Beyond Workarounds: Enhancing Education, Care, and Wellness on Inpatient Medicine Rotations—A Multicenter Qualitative Study

Background

Inpatient medicine rotations (IMRs) aim to deliver exceptional clinical education and high-quality patient care. However, increasing workloads and the fast pace of inpatient wards are undermining this dual objective.

Objective

To explore tensions and challenges between balancing education and clinical practice on IMRs and how physician-leaders are addressing them.

Design

Constructivist grounded theory.

Participants

Inpatient medicine rotation physician-leaders from academic medical centers in the United States and Canada.

Approach

Data collection involved semi-structured individual and group interviews, collected and analyzed iteratively to develop an explanatory conceptual model. Rigor was enhanced through constant comparison, investigator triangulation, and return-of-findings sessions.

Key Results

Twenty interviews involving 27 participants from 20 distinct training programs were conducted. Participants endorsed IMRs unique clinical and educational value. However, they flagged how increasing workloads and resource challenges produce tensions that can undermine the quality of both which, as a consequence, negatively impact attending and trainee wellness. While reactionary “workarounds” were the norm, they often created unanticipated problems. Key IMR features and strategies for success were identified and organized into six categories: (1) patient mix/census; (2) leadership collaboration; (3) collaborative care models; (4) rotation scheduling; (5) clinical workflow; (6) educational workflow. How physician-leaders configured their IMR structures and processes within these categories had the potential to support or undermine the delivery of high-quality care, education, and wellness.

Conclusions

Inpatient medicine rotations, which is essential for clinical care and education, are currently facing serious challenges from a changing clinical and educational landscape. Our findings present a conceptual model highlighting key modifiable variables, giving physician-leaders a framework to assess and enhance their IMR’s clinical learning environment, thus fostering quality care, education, and clinician wellness.