Capsule Commentary on Ratcliffe et al., “Service and Education: the Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services”
J Gen Intern Med
Capsule Commentary on Ratcliffe et al., BService and Education: the Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services^
Tyler J. Albert 0 1 2
0 Hospital & Specialty Medicine, VA Puget Sound Healthcare System, Division of General Internal Medicine, Department of Medicine, University of
1 Washington , Seattle, WA , USA
2 Compliance with Ethical Standards:
his study by Ratcliffe et al1 explores the relationship
between clinical workload, patient characteristics, and
educational outcomes through direct observation of medicine
teams at teaching hospitals. The authors found only modest
associations between team workload and teaching time.
Surprisingly, there was a direct positive correlation between
increased patient complexity and higher workloads leading to
more time for teaching a broader variety of educational topics.
Teaching was largely unscripted and dynamic yet closely
followed the ABIM blueprint for core internal medicine
content. Interestingly, the authors found increased educational
time for unanticipated patient complications that was
accompanied by a reciprocal negative educational effect for other
patients on the team.
This study contributes to the literature on factors associated
with teaching during rounds. Data on bedside rounding could
certainly have strengthened this contribution with quantitative
and qualitative information on this important educational tool
that is declining in practice.2 One can surmise that
unanticipated patient complications led to more bedside interactions
between the patient and medical team, thus explaining the
increased educational experiences associated with these
As the authors mention, this study may temper concerns
that increasing clinical demands have negative effects on
teaching during attending rounds. It is encouraging that
general medicine wards remain comprehensive teaching venues
for core internal medicine content. However, the percentage of
rounds actually spent on educational activities continues to
dwindle in comparison to prior eras,3 which should only serve
to bolster our efforts to return to the bedside.4,5
Conflict of Interest: The author has no conflicts of interest with this
1. Ratcliffe TA , Crabtree MA , Palmer RF , Pugh JA , Lanham HJ , Leykum LK . Service and education: the association between workload, patient complexity, and teaching on internal medicine inpatient services . J Gen Intern Med . https://doi.org/10.1007/s11606-017-4302-9.
2. Crumlish CM , Yialamas MA , McMahon GT . Quantification of bedside teaching by an academic hospitalist group . J Hosp Med . 2009 ; 4 ( 5 ): 304 - 7 .
3. Priest JR , Bereknyei S , Hooper K , Braddock CH 3rd. Relationships of the location and content of rounds to specialty, institution, patient-census and team size . PLoS One . 2010 ; 5 ( 6 ): e11246 .
4. Gonzalo JD , Chuang CH , Huang G , Smith C. The return of bedside rounds: an educational intervention . J Gen Intern Med . 2010 ; 25 ( 8 ): 792 - 8 .
5. McGee S. A piece of my mind. Bedside teaching rounds reconsidered . JAMA . 2014 ; 311 ( 19 ): 1971 - 2 .