Saturday, August 27, 2011

Teaching in the New Duty Hour Environment

I have been a teaching doctor for over 10 years.  It has been an incredibly rewarding experience, helping shape the physicians of tomorrow.  “Back in the day” we used to teach in the hospital inpatient setting several months a year, in addition to having a “clinic” or “office”, where we saw outpatients and developed long-lasting healing relationships as primary care physicians.
Now  those days are few and far between.  The opportunities for those to teach in both inpatient and outpatient venues have diminished.  Mostly, the frenetic pace of the inpatient environment is simply taxing (physically and emotionally), and that in and of itself makes it difficult to “be on wards” so much (for the non-hopsitalists) and also maintain a cohesive, outpatient practice.
I always get jazzed up when I start a new inpatient tour of duty, and I usually do so earlier in the year, when new interns and medical students are still early in the training period.  It is great to see the interest learners have in performing certain components of the physical exam, to mentor them through tougher situations, such as telling patients a difficult diagnosis, and to observe learners improve literally in front of one’s eyes.
With the new duty hours, however, the time for teaching has clearly gone down.  Documentation requirements have become more stringent throughout the years, necessitating more time in front of a computer and less time with patients and learners.  Nevertheless, I do feel that today’s learners are just as dedicated as those of previous generations to the provision of high-quality, excellent patient care.  In addition, the duty hour restrictions were thrust upon them, not the other way around.
The teaching docs of the future need to figure out how to integrate “snippets of learning” into a busy day.  Handoffs will become one of the most important skills of today’s trainees (they probably already are).  Learners need to remember that “teaching moments” will probably not occur as a “60-minute chalkboard lecture on abnormal liver tests” as much as in the past, but rather integrated into the care of the patients (and isn’t that the best way to learn anyway?).  Communication skills will need to be stressed, and bedside rounding (in pediatrics, known as “Family-Centered Rounds”, with nurses, pharmacists, other health care professionals and families all together at the same time) will be critical to evaluate how learners interact directly with patients.
I have confidence that today’s learners will learn the necessary skills to continue to provide the best care for patients, and also maintain a semblance of a life outside of medicine.  Something tells me that they already know how to figure out the “work-life balance” better than my generation.