Development and Evaluation of a Direct Care Hospitalist Service Internal Medicine Sub-internship Rotation

Background: Direct Care Hospitalist Services (DCHS) can increase internal medicine (IM) sub-internship rotation availability while providing hospitalists additional teaching opportunities.

Aim: Implement and evaluate a DCHS sub-internship.

Setting: Urban Academic Medical School.

Participants: IM sub-interns, hospitalists.

Program description: One to two sub-interns were paired with three hospitalists on 3 weeks of day service and five nights in an apprenticeship model. Sub-interns admitted and followed patients on days and cross-covered and admitted on nights.

Program evaluation: DCHS sub-intern rotation satisfaction and skills preparedness were surveyed over 2 years. Sub-interns rotating on resident-covered service (RCS) were surveyed in year 2, and results compared to DCHS. Hospitalists were surveyed year 1 to rate satisfaction. Year 2 DCHS cross-cover paging data was tabulated to evaluate clinical content. DCHS and RCS sub-interns rated satisfaction and preparedness similarly. DCHS sub-interns rated time management (3.86 vs 4.33, p = 0.19) and calling consults (4.4 vs 4.8, p = 0.56) lower, but cross-cover higher (4.14 to 3.67, p = 0.34) than RCS. DCHS sub-interns averaged 39.4 (SD 4.1) nightly cross-cover pages with most related to acute symptoms (46%). Hospitalists were highly satisfied with their rotation experience.

Discussion: Sub-interns were highly satisfied with DCHS sub-internship. Future work will target gaps in preparedness for urgent patient care issues.