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

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.