Examining the Impact of a Direct Care Hospitalist Teaching Service on Resident Sense of Patient Care Ownership

Pressures on academic medical centers to efficiently manage throughput and high patient volumes while balancing clinical and educational objectives have led to innovations beyond the traditional teaching service (TTS). One such innovation is a direct care hospitalist teaching service (DCHTS), defined as services where attendings directly engage with and direct the care of patients alongside residents. The effect of DCHTS on residents' sense of patient care ownership is unknown.

To assess residents' sense of patient care ownership, which is integral to professional identity formation, on an DCHTS compared to a TTS.

We surveyed residents using a 13-item previously validated instrument to measure patient care ownership (PCOI) from April 2023 to June 2024 in a tertiary care academic medical center in the Northeast where a DCHTS is located on the same hospital floor as a TTS. Results were assessed using a 5-point Likert scale.

Response rate was 50.9% (59 of 116 senior residents). There were no significant differences in most PCOI items. Differences included: DCHTS residents more often endorsed being the "go-to" person for knowledge about their patients (p-value = 0.03); TTS residents more often endorsed ensuring continuity when off service (p-value = 0.04).

Our data suggest that residents have similar experiences of patient care ownership across most domains of a validated PCOI on both an DHCTS and TTS. Innovative approaches to structuring inpatient teams may meet institutional goals and programmatic needs of senior residents transitioning to independent clinical practice while not jeopardizing resident professional development.