Exploring educational ideals, variability, and the attending physician experience on the Internal Medicine Clinical Teaching Unit

Abstract

The Clinical Teaching Unit (CTU) model, in which teams of multilevel learners care for internal medicine inpatients under the supervision of an attending physician, has been a cornerstone of internal medicine training. Despite its longevity, best practices for educational activities on the CTU are unclear. To explore attending physicians’ perspectives on educational ideals for the CTU and barriers to achieving them, and to deepen understanding of current and ideal CTU experiences. An electronic survey was developed and administered to gather opinions from CTU attending physicians in a single large academic program ( n = 92) in March 2023. The survey was designed to maximize written responses by providing prompts throughout and space for open-ended narratives. Questions pertained to attending physicians’ practices on CTUs and their perspectives on ideal states. Responses were analyzed thematically using an inductive, iterative coding process involving multiple investigators. The response rate was 87% (80/92). Quantitative responses were analyzed using descriptive statistics. A total of 792 free-text answers were collected, comprising 17,243 words. Four major themes were identified: perceptions of ideal educational practice at the CTU; drivers of variability in educational practices and preferences; reflections on the CTU attending experience; and navigating evolving residency culture and expectations. A recurring theme was concern that the essential role of clinical experience in preparing for independent practice may not be fully recognized. The findings underscore the need to align educational goals with clinical demands while supporting sustainable attending physician practices and may inform best practices for CTU-based education grounded in current clinical realities.