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Development and Evaluation of a Direct Care Hospitalist Service Internal Medicine Sub-internship Rotation
Ethan Molitch-Hou1, Irsk Anderson2, Arti Tewari3
1Section of Hospital Medicine, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA. emolitchhou@uchicago.edu.
Background:
Direct Care Hospitalist Services (DCHS) can increase internal medicine (IM) sub-internship rotation availability while providing hospitalists additional teaching opportunities.
Aim:
Implement and evaluate a DCHS sub-internship.
Setting:
Urban Academic Medical School.
Participants:
IM sub-interns, hospitalists.
Program Description:
One to two sub-interns were paired with three hospitalists on 3 weeks of day service and five nights in an apprenticeship model. Sub-interns admitted and followed patients on days and cross-covered and admitted on nights.
Program Evaluation:
DCHS sub-intern rotation satisfaction and skills preparedness were surveyed over 2 years. Sub-interns rotating on resident-covered service (RCS) were surveyed in year 2, and results compared to DCHS. Hospitalists were surveyed year 1 to rate satisfaction. Year 2 DCHS cross-cover paging data was tabulated to evaluate clinical content. DCHS and RCS sub-interns rated satisfaction and preparedness similarly. DCHS sub-interns rated time management (3.86 vs 4.33, p = 0.19) and calling consults (4.4 vs 4.8, p = 0.56) lower, but cross-cover higher (4.14 to 3.67, p = 0.34) than RCS. DCHS sub-interns averaged 39.4 (SD 4.1) nightly cross-cover pages with most related to acute symptoms (46%). Hospitalists were highly satisfied with their rotation experience.
Discussion:
Sub-interns were highly satisfied with DCHS sub-internship. Future work will target gaps in preparedness for urgent patient care issues.
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