Optimizing learners on direct care teaching services: A qualitative study of hospitalist clinicians at 26 sites

Background: Academic medical centers are experiencing rapid clinical growth which has outpaced traditional teaching services. Learners such as medical students, advanced practice provider fellows, and residents may be placed onto direct care teaching services (i.e., inpatient services where attendings provide both direct care to patients and supervise learners) creating potential challenges for attending physicians due to clinical demands. Objective: Characterize the hospitalist experience with direct care teaching services. Methods: Embedded mixed methods study with a 16-question survey and semistructured focus groups using rapid qualitative methods. Setting and participants: Virtual focus groups in the Hospital Medicine Reengineering Network (HOMERuN). Main Outcome and measures: Qualitative themes. Results: Thirty-eight hospitalist clinicians from 26 hospital systems across five geographic regions participated in the focus groups. Thirty-four (89%) of participants responded to the survey and were predominantly physicians (97%). Most participants preferred traditional teaching services compared with direct care teaching services with 82% replying somewhat or to a great extent. Thematic analysis identified three themes: (1) Hospitalists prefer traditional teaching services in part due to a time and workload mismatch in direct care teaching services; (2) Adaptations can support attending physicians in direct care teaching services such as adjusting workloads based on the level of learners; and (3) Direct care teaching services were perceived to serve an important role by providing direct and personalized teaching, and offering teaching opportunities. Conclusion: Direct care teaching services pose challenges given clinical workloads, time constraints for educational activities. Addressing these challenges may make these types of services more sustainable.