• CMAJ · Feb 2022

    A systematic review of evidence-based practices for clinical education and health care delivery in the clinical teaching unit.

    • Brandon Tang, Ryan Sandarage, Jocelyn Chai, Kristin Anne Dawson, Katrina Rose Dutkiewicz, Stephan Saad, Vanessa Kitchin, Rose Hatala, Iain McCormick, and Barry Kassen.
    • Department of Medicine (Tang, Hatala); Faculty of Medicine (Sandarage, Chai, Dawson); Divisions of General Internal Medicine (Dutkiewicz, McCormick, Kassen), Infectious Diseases (Saad) and Community Internal Medicine (Kassen); Vancouver Fraser Medical Program and Woodward Library (Kitchin); University of British Columbia, Vancouver, BC bran.tang@mail.utoronto.ca.
    • CMAJ. 2022 Feb 14; 194 (6): E186-E194.

    BackgroundThe clinical teaching unit is a widespread clinical training model that requires reform to prepare physicians for practice in the 21st century. In this systematic review, we aimed to identify evidence-based practices in internal medicine clinical teaching units that contribute to improved clinical education and health care delivery.MethodsWe searched several databases from 1993 until Apr. 5, 2021, to identify published studies in inpatient clinical teaching units that involved medical trainees and reported outcomes related to trainee education or health care delivery. We identified emergent themes using a narrative approach and determined confidence in review findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) methodology.ResultsWe included 107 studies of internal medicine clinical teaching units, of which 93 (87%) were conducted in North America. Surveys (n = 31, 29%), trials (n = 17, 16%) and narrative studies (n = 15, 14%) were the most prevalent study designs. Practices identified as contributing to improved clinical education or health care delivery included purposeful rounding (high confidence), bedside rounding (moderate confidence), resource stewardship interventions (high confidence), interprofessional rounds (moderate confidence), geographic wards (moderate confidence), allocating more trainee time to patient care or educational activities (moderate confidence), "drip" continuous models of admission (moderate confidence), limiting duty hours (moderate confidence) and limiting clinical workload (moderate confidence).InterpretationIn this review, we identified several evidence-based practices that may contribute to improved educational and health care outcomes in clinical teaching unit settings. These findings may offer guidance for policies, resource allocation and staffing of teaching hospitals.© 2022 CMA Impact Inc. or its licensors.

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