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Redesigned Residency Model Has Educational Benefits

Experimental arrangement linked to fewer patients per intern, more time for learning activities

THURSDAY, April 8 (HealthDay News) -- An experimental model of inpatient service for an internal medicine residency program is associated with greater trainee satisfaction and more time for educational activities, according to research published in the April 8 issue of the New England Journal of Medicine.

Graham T. McMahon, M.D., of Brigham and Women's Hospital in Boston, and colleagues designed an experimental inpatient care model with reduced resident workload comprising two teams, each with two attending physicians, two residents and three interns. Attending physicians supervised the teams throughout the workday and at bedside team teaching rounds. They compared this model with a control model comprising two teams, each with one resident, two interns, and multiple supervising attending physicians. Over 12 months, 1,892 patients were assigned to the experimental teams and 2,096 were assigned to the control teams.

The researchers found that the average patient census per intern was significantly lower on the experimental teams (3.5 versus 6.6 patients). Trainee satisfaction was higher in the experimental teams (78 versus 55 percent). Length of patient stay and readmission rates were not greater in the experimental teams, and adherence to quality of care standards was similar in the two groups. Interns on the experimental teams spent more time in learning (20 versus 10 percent of total time) and teaching (8 versus 2 percent) activities.

"Our study shows that an educationally centered program, constructed to address the educational needs of trainees, can be successfully introduced without adversely affecting the quality of care. Our findings therefore support many of the recommendations made by educational leaders and the Institute of Medicine for the reform of graduate medical education," the authors conclude.

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