Beyond Workarounds: Enhancing Education, Care, and Wellness on Inpatient Medicine Rotations -A Multicenter...

Area of Science:

• Medical Education
• Healthcare Management
• Clinical Practice

Background:

• Inpatient medicine rotations (IMRs) are crucial for clinical education and patient care.
• Increasing workloads and fast-paced environments threaten the dual objectives of IMRs.
• Tensions arise between educational goals and clinical demands in IMRs.

Purpose of the Study:

• To explore the challenges of balancing education and clinical practice in IMRs.
• To understand how physician-leaders address these competing demands.
• To identify strategies for optimizing the IMR learning environment.

Main Methods:

• Constructivist grounded theory approach.
• Semi-structured interviews with 27 physician-leaders from 20 academic medical centers in the US and Canada.
• Iterative data analysis to develop a conceptual model, enhanced by constant comparison and triangulation.

Main Results:

• Participants recognized the value of IMRs but highlighted how workload and resource issues create tensions impacting care, education, and wellness.
• Reactive "workarounds" were common but often led to unintended consequences.
• Six key categories for IMR success were identified: patient mix/census, leadership collaboration, collaborative care models, scheduling, clinical workflow, and educational workflow.

Conclusions:

• IMRs face significant challenges from evolving clinical and educational landscapes.
• A conceptual model with modifiable variables offers physician-leaders a framework to enhance IMRs.
• Optimizing IMRs can foster high-quality care, education, and clinician wellness.