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The Past and Future of Inpatient Education

February 25, 2024
by Mark David Siegel

Hi everyone,

¡Hola desde México! I’ve stepped away from the rank list for a few days to visit Mexico City and Puebla and consume tacos, mueganos, and mole poblano. Before we leave for breakfast, I want to address a hot topic in our residency: the past and future of inpatient education.

Before I became Program Director, the Chiefs led three daily Morning Reports, one at the VA and two at YNHH. Work rounds paused at 9:30A, and all residents came, even those in the MICU. Cases were live, often chosen the day before, and discussions were spontaneous and unpredictable. Slides were rarely used; instead, a resident “scribed” details on a white board, which was also used to explain complex concepts like mixed acid-base disturbances. Report was for residents only, except on Fridays, when we held Intern Report. On other days, interns stayed on the floors, calling consults, entering orders, and writing notes. At 11AM, the firms held attending rounds, and at noon, we had faculty-led didactics and peer teaching.

Over time, the system changed, sometimes for the better, sometimes not. Growing clinical demands kept ICU teams away from Report, and eventually, the South, West, and North Pavilion teams stopped coming too. Live cases were gradually replaced by curated PowerPoints, which highlighted great cases that residents worked on for weeks. The teaching was strong, and interns on East Pavilion teams started coming, while residents on other floors began asking if we could move the time of Report so they wouldn’t miss out.

In early 2020, all didactics were shut down to avoid spreading COVID. Eventually, conferences returned on Zoom, but they lacked the energy of in-person teaching. When intern recruitment became virtual, we moved Report to noon to accommodate candidates on the West Coast. The new time slot allowed more residents to attend, but we had to move noon didactics to 3PM, which killed the conference because virtually no one came.

These days, inpatient education has evolved into an array of mostly in-person sessions. We have an 8:30AM conference, featuring skill building and journal club. Most firms hold teaching rounds several times per week. At noon, we have case discussions, peer teaching, faculty lectures, Program Director’s meetings, Jeopardy!, and other assorted offerings.

But many of you have identified a problem: our teaching lacks a guiding strategy and several questions need to be answered. What topics should we cover, and what format should we use? How do we educate residents on night shifts? How can we expose more residents to our world-renowned faculty, including experts from other departments? How can we incorporate more POCUS and simulation sessions?

The resident-led Education Committee is currently soliciting input and considering our options. I have few pre-conceived notions about the direction to take beyond believing that the best learning happens in-person, when residents actively participate, and when topics are case-based, relevant, and practical. Our didactics are already great, but the time has come to make them consistently spectacular.

On that note, I’m off to enjoy one last day in Mexico City. Tonight, I hope to certify the rank list, and tomorrow morning, we’ll be flying home.

Take care and see you soon,


Submitted by Mark David Siegel on February 25, 2024