Over the past several decades, hospitalized patients have become increasingly complex, often with multisystem needs. In response, hospital teams now rely heavily on subspecialty consultants and interprofessional colleagues. While this has improved care delivery, fragmentation of responsibilities has changed the clinical learning environment, and graduate medical education has suffered.
By the mid-2020s, collaborative models of care made it unclear who was responsible for teaching and evaluating residents. Subspecialty consultation—particularly e-consults—were common, but residents and fellows rarely met face-to-face, forfeiting opportunities for workplace learning. Isolation and anonymity overtook any sense of community in the hospital, and rates of burnout soared. Moreover, asynchronous siloed work patterns led to misunderstandings and conflicting recommendations from different teams.
Recognizing the potential for the built environment to impact work patterns and workplace learning, we assessed whether colocating medicine subspecialty fellows in a shared workspace near the medicine resident workroom could increase face-to-face interactions during subspecialty consultation. We hypothesized this would have benefits for communication, teaching, and burnout.
Schematic of Old and New Hospital Buildings on Campus
Note: Panel A depicts the original distribution of fellow workspaces across 3 buildings in 2020; Panel B shows the colocated resident and fellow workspaces on the 7th floor of the new inpatient hospital building, opened in 2030.
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