Such tasks include obtaining outside medical records, communicating with outpatient primary care provider (PCP) offices, and coordinating inpatient testing and procedures. At the same time, many academic medical institutions operate in partnership with or close proximity to undergraduate campuses with many pre-healthcare students who desire both work-study employment and occupational exposure to the healthcare field.
Purpose: To develop a program that would accomplish two simultaneous goals. First, to employ assistants that would work with the three inpatient internal medicine teaching teams at our institution, performing clinical support tasks, so that the residents could better focus on efficient clinical care and education. Second, to create a fiscally responsible work-study program that would allow our undergraduate partner institution to fill these positions, providing undergraduates with an opportunity to earn work-study income while obtaining valuable healthcare insight and experience for their future careers.
Description: We obtained funding for three undergraduate assistant positions, one for each inpatient team, at a work-study salary of $12 per hour. The original sample tasks posted were obtaining outpatient medical records and communicating with primary care physician offices, with the understanding that additional tasks would be added as the assistants learned them. The residents were told that they could teach the assistants how to do any reasonable clinical support tasks that did not require licensure, including interactions with patients and hospital clinical and non-clinical staff. The assistants were employed up to 20 hours each week, generally working from approximately 8am to 12pm for 4 days per week. They accompanied the team on morning rounds on working days, breaking off to perform tasks as needed, but otherwise observing clinical care and obtaining valuable shadowing experience. A resident survey regarding perceived impact of the student assistant program was administered approximately 6 months after the program was initiated. Of 29 resident respondents, 64% felt that the program allowed them to work more efficiently, 71% felt that it improved patient care, and 79% felt that the program was a benefit to the residency overall. In addition, we have written a letter of recommendation for one of our student assistant’s medical school applications.
Conclusions: This program has accomplished the goals of reducing clinical support task workload for residents on their inpatient medicine rotations, and providing a unique employment and healthcare immersion experience for our undergraduates. The model would seem to be implementable at other academic medical institutions associated with undergraduate campuses.