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What the “Nonteaching” Service Can Teach Us

Repp, Allen B. MD, MSc; Bartsch, Jason C. MD; Pasanen, Mark E. MD

doi: 10.1097/ACM.0000000000001833
Perspectives
AM Rounds Blog Post

“Teaching” services usually incorporate a cadre of learners such as resident physicians and medical students as part of the care team, led by a faculty physician. “Nonteaching” services, in contrast, are usually defined by the absence of resident physicians on the care team. The care for patients on a nonteaching service is frequently managed directly by a faculty or nonfaculty physician. Nonteaching services have grown in number and size at academic medical centers (AMCs) in response to regulatory requirements, operational demands, and efforts to improve clinical education. The allocation of patients to teaching and nonteaching services is frequently based on perceived teaching value of hospitalized patients, which can potentially lead to a number of unintended consequences for medical education, professional satisfaction, and patient care. Through a series of four lessons, the authors describe how the structure of nonteaching services can result in curricular gaps, devalue attending physicians, and undermine the educational and clinical missions of AMCs. Anticipating the continued expansion and evolution of nonteaching services, the authors propose seven design principles for nonteaching services to ensure robust education for students and resident physicians, advance quality of care, and enhance attending physician and patient experience.

A.B. Repp is associate professor and vice chair for quality, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont; ORCID: http://orcid.org/0000-0001-7513-532X.

J.C. Bartsch is assistant professor, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont.

M.E. Pasanen is associate professor, internal medicine residency program director, and chief, Division of Hospital Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont.

Editor’s Note: An Invited Commentary by L.M. Bellini and J. Ende appears on pages 13–15.

An AM Rounds blog post on this article is available at academicmedicineblog.org.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Allen B. Repp, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401; e-mail: allen.repp@uvm.edu.

© 2018 by the Association of American Medical Colleges