Inpatient Teaching Today

patient teacher, perhaps the most intense assignment clinician-educators are asked to assume. Always challenging, inpatient teaching currently must meet requirements and regulations that did not even exist years ago. Today’s handbook of inpatient teaching includes chapters written by (1) the Accreditation Council on Graduate Medical Education (ACGME) governing training experiences and working conditions for residents; (2) managed care organizations and hospital utilization committees establishing guidelines for admissions, length of stay, and utilization of diagnostic tests, consultations, and other resources; and (3) the Health Care Financing Administration (HCFA) and other third-party payers setting forth requirements that affect the level of the attending physicians’ involvement in patient care and the allocation of their time, and at least indirectly, housestaff responsibility and learning. But the purpose of this article is not to bemoan the new rules and regulations. In fact, each of these requirements in its own way makes sense. Rather, in this article I try to identify solutions to the inpatient teacher’s challenges, both old and new. But first we should ask, what is the essence of inpatient teaching? What about it cannot be sacrificed, no matter how much the environment may change? That question requires that we consider theories of learning and cognition around which personal models of teaching can be built. Second, we should ask, how successful inpatient teachers do their jobs so well. Everyone faces the same dilemmas when they teach on rounds. What is it about the best attending physicians that makes them stand out? And third, what solutions can be applied to the inpatient teaching problems we face today? What can be done to ensure that the inpatient rounds we will make tomorrow are as memorable as the best rounds our predecessors made in the past? Or even, dare we ask, can we do better?