Toward a Utopian Model for Teaching and Nonteaching Services: Every Journey Begins With a First Step

Nonteaching services are an imperfect step toward enabling inpatient teaching services to transition from an unregulated, natural state, driven solely by the exigencies of patient volume and throughput, to one that is more controlled and intends to achieve the proper balance between service and education. As career educators the authors prefer to view nonteaching services as critical components of an integrated system that enables the best possible patient care and learning, yet they acknowledge that, to meet the needs of patients and learners, teaching and nonteaching services alike must be truly complementary, collaborative, and integrated components of a single system.In this Invited Commentary the authors offer a "utopian" view of a teaching service in an institution that explicitly acknowledges its contract with society to transform health care delivery. In this setting, highly engaged teachers and learners are supported by a high-performing cast of an advanced practice provider, primary nurses, a social worker, a case manager, a clinical pharmacist, and an analyst. This group forms a Clinical Learning Unit (CLU) where the curriculum has evolved into an interdependent framework of basic, clinical, and systems science. CLUs train tomorrow's health care workforce through adaptive service learning made possible because the team has a manageable census, time for daily reflection, and inspiring relationships with trained teachers. CLUs cannot exist without complementary nonteaching services.Elsewhere in this issue Repp and colleagues outline seven design principles to improve nonteaching services. These are a good first step toward the utopian vision outlined by the authors.