Sleeping at Home: An Innovative Model for Teaching Family Medicine Residents

BOSTON (July 25, 2011) - A new model for training residents in family medicine, under development at the Tufts University Family Medicine Residency program at Cambridge Health Alliance, relies less on training in hospitals and, instead, emphasizes training at the type of clinics where family medicine doctors are most apt to work. This model, one of several new ones being developed to address the need for more family care physicians, relies on the use of hospitalists to co-teach residents. Preliminary results of the implementation of this new model were published in a brief report in the June issue of the Journal of Graduate Medical Education.

The novelty of the new Tufts Family Medicine model stems from the use of hospitalists, doctors who specialize in treating patients after they are admitted to a hospital, to both co-teach residents and to provide care for the residents' patients at night. Hospitals have traditionally relied on residents - recent graduates from medical school receiving additional training under the supervision of licensed physicians - to provide round-the-clock patient care. With hospitalists now serving as the primary workforce in the model's teaching hospital, residents are able to learn how to care for hospitalized patients without the unnecessarily long hours.

"Residents need to be shielded from working excessive hours. Residents in family medicine and primary care need more time in the outpatient clinical settings that they will practice in, rather than hospitals. These two needs, combined with the rapid growth of hospitalist care, drove the development of this new model," said co-author Allen Shaughnessy, PharmD, MMedEd, associate program director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance and professor at Tufts University School of Medicine.

Under the new teaching method, residents no longer have to undergo an extensive and grueling hospital training experience. Residents are now able to sleep at home and hand over the responsibilities for their patients to a hospitalist in the evenings. Residents on rotation in the hospital during the day leave at night, but return to the hospital if a clinic patient is admitted. While at home, the residents remain available to outpatients by phone if on call.

"The hospitalist and one faculty physician oversee a team of four residents," said co-author Deborah Erlich, MD, research associate and teaching fellow in the Tufts University Family Medicine Residency program at Cambridge Health Alliance. "This group of six doctors makes up a service team. The result is an interdisciplinary, collaborative model that allows for teaching, guidance, and proper supervision of residents, with the hospitalist and faculty physician each bringing unique expertise to the team."

Shaughnessy and Erlich report that the model creates strong work relationships within the service teams and teaches residents several skills, including the art of effective communication to a covering physician, learning how to better anticipate overnight-care needs of their patients, and how to service patient calls from home, just as they will do as fully licensed family physicians.

"By uncoupling the educational experience of the residents from the service demands of the hospital, residents gain experience in an outpatient setting that aligns with their plans to work as primary care physicians," said Shaughnessy.

Erlich Deborah R. and Shaughnessy Allen F. Journal of Graduate Medical Education. 2011 (June); 3 (2), 243-245. "Sleeping at Home: A New Model for a Hospital Teaching Service."

About Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences
Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, biomedical sciences, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level. Ranked among the top in the nation, the School of Medicine is affiliated with six major teaching hospitals and more than 30 health care facilities. Tufts University School of Medicine and the Sackler School undertake research that is consistently rated among the highest in the nation for its effect on the advancement of medical science.

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