Molitch-Hou Ethan, Anderson Irsk, Tewari Arti, Kowalczyk Nicholas S, Feaster Nia, Martin Shannon K
Section of Hospital Medicine, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
Section of General Internal Medicine, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, USA.
J Gen Intern Med. 2025 Jan;40(1):277-283. doi: 10.1007/s11606-024-08878-5. Epub 2024 Sep 16.
Direct Care Hospitalist Services (DCHS) can increase internal medicine (IM) sub-internship rotation availability while providing hospitalists additional teaching opportunities.
Implement and evaluate a DCHS sub-internship.
Urban Academic Medical School.
IM sub-interns, hospitalists.
One to two sub-interns were paired with three hospitalists on 3 weeks of day service and five nights in an apprenticeship model. Sub-interns admitted and followed patients on days and cross-covered and admitted on nights.
DCHS sub-intern rotation satisfaction and skills preparedness were surveyed over 2 years. Sub-interns rotating on resident-covered service (RCS) were surveyed in year 2, and results compared to DCHS. Hospitalists were surveyed year 1 to rate satisfaction. Year 2 DCHS cross-cover paging data was tabulated to evaluate clinical content. DCHS and RCS sub-interns rated satisfaction and preparedness similarly. DCHS sub-interns rated time management (3.86 vs 4.33, p = 0.19) and calling consults (4.4 vs 4.8, p = 0.56) lower, but cross-cover higher (4.14 to 3.67, p = 0.34) than RCS. DCHS sub-interns averaged 39.4 (SD 4.1) nightly cross-cover pages with most related to acute symptoms (46%). Hospitalists were highly satisfied with their rotation experience.
Sub-interns were highly satisfied with DCHS sub-internship. Future work will target gaps in preparedness for urgent patient care issues.
直接护理住院医师服务（DCHS）可以增加内科（IM）实习轮转的机会，同时为住院医师提供更多教学机会。
实施并评估一项DCHS实习项目。
城市学术医学院。
IM实习医生、住院医师。
一至两名实习医生与三名住院医师配对，以学徒模式进行为期3周的日间服务和五个晚上的工作。实习医生在白天负责收治和跟踪患者，并在晚上进行交叉值班和收治患者。
在两年时间里对DCHS实习轮转的满意度和技能准备情况进行了调查。在第二年对在住院医师覆盖服务（RCS）轮转的实习医生进行了调查，并将结果与DCHS进行比较。在第一年对住院医师进行了调查以评估满意度。统计了第二年DCHS交叉值班的传呼数据以评估临床内容。DCHS和RCS实习医生对满意度和准备情况的评价相似。DCHS实习医生对时间管理（3.86对4.33，p = 0.19）和呼叫会诊（4.4对4.8，p = 0.56）的评价较低，但对交叉值班的评价（4.14对3.67，p = 0.34）高于RCS。DCHS实习医生平均每晚接到39.4（标准差4.1）次交叉值班传呼，其中大部分与急性症状有关（46%）。住院医师对他们的轮转经历非常满意。
实习医生对DCHS实习项目非常满意。未来的工作将针对紧急患者护理问题准备方面的差距。
