The impact of oncology hospitalist utilization on resident education.

Abstract

11034 Background: In multiple U.S. cancer centers, dedicated hospitalists provide inpatient care to admitted patients as medical oncologists focus increasingly on outpatient care. Hospitalist integration is most common in medical oncology. Despite increasing prevalence of this model, little is known about the impact of oncology hospitalists on medical education. Methods: Beginning 6/26/21, an oncology hospitalist service was established at Yale-New Haven Hospital’s Smilow Cancer Center. In the first year of the program, the Hospitalist Service (HS) provided a dedicated oncology hospitalist as the attending of record on one of two inpatient teaching services. The hospitalist was supported by a consulting medical oncologist. The traditional service (TS), led by a rotating board-certified medical oncologist, remained unchanged. The study interval was the first 11 months of the program, 6/26/21-5/28/22. Residents were randomly assigned to either the HS or TS. A two-week period in January was excluded due to hospitalist redeployment during the COVID-19 Omicron surge. At the conclusion of the study, a survey was distributed to residents to evaluate the educational experience on TS and HS. Questions using five-point Likert scales were used to elicit information on the quality and content of formal teaching, goals of care discussions and mentorship. The Yale University IRB considered this study to be Quality Improvement and required no further action. The Mann-Whitney U test was used to assess for differences between the two groups with a p-value of < 0.05 indicating statistical significance. Results: Out of 84 eligible residents, 36 (43%) responded including 19 interns (53%), 11 second years (31%) and 6 third years (17%). There were 15 responses (42%) following an HS rotation and 18 following a TS rotation (50%). Three individuals (8%) did not complete the entire survey and were excluded. All residents rotating on HS reported that their attending was easily accessible by phone compared with only 69% of those on TS (p = 0.11). Sixty-nine percent of residents on HS compared to 73% on TS noted having adequate opportunities to lead GOC discussions (p = 0.87). Fifty-four percent of residents on HS felt they had sufficient support during family meetings compared to 69% on TS (p = 0.98). Compared with only 8% on HS, 22% of residents on TS felt there were sufficient opportunities for oncology-specific professional mentorship (p = 0.64). Satisfaction with the amount of informal teaching did not differ significantly between the teams (p = 0.62). Altogether, 87% of residents reported that the total amount of teaching led to insufficient time for patient care. Conclusions: This survey suggests hospitalists provide greater accessibility at the cost of decreased specialty-specific mentorship in oncology. Further work is needed to better understand challenges and opportunities surrounding oncology hospitalist integration in academic medicine.