Impact of Clinical Demands on the Educational Mission in Hospital Medicine at 17 Academic Medical Centers : A Qualitative Analysis

Link to article at PubMed

Ann Intern Med. 2023 Nov;176(11):1526-1535. doi: 10.7326/M23-1497. Epub 2023 Nov 14.


BACKGROUND: Clinical growth is outpacing the growth of traditional educational opportunities at academic medical centers (AMCs).

OBJECTIVE: To understand the impact of clinical growth on the educational mission for academic hospitalists.

DESIGN: Qualitative study using semistructured interviews that were analyzed using a mixed inductive and deductive method at the semantic level.

SETTING: Large AMCs across the United States that experienced clinical growth in the past 5 years.

PARTICIPANTS: Division heads, section heads, and other hospital medicine (HM) leaders who oversaw and guided academic and clinical efforts of HM programs.

MEASUREMENTS: Themes and subthemes.

RESULTS: From September 2021 to January 2022, HM leaders from 17 AMCs participated in the interviews, and 3 key themes emerged. First, AMCs' disproportionate clinical growth highlighted the tension between clinical and educational missions. This included a mismatch in supply and demand for traditional teaching time, competing priorities, and clinical growth being seen as both an opportunity and a threat. Second, amid the shifting landscape of high clinical demands and evolving educational opportunities, hospitalists still strongly prefer traditional teaching. To address this mismatch, HM groups have had to alter recruitment strategies and create innovative solutions to help build academic careers. Third, participants noted a need to reimagine the role and identity of an academic hospitalist, emphasizing tailored career pathways and educational roles spanning well beyond traditional house staff teaching teams.

LIMITATION: The study focused on large AMCs.

CONCLUSION: Although HM groups have implemented many creative strategies to address clinical growth and keep education front and center, challenges remain, particularly heavy clinical workloads and a continued dilution of traditional teaching opportunities.

PRIMARY FUNDING SOURCE: Society of Hospital Medicine Student Scholar Grant.

PMID:37956429 | DOI:10.7326/M23-1497

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