Hospitalists serve as teachers and role models for students, trainees, and other hospital staff. Expertise in Hospital Medicine includes not only the clinical knowledge and skills pertinent to acute inpatient medicine but also the skills and attitudes of institutional safety practices. These practices may include delivery of safe handoffs, prevention of health care–associated infections with hand washing and antimicrobial resistance by evidence-based antibiotic prescribing, and actively engaging in institutional patient safety and quality improvement initiatives. Hospitalists' availability and physical proximity to learners clearly positions them to become effective educators. But hospitalists' success as teachers cannot rely on physical proximity alone. The structure of Hospital Medicine practice poses challenges: lack of time, competing demands between clinical work and education, and the pressure of duty hour restrictions. In addition, hospitalists face common hurdles of how to teach at multiple levels simultaneously, how to assess competence, and how to provide feedback. To succeed in the critical role of educator, hospitalists must establish a productive learning environment in which to work. This chapter will focus on applying some of these key principles and skills in medical education that the hospitalist will find useful in daily work.
In order to meet the goal of effective teaching, hospitalists should first have a clear understanding of what expectations exist. The Core Competences in Hospital Medicine: A Framework for Curriculum Development by the Society of Hospital Medicine (SHM) sets expectations about the role of the hospitalist as teacher. These include the knowledge (eg, teachable moments and microskills), skills (eg, setting expectations and role modeling), and attitudes (eg, recognizing the needs of the learner) required for hospitalist educators. Hospitalists should reflect on how to apply these expectations as they manage patients with students, residents, physician assistants, nurse practitioners, and other members of the multidisciplinary team. Beyond serving as supervisor, explicit goals should include serving as a clinical role model: competent with clinical knowledge, demonstrating analytic ability and professionalism, and incorporating new knowledge into practice. Hospitalists should strive to support their teams by mentoring, showing interest and providing advice about careers, anticipating mistakes, and when they occur minimizing them in a nonblaming manner, and providing feedback. Teaching should be dynamic and engaging, flexible enough to meet the needs of different learners, balanced with variable clinical demands, and incorporate self-reflection.
David Irby's observational study of “master teachers” is a useful reference for hospitalists who plan to teach. Irby proposes a model in which educators divide their teaching time into three phases: planning, teaching, and self-reflection. The objectives outlined in the Core Competencies should be kept in mind in each of these three phases. This framework adapts easily to one-on-one teaching, bedside teaching on rounds, and small group learning in team or attending rounds.
In the planning phase the teacher prepares the session by talking with learners ahead of time, gets to know them well enough to understand what they need, and sets priorities based on time and needs assessment. ...