Clinical teaching unit design: a realist systematic review protocol of evidence-based practices for clinical education and health service delivery

Abstract

IntroductionThe clinical teaching unit (CTU) has emerged as a near-ubiquitous model of clinical education across Canadian and international medical schools since it was first proposed over 50 years ago. However, while healthcare has changed dramatically over this period, the CTU model has remained largely unchanged. We thus aimed to systematically review principles of CTU design that contribute to improved outcomes in clinical education and health service delivery.Methods and analysisWe will perform a realist systematic review in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) II protocol for realist reviews. Databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews and Cumulative Index of Nursing and Allied Health Literature (CINAHL), were searched to find primary research articles published from 1993 to 2019 involving CTUs or other teaching wards, and outcomes related to either trainee education or health service delivery. Two reviewers will independently screen studies in a two-stage process. Retrieved titles and/or abstracts of studies will be screened in the first stage, with full texts reviewed in the second stage. Selected articles meeting inclusion criteria will undergo data abstraction using a standardised, pre-piloted form for assessment of study quality and knowledge synthesis.Ethics and disseminationThis review will generate higher quality evidence on the design of CTUs as a model for both clinical education and health service delivery. In addition, further knowledge translation efforts may be necessary to ensure that known best practices in CTU design become common practice.

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

“…In total, we con sidered 2464 studies after removing duplicates; 358 articles underwent fulltext review, of which 262 articles met inclusion criteria. Given the range of clinical specialties represented in included studies (Appendix 1, Section 3, Supplementary Table 1), as determined a priori, 5 we limited data analysis to studies from general internal medicine CTUs to limit contextual variability. Therefore, we included 107 studies in our analysis, which are summarized in Table 1 and described in detail in Appendix 1, Section 3, Supplementary Table 2.…”

“…Two reviewers (B.T., R.S., J.C., K.A.D., K.R.D., S.S.) independently extracted data from each included study using a standardized, prepiloted form. 5 Two reviewers (B.T., R.S., J.C., K.A.D., K.R.D.) independently assessed methodological quality for all studies, using the Medical Education Research Study Quality Instrument (MERSQI) 6 for quantitative studies and the Consolidated Criteria for Reporting Qualitative Research (COREQ) instrument 7 for qualitative studies.…”

Association Between Health System Factors and Utilization of Routine Laboratory Tests in Clinical Teaching Units: a Cohort Analysis

“…medical students and resident physicians) directly involved in patient care under the supervision of an internist acting as the most responsible practitioner (MRP). 21 While some literature has found similar overall costs for resource utilization between teaching and non-teaching units, other studies have suggested slightly higher overall costs associated with teaching hospitals, as well as higher isolated costs for laboratory and radiographic testing within teaching units. 22,23 Conducting our analysis within this setting provides useful insights into factors affecting laboratory test utilization with a degree of external validity within other academic structures similar to CTUs.…”

Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis

“…6 The attending physician serves as the most responsible physician for patient care, while simultaneously teaching learners of various skill levels and leading multidisciplinary teams of health care providers. 7 The attending physicians instruct and act as role models for the future physician workforce. 8 This role requires the execution of professional competence and is vulnerable to several unpredictable contextual factors.…”