Rethinking the clinical teaching unit model in Canada: Lessons from Hamilton

Since the 1960s, the Clinical Teaching Unit (CTU) has been the foundation of internal medicine education in Canada, balancing clinical service with graded learner autonomy. Over the past two decades this traditional model has been strained by several factors. These include increasing patient complexity, higher capacity pressures, pressure to shorten hospital stays, and the implementation of Competency-Based Medical Education (CBME). The declining resident availability on CTU and rising service demands have prompted the need for structural re-evaluation. This article examines the evolution of the CTU in Hamilton, Ontario, focusing on the reorganization of inpatient General Internal Medicine services at the Juravinski Hospital. We adopted a hybrid model that transitioned the Juravinski hospital to a largely resident independent hospitalist service while preserving focused academic teaching teams with capped patient volumes. This approach emphasized senior resident preceptor style supervision and direct observation which aligned with CBME principles, while maintaining hospital efficiency. Although challenges remain, the Hamilton experiment demonstrates how adaptive, resident independent and preceptor-based models can preserve educational quality while meeting hospital demands. This offers important lessons for reimagining future roles of CTU's across Canada.