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Development and Evaluation of a Direct Care Hospitalist Service Internal Medicine Sub-internship Rotation.

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Direct Care Hospitalist Services (DCHS) provide valuable internal medicine (IM) sub-internship opportunities. Both DCHS and resident-covered services yielded similar satisfaction and preparedness, with future work focusing on urgent care readiness.

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Area of Science:

  • Medical Education
  • Internal Medicine
  • Hospitalist Services

Background:

  • Direct Care Hospitalist Services (DCHS) can enhance the availability of internal medicine (IM) sub-internship rotations.
  • These services also offer hospitalists increased opportunities for teaching.

Purpose of the Study:

  • To implement and evaluate a Direct Care Hospitalist Services (DCHS) sub-internship program.
  • To compare the experiences of sub-interns in DCHS with those in a resident-covered service (RCS).

Main Methods:

  • An urban academic medical school implemented an apprenticeship model where 1-2 IM sub-interns were paired with 3 hospitalists.
  • Sub-interns managed patients during the day and provided cross-coverage at night over 3 weeks of day service and 5 nights.
  • Surveys assessed sub-intern and hospitalist satisfaction and preparedness; DCHS cross-cover paging data was analyzed.

Main Results:

  • DCHS and RCS sub-interns reported similar overall satisfaction and preparedness.
  • DCHS sub-interns rated time management and calling consults lower, but cross-coverage higher than RCS.
  • Hospitalists expressed high satisfaction with their teaching experience, and DCHS sub-interns averaged 39.4 nightly cross-cover pages, primarily for acute symptoms.

Conclusions:

  • Sub-interns reported high satisfaction with the DCHS sub-internship experience.
  • Further development is needed to address preparedness for urgent patient care situations within the DCHS model.