There are no non-teaching services at Tulane: every patient admitted to one of our three hospitals is provided care by a Tulane resident who is staffed by one teaching attending. There are no private physicians barking orders without explanation to the Tulane residents. This is important, because you cannot really learn medicine without being in the position of making the critical decisions for your patients. And this decision making cannot come by proxy: you only learn the indications and contraindications for an intervention when you are responsible for the outcomes of the decision. This is not to say that Tulane residents do not have supervision, to the contrary….

Most of the teaching services at Tulane are staffed by Teaching Hospitalists. These are individuals who attend on the wards from six to eight months per year, so they become very good in knowing the intracies of the system, and very adept at the art of teaching residents in the context of clinical care. Furthermore, they have no afternoon obligations (e.g., a colonoscopy clinic) that prompt them to rush through morning rounds so that they can get to their clinic. The morning attending rounds are from 10 to 12 noon each day, and they are devoted to education during this time; there is no rush. In addition, they are around in the afternoon to supervise procedures, often times rounding a second time with the senior residents to do advanced level teaching and patient planning. The final benefit is that the hospitalist each staff a discharge follow-up clinic that allows the ward teams to discharge patients without the anxiety of worrying about whether the patient will be ok until their next clinic visit.

For those interested in a career in hospitalist medicine, the extensive hospitalist system provides a great opportunity to work with mentors performing hospitalist-based research: quality improvement, patient-care protocols, and systems improvement projects.