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Effect of a Pediatric Hospitalist System on Housestaff Education and Experience
Christopher P. Landrigan, MD, MPH;
Sharon Muret-Wagstaff, PhD;
Vincent W. Chiang, MD;
Daniel J. Nigrin, MD, MS;
Donald A. Goldmann, MD;
Jonathan A. Finkelstein, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:877-883.
Objective To determine the effect of a pediatric hospitalist system on housestaff
education and experience.
Setting Free-standing academic children's hospital. Hospitalists were introduced
in June 24, 1998, to supervise teaching and care on the general pediatric
wards.
Methods On 2 surveys, housestaff rated their skills, knowledge, and experiences
on the wards (experiences survey), and the quality of teaching and supervision
by attending physicians (attending survey). Responses before and after the
introduction of the hospitalist system were compared using Wilcoxon nonparametric
tests.
Results Seventy-six (70%) of the 109 interns and 54 (62%) of the 87 senior residents
responded to the experiences survey. Following introduction of the hospitalist
system, the interns' mean overall rating of the general pediatrics wards rose
from 4.1 to 4.7 on a 5-point Likert scale (P = .01).
Their ratings of comparison rotations did not change significantly. Interns'
satisfaction with the educational experience (3.2 to 3.5 of a 4-point Likert
scale, P<.05), supervision, and quality of life
on the pediatrics wards also improved significantly, as did their self-assessments
of skills and knowledge related to general pediatrics training. Senior residents'
ratings were generally unchanged. Three hundred seventy-one (63%) of the 593
attending physicians' surveys were completed. Compared with nonhospitalist
attendings, hospitalists were rated more effective role models (4.7 vs 4.5
points, P<.05) and teachers (4.7 vs 4.4 points, P<.01). They were rated more knowledgeable (4.8 vs 4.5
of 5, P<.001) and accessible (4.7 vs 4.5 points, P<.05), involved housestaff more in the learning process
(4.7 vs 4.4 points, P<.05), and gave better feedback
(4.5 vs 4.2 points, P<.01). Hospitalists' bedside
teaching, however, was rated lower (3.7 vs 4.2 points, P<.001).
Conclusions Overall, hospitalists were rated significantly higher as educators than
were traditional attending physicians. Introduction of a hospitalist system
was associated with improved intern experience and quality of life on general
pediatrics wards, and with improved self-reported skills and knowledge in
general pediatrics.
From the Department of Medicine, Children's Hospital (Drs Landrigan,
Muret-Wagstaff, Chiang, Nigrin, Goldmann, and Finkelstein), and the Departments
of Pediatrics (Drs Landrigan, Muret-Wagstaff, Chiang, Nigrin, Goldmann, and
Finkelstein) and Ambulatory Care and Prevention (Dr Finkelstein), Harvard
Medical School, Boston, Mass.
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