Hospitalists serve as teachers and role models for students, trainees, and other hospital staff. Expertise in Hospital Medicine includes not only the clinical knowledge and skills pertinent to acute inpatient medicine but also the skills and attitudes of institutional safety practices. These practices may include delivery of safe handoffs, prevention of health care–associated infections with hand washing and antimicrobial resistance by evidence-based antibiotic prescribing, and actively engaging in institutional patient safety and quality improvement initiatives. Hospitalists’ availability and physical proximity to learners clearly positions them to become effective educators. But hospitalists’ success as teachers cannot rely on physical proximity alone. The structure of Hospital Medicine practice poses challenges: lack of time, competing demands between clinical work and education, and the pressure of duty hour restrictions. In addition, hospitalists face common hurdles of how to teach at multiple levels simultaneously, how to assess competence, and how to provide feedback. To succeed in the critical role of educator, hospitalists must establish a productive learning environment in which to work. This chapter will focus on applying some of these key principles and skills in medical education that the hospitalist will find useful in daily work.

In order to meet the goal of effective teaching, hospitalists should first have a clear understanding of what expectations exist. The Core Competences in Hospital Medicine: A Framework for Curriculum Development by the Society of Hospital Medicine (SHM) sets expectations about the role of the hospitalist as teacher. These include the knowledge (eg, teachable moments and microskills), skills (eg, setting expectations and role modeling), and attitudes (eg, recognizing the needs of the learner) required for hospitalist educators. Hospitalists should reflect on how to apply these expectations as they manage patients with students, residents, physician assistants, nurse practitioners, and other members of the multidisciplinary team. Beyond serving as supervisor, explicit goals should include serving as a clinical role model: competent with clinical knowledge, demonstrating analytic ability and professionalism, and incorporating new knowledge into practice. Hospitalists should strive to support their teams by mentoring, showing interest and providing advice about careers, anticipating mistakes, and when they occur minimizing them in a nonblaming manner, and providing feedback. Teaching should be dynamic and engaging, flexible enough to meet the needs of different learners, balanced with variable clinical demands, and incorporate self-reflection.

David Irby’s observational study of “master teachers” is a useful reference for hospitalists who plan to teach. Irby proposes a model in which educators divide their teaching time into three phases: planning, teaching, and self-reflection. The objectives outlined in the Core Competencies should be kept in mind in each of these three phases. This framework adapts easily to one-on-one teaching, bedside teaching on rounds, and small group learning in team or attending rounds.

In the planning phase the teacher prepares the session by talking with learners ahead of time, gets to know them well enough to understand what they need, and sets priorities based on time and needs assessment. This focus on the trainee helps shift the emphasis away from what the teacher wants to teach to what the learners need.

In the teaching phase the teacher diagnoses both the learner and the patient. The teacher asks questions of the learner about the patient in order to make a clinical decision, and also questions the learner on what he or she understands so the teacher can tailor his or her teaching. The one-minute preceptor and varying questions are two potential strategies that hospitalists can easily incorporate into their clinical teaching (see Bedside Teaching below).

The last phase is self-reflection. The hospitalist should spend time at the end of a session or rotation to reflect on what went well in his teaching and what he can improve. It may include asking for feedback from learners, team members, and peers. This is an essential component of effective teaching as the individual hospitalist can continue to develop his or her teaching scripts and skills.

Adult learning theory espouses that learners need to clearly understand the expectations of them. For single teaching sessions, this can be accomplished with a brief introduction at the beginning of the session. The longer the teacher-learner relationship, the more formal the expectations sessions can be. Setting aside time to discuss specifics reinforces the importance of education, especially in times of busy service.

Expectations should cover not only the hospitalist’s goals but also the learners’ goals. The focus becomes learner-centric instead of teacher-centric alone. Partnering with the team around these goals helps members to become active participants in their own education. Expectations should include explicit details regarding roles and responsibilities of the team. Patient safety is clearly tied to effective teamwork and being explicit about this helps learners understand this concept as well. Topics to discuss could include the following:

• Communication: Contact numbers and expectations of when communication should take place within team.
  
• Logistics on rounds: Details such as start time, presenters of cases, and location of rounds should lead to a negotiated plan that provides autonomy to the learner and allows the hospitalist to sufficiently supervise care.
  
• Teaching role for the residents or other senior members of the team: With the close proximity of attending hospitalists on the medical units, the autonomy of more advanced learners or team members is at risk, as more junior team members will naturally come directly to the attending. Explicit attention to the residents and their role can help preserve autonomy.
  
• Collective educational goals for the month: A discussion should include a list of didactic topics and skills such as presenting or synthesizing assessments and plans at the bedside. This will help hospitalists plan their teaching in a learner-centric way.
  
• Clinical expectations for how to function as a team: Details such as who is responsible for the parts of clinical care including communication with patients, families, primary care physicians, and consultants should be discussed. Other patient safety issues such as follow-up of pending test results at discharge and attention to the group’s behavior around hand hygiene or DVT prophylaxis should be agreed upon as well.
  
• Expectations regarding documentation: Expectations for admission, daily documentation, and discharge documentation are a key component of the teaching hospitalist’s role. Few other teachers will be able to directly observe a student or house officer’s daily work. Setting expectations early in the month will allow you to teach this critical skill and provide meaningful feedback.

One of the realities of practicing as a teaching hospitalist is that learners’ schedules are not always synchronized with the teacher’s schedule. As a result, hospitalists may have limited opportunities to assess and provide feedback. Setting clear and appropriately focused goals at the beginning of the rotation provides more effective assessment.