RT Journal Article
SR Electronic
T1 A systematic review of evidence-based practices for clinical education and health care delivery in the clinical teaching unit
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E186
OP E194
DO 10.1503/cmaj.202400
VO 194
IS 6
A1 Tang, Brandon
A1 Sandarage, Ryan
A1 Chai, Jocelyn
A1 Dawson, Kristin Anne
A1 Dutkiewicz, Katrina Rose
A1 Saad, Stephan
A1 Kitchin, Vanessa
A1 Hatala, Rose
A1 McCormick, Iain
A1 Kassen, Barry
YR 2022
UL http://www.cmaj.ca/content/194/6/E186.abstract
AB Background: The 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.Methods: We 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.Results: We 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).Interpretation: In 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.