DOI: 10.3138/cjgim.2025.0052 ISSN: 2369-1778

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

Lindsay Melvin, Moira K Kapral, Zac Feilchenfeld, Lynfa Stroud, Shiphra Ginsburg

Abstract

Background:

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.

Objective:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

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