Thread by @medrants

1/Time for a #UncleBob screed. The question Andrew raises is a very interesting one. First I must provide my understanding of the purpose of teaching ward attending physicians.
I divide this into providing excellent patient care & helping learners grow.

https://twitter.com/andrewolsonmd/status/1515503749367836676

2/ Providing high quality care is a given. Excellent ward attendings evolve with clinical practice (consider the 10,000 hour "rule"). But I would argue that both outpatient clinical practice and inpatient practice are beneficial.

3/ And I believe I learn more in a month of ward attending than if I did a month of solo patient care. Patient care requires attention to detail, diagnostic excellence, management efficiency and proper use of tests and consultants.

4/ Experience does matter - but doing hospitalist work may or may not help. We all need deliberate practice - and if we strive for that, teaching attending physicians who are involved in patient care grow just as fast or (IMHO) faster than solo hospitalists.

5/ Now for the second half of the job - helping learners grow. We teach students, interns and residents internal medicine. The best educators help all grow. Research tells us that learners want to know how we think. That is part of becoming an experienced educator.

6/ Some in this thread have emphasized system aspects - d/c planning, d/c notes/, billing, med rec, orders. Yet when you learn those skills at one hospital and work at a different hospital your really have to start all over.

7/ I have taught in 2 University hospitals, a VA and a community hospital. The systems are all different as are the computer systems. Our residents become skilled and quickly teach this to our interns. Most of our residents do not become hospitalists.

8/ Spending time on these system issues must then take time away from teaching medicine - the raison d'etre of medical school and residency. We desperately need the best educators who can share their wisdom as well as their knowledge.

9/ I learned more about bedside manner from my 15 years doing outpatient medicine than I ever learned in hospital medicine. The dichotomization of internal medicine into inpatient and outpatient may have a negative impact on education - but that is just conjecture to rile.

10/ “You have your way. I have my way. As for the right way, the correct way, and the only way, it does not exist.”― Friedrich Wilhelm Nietzsche
We need educators 2 bring different skills to ward attending. Please avoid the argument that one road takes a superior path 2 another