title: A controlled investigation of optimal internal medicine ward team structure at a teaching hospital.
abstract: BACKGROUND
  The optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents.
  
  
  METHODS
  Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff∶attending ratio of 5:1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3:1 and 2:1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared.
  
  
  RESULTS
  Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams.
  
  
  CONCLUSIONS
  Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes.
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California, United States of America. bspellberg@labiomed.org
authors.forename: Brad
authors.initials: B
authors.lastname: Spellberg
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Lewis
authors.forename: Darryl
authors.initials: D
authors.lastname: Sue
authors.forename: Bahman
authors.initials: B
authors.lastname: Chavoshan
authors.forename: Janine
authors.initials: J
authors.lastname: Vintch
authors.forename: Mark
authors.initials: M
authors.lastname: Munekata
authors.forename: Caroline
authors.initials: C
authors.lastname: Kim
authors.forename: Charles
authors.initials: C
authors.lastname: Lanks
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.forename: William
authors.initials: W
authors.lastname: Stringer
authors.forename: Darrell
authors.initials: D
authors.lastname: Harrington
mesh_terms: D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000458:organization & administration; D007396:Internship and Residency / Q000458:organization & administration*; D015141:Los Angeles; D008505:Medical Staff, Hospital / Q000193:education* / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*