ABSTRACT
Objective(s)
To evaluate the consult and emergency care experience of Otolaryngology—Head and Neck Surgery (OHNS) trainees with a hospitalist faculty model.
Methods
An anonymous survey was distributed to OHNS residents across institutions with hospitalist models. Each respondent reported trainee and institutional details and completed a 12‐item five‐point Likert‐scale questionnaire rating resident experiences working with (1) faculty hospitalist and (2) rotating on‐call coverage models across three domains: educational features, workflow efficiency, and global experience. Subgroup analyses were conducted stratifying by training level (junior vs. senior) and degree of hospitalist experience (≥ 60% vs. < 60%).
Results
Among 50 respondents (response rate 39.7%), the hospitalist model demonstrated superior performance across all domains. More respondents reported favorable education‐to‐service ratios with hospitalist supervision (58.0%) versus rotating coverage (14.0%, p < 0.001). The hospitalist model had higher ratings for quality of clinical instruction (mean difference = 0.58, p < 0.001), surgical instruction (0.37, p = 0.035), and managing emergencies (0.45, p < 0.001). Notably, 64.0% of residents reported rarely or never feeling rushed in the OR with hospitalist supervision, compared to 36.0% with rotating coverage (p < 0.001). Workflow advantages of the hospitalist model included improved procedural timeliness (p = 0.022), handoff efficiency (p = 0.002), and treatment plan clarity (p < 0.001). Training level did not significantly modulate responses. Residents with more hospitalist experience (≥ 60%) reported significantly greater advantages in clinical instruction (p = 0.026) and surgical teaching (p = 0.008) compared to those with less experience.
Conclusion
The hospitalist model provides educational advantages and operational efficiency. These findings support the curricular and systemic value of a hospitalist role in enhancing overall satisfaction and potentially mitigating trainee burnout.
Level of Evidence
N/A.
Keywords: consult service, hospitalist, surgical education
The flagship consult service is both clinically active and a formative clinical rotation for residents. Fifty trainees from over four institutions who participated in both a hospitalist faculty model and rotating coverage for the consult service were surveyed about the quality of their educational experience and workflow efficiency. Trainees reported significantly better global experiences, instruction, clarity of plans, and timeliness of surgeries with the hospitalist model compared to the rotating model.
1. Introduction
The hospitalist role emerged in internal medicine in the mid‐1990s to address growing inpatient demands while improving efficiency and quality of care [1]. This paradigm of a dedicated inpatient consultant has since expanded to surgical specialties, which face unique challenges balancing concurrent outpatient clinics, operating room commitments, and urgent inpatient consultations [2, 3]. The hospitalist model in Otolaryngology—Head and Neck Surgery (OHNS) was pioneered at the University of California—San Francisco (UCSF) in 2007, establishing a dedicated inpatient attending role for complex, comprehensive OHNS services and emergencies at a quaternary academic medical center [4].
Since that time, studies from various institutions have demonstrated that the OHNS hospitalist role improves the rate of captured billable encounters and procedures, streamlines evaluations, and reduces delays in procedures such as tracheostomies [5, 6, 7, 8]. This role complements surges in OHNS consultations, which have been reported even prior to the COVID‐19 pandemic, with growth rates of 120%–144% over 4–5 year time frames [9, 10]. Beyond financial productivity and quality of care, other advantages of the hospitalist model have been reported, including improved continuity of care, enhanced interdepartmental collaboration, and a more enriching educational experience for trainees [6, 8, 11].
Despite these reported benefits, many institutions continue with a rotating on‐call coverage model in which coverage is shared across a practice and providers often juggle outpatient and operative duties while on call. An alternate hybrid “chief‐of‐service” approach has also evolved in which consult duties are overseen with rotating coverage in the absence of concurrent outpatient clinic or operative duties [12]. At our own institution, some of these models are employed to manage consultative work at our affiliate hospitals, while staffing of the main consult hospitalist role has evolved to now comprise three attendings with subspecialty expertise: Rhinology expertise on Monday and Wednesday, Otology expertise on Tuesday, and Laryngology expertise on Thursday–Friday.
The consult experience is distinctly positioned at the intersection of several critical training priorities: it provides an early and primary educational setting for core competencies such as airway management and upper aerodigestive emergencies [13]. The rotation is also associated with a high‐intensity workload that may contribute to significant burnout rates among OHNS trainees [14]. Despite the formative impact of the consult service on a trainee, rigorous evaluation of the educational impact of the hospitalist model remains a gap in the literature. Recent transitions to hospitalist paradigms and fluctuations in hospitalist staffing within our study cohort provide an opportunity to assess the experience of residents who have experienced different models.
Prior experience at Louisiana State University (LSU) showed that increased faculty availability for rounds, staffing, and procedures improved the frequency and quality of teaching, per the authors [8]. In internal medicine, the hospitalist model has been shown to positively impact trainee experiences, including one review of six cohort studies in which trainees within hospitalist systems generally reported greater satisfaction, teaching effectiveness, and autonomy compared to trainees in non‐hospitalist systems [15].
Despite anecdotal reports of educational benefit from the hospitalist role in OHNS, quantitative assessments are lacking. Our aim is to evaluate the impact of the hospitalist model on the experience of residents from an educational, logistical, and global perspective. We hypothesized that residents who have experienced both a hospitalist and rotating on‐call attending coverage of their main inpatient consult rotation would find the hospitalist system conducive to clinical instruction, beneficial for coordination of care, and improve the education‐to‐service ratio.
2. Methods
2.1. Study Design
This multi‐institutional, cross‐sectional study was deemed exempt by the UCSF Institutional Review Board. The study was developed in collaboration with a national OHNS hospitalist consortium that convenes monthly online, including faculty from UCSF, Emory, LSU, and the University of California—Los Angeles (UCLA). Institutional partners participated in the development, pilot testing, and distribution of the survey, which was anonymously distributed to OHNS residents via email during a 2‐month enrollment period (April 30, 2025—June 30, 2025). Inclusion criteria included current OHNS residents at participating institutions with hospitalist consult coverage; no exclusion criteria were applied based on training level or proportion of hospitalist exposure.
2.2. Survey Questionnaire
The survey was securely administered through Qualtrics (Provo, UT), and respondents were informed that the questionnaire was part of an ongoing study. Trainee details were captured, including the respondents' institution, current year in residency represented by postgraduate year (PGY), the volume of consult experience by clinical year, and the distribution of consult experience between hospitalist and rotating coverage. Respondents then proceeded to answer 12 questionnaire items.
Educational quality assessments utilized five‐point Likert scales across three primary domains: global educational experience (overall satisfaction, educational value), clinical instruction quality (regarding medical management, management of emergencies, surgical technique, sense of feeling rushed during procedures), and operational efficiency (timeliness of interventions, timely staffing of high‐acuity consults, timely staffing of low‐acuity consults, ease of staffing consults, efficiency of hand‐offs, care coordination). The 12‐item instrument appears in Table S1. Participants were instructed to grade each of the items in reference to their experience on (1) a designated hospitalist system and (2) a rotating coverage system. Responses were excluded if less than 80% of the survey questions were answered.
2.3. Statistical Analysis
Data responses were exported using Microsoft Excel and analyzed using Rstudio [16] (v2025.09.0 + 387) and R [17] (v4.5.1) for summary statistics, visualizations, and statistical analyses. Median and interquartile range (IQR) were computed. Wilcoxon signed‐rank tests were used to assess paired differences between coverage models. Statistical significance was set at a p value of 0.05. Subgroup analyses stratified residents by training level (junior: PGY 1–3; senior: PGY 4–5) and hospitalist proportionality (≥ 60% vs. < 60% hospitalist experience), using Wilcoxon rank‐sum tests and difference‐in‐differences approaches. The 60% threshold was chosen because it approximated the cohort median.
3. Results
3.1. Cohort Overview
In total, 50 residents completed the survey, yielding an estimated response rate of 39.7% (n = 50/126). The cohort comprised 16 trainees from UCSF, 13 from LSU, 10 from Emory, 8 from UCLA, and 3 from other institutions (Table 1). The cohort included representatives from all PGY levels: PGY‐1 (n = 4, 8.0%), PGY‐2 (n = 10, 20.0%), PGY‐3 (n = 14, 28.0%), PGY‐4 (n = 10, 20.0%), and PGY‐5 (n = 12, 24.0%). The respondents had more experience with the hospitalist service, with a median of 70% (IQR: 20%–80%), as shown in Figure 1. A majority of respondents reported that the bulk of their consult experience occurred in PGY2 (n = 34, 68.0%), followed by PGY1 (n = 15, 30.0%).
TABLE 1.
Characteristics of study cohort.
| Characteristic | N (%) |
|---|---|
| Year in training | |
| PGY1 | 4 (8%) |
| PGY2 | 10 (20%) |
| PGY3 | 14 (28%) |
| PGY4 | 10 (20%) |
| PGY5 | 12 (24%) |
| Home institution | |
| University of California—San Francisco | 16 (32%) |
| Louisiana State University | 13 (26%) |
| Emory University | 10 (20%) |
| University of California—Los Angeles | 8 (16%) |
| Other | 3 (6%) |
FIGURE 1.
Distribution of hospitalist model. Histogram of responses by trainee reflecting the proportion of consult rotation experience with a hospitalist attending model as opposed to a rotating model. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]
Survey completion was high with 43 of 50 (86.0%) respondents completing all survey items. At most two question responses were empty among the seven respondents with missing data.
3.2. Overall Educational Experience and Service‐Education Balance
The hospitalist system was associated with a more favorable ratio of education to service (Figure 2A). Most respondents characterized the hospitalist system as providing more education than service (58.0% vs. 14.0%, p < 0.001, respectively). Respondents were asked if their consult rotation was a positive educational experience (Figure 2B), with almost twice as many trainees strongly agreeing with the hospitalist system compared to the rotating system (58.0% vs. 30.0%, respectively, p < 0.001).
FIGURE 2.
Perception of hospitalist and rotating coverage experiences across (A) overall education‐to‐service balance and (B) positive educational experience. There are significantly better trainee experiences in the hospitalist model compared to the rotating coverage model across global experiences. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]
3.3. Comparative Outcomes in Instruction and Workflow
Statistically significant differences were also observed across instructional and workflow‐related questions, as shown in Table 2. Respondents reported better instruction for medical management (mean difference: 0.58, W = 1724, p < 0.001, Figure 3A), managing emergencies (mean difference = 0.45, W = 1624, p < 0.001), and surgical instruction (mean difference = 0.37, W = 1504, p = 0.035, Figure 3B). Additionally, nearly two‐thirds of respondents reported that they were never or rarely rushed in the OR in the hospitalist system (n = 32, 64.0%) compared to about a third in the rotating system (n = 18, 36.0%), a difference that was statistically significant (mean difference = −0.70, W = 654, p < 0.001, Figure 3C).
TABLE 2.
Comparison of hospitalist versus rotating coverage experience in OHNS trainees.
| Survey question | Mean rank (H) | Mean rank (R) | Difference (H − R) | W | p |
|---|---|---|---|---|---|
| Global experience | |||||
| Education‐to‐service balance | 3.70 | 2.46 | 1.240 | 1965 | < 0.001* |
| Surgical rush/pressure | 2.06 | 2.77 | −0.702 | 654 | < 0.001* |
| Positive experience | 4.52 | 4.04 | 0.480 | 1649 | 0.002* |
| Educational value | |||||
| Clinical medical knowledge | 4.52 | 3.94 | 0.580 | 1724 | < 0.001* |
| Clinical emergency skills | 4.43 | 3.98 | 0.449 | 1624 | 0.001* |
| Surgical technical skills | 4.35 | 3.98 | 0.367 | 1504 | 0.035* |
| Efficiency of workflow | |||||
| Development of clear treatment plans | 4.54 | 4.04 | 0.500 | 1688 | < 0.001* |
| Timeliness of staffing high acuity cases | 4.70 | 4.56 | 0.140 | 1460 | 0.072 |
| Timeliness of staffing low acuity cases | 4.56 | 3.80 | 0.760 | 1819 | < 0.001* |
| Timeliness of surgeries/procedures | 4.36 | 4.04 | 0.320 | 1549 | 0.022* |
| Continuity of care post‐admission | 4.04 | 3.94 | 0.100 | 1391 | 0.305 |
| Hand‐off communication | 4.56 | 4.08 | 0.479 | 1530 | 0.002* |
Note: Higher mean ranks indicate more favorable responses.
Abbreviations: H = hospitalist experience; R = rotating experience; W = Wilcoxon test statistic.
p < 0.05 determines significance.
FIGURE 3.
Perception of hospitalist and rotating coverage experiences across educational experiences in (A) gaining medical knowledge, (B) surgical instruction, and (C) feeling rushed in the operating room. There are significantly better trainee experiences in the hospitalist model than in the rotating‐coverage model across all parameters. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]
Workflow‐related features were also examined. Trainees reported that the hospitalist model was significantly advantageous in the timeliness of procedures (mean difference = 0.32, W = 1549, p = 0.022), efficient handoffs (mean difference = 0.48, W = 1530, p = 0.002), and clearer treatment plans (mean difference = 0.50, W = 1688, p < 0.001) (Table 2). Statistically significant differences were observed in the timeliness of staffing of low acuity consults (mean difference = 0.76, W = 1819, p < 0.001) but not high‐acuity consults (mean difference = 0.14, W = 1460, p = 0.072). Coordination of post‐admission follow‐up was not significantly different between the two models (mean difference = 0.10, W = 1391, p = 0.305).
3.4. Sub‐Analysis by Resident Seniority
Residents were grouped between junior (PGY 1–3, n = 28, 56.0%) and senior (PGY 4–5; n = 22, 44.0%) levels. Differences between ratings in the hospitalist and rotating models were calculated. Wilcoxon rank sum testing did not demonstrate any significant differences between junior and senior distributions across any survey items, including efficiency, global experience, and positive educational experience (Figure S1).
3.5. Sub‐Analysis by Proportional Hospitalist Experience
Respondents were also stratified by the proportion of their experience with the hospitalist paradigm as high (≥ 60% hospitalists) versus low (< 60%). Trainees with a high proportion of hospitalist experience reported more favorable experiences with the hospitalist system across clinical instruction (high: 0.862 vs. −0.222, W = 162, p = 0.026), surgical instruction (high: 0.793, low: −0.263, W = 155, p = 0.008), and timely staffing of high acuity cases (high: 0.300, low: −0.167, W = 188, p = 0.037) as seen in Figure S2.
4. Discussion
Our study provides valuable insights into the benefit of the trainee experience in the consult hospitalist system. Our cohort comprised 50 respondents from multiple institutions that have adopted the hospitalist consult model. Residents working within the hospitalist model report improvement in the educational experience and workflow efficiency. Specifically, the hospitalist system was associated with a significantly more positive educational experience (p = 0.002) and a better education‐to‐service ratio (p < 0.001) with more than twice as many respondents describing a favorable education‐to‐service impression in the hospitalist system (n = 29, 58.0%) compared to the rotating system (n = 7, 14.0%). This highlights the impact this model can have on surgical training and the resident experience.
In other specialties, the hospitalist model has been shown to improve trainee education and efficiency. A study in a vascular surgery program reported that among 24 trainees, 57% reported dramatic improvements in resident education. Additionally, the study demonstrated that 75% reported improved timeliness of patient care and 83% reported increased resource utilization [3]. Another study in vascular surgery demonstrated that indicators of burnout improved in both trainees and faculty after the implementation of a hospitalist model [18]. A survey of Emergency Department (ED) physicians after a UCSF implementation of an acute surgical hospitalist reported improvements in timeliness of care as well as supervision of surgical residents [2].
Our study is limited by its small cohort size, inherent biases in subject‐reported measures, its retrospective nature, and potential confounding factors, including the nature of faculty who choose to work as hospitalists and possible variations in hospital settings. The relatively favorable educational experience reported by residents working with a hospitalist may be influenced by factors other than the presence of a hospitalist paradigm. It is possible that the hospitalists in this relatively small cohort represent Otolaryngologists who prioritize teaching, and these personal characteristics impact the resident educational experience independent of the hospitalist structure. Additionally, residents work in multiple hospital settings, and their impression of the consultative role may be influenced by differences in the hospital environment independent of the hospitalist paradigm. We attempted to mitigate this potential confounding factor by instructing residents to limit their responses to their consultative experience at the main/flagship hospital in their system.
Hospitalist systems may vary by institution, with some hospitalists dedicating 100% of their clinical time to this role, while others implement a “job‐share” approach to the hospitalist role, with faculty dedicating one or more days. Additionally, differences exist in the subspecialty training of hospitalist faculty across our cohort. The favorable results across these heterogeneous approaches suggest that departments may be able to customize the hospitalist role to meet institutional needs while maintaining the beneficial educational experience.
5. Conclusion
Otolaryngology residents working in a hospitalist paradigm report a favorable educational experience relative to working with rotating faculty coverage of the consultative service. Benefits described include improved service/education balance and workflow efficiencies. This added value should be considered as institutions evaluate implementation of an otolaryngology hospitalist paradigm.
Funding
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Table S1: List of survey questions and responses based on Likert‐scale ratings.
Figure S1: Distributions of hospitalist and rotating coverage experiences with differences between junior and senior residents across: (A) overall education‐to‐service balance, (B) overall educational experience, and (C) quality of instruction of emergent clinical skills. Differences in hospitalist and rotating model scores were calculated between junior and senior residents, with positive values favoring hospitalist experience. There were no significant differences.
Figure S2: Distributions of hospitalist and rotating coverage experiences with differences in between those with more hospitalist (≥ 60%) versus more rotating coverage experience across: (A) clinical instruction, (B) surgical instruction, and (C) timeliness of staffing high acuity cases. Differences in hospitalist and rotating model scores were calculated between those with more or less hospitalist experience, with positive values favoring the hospitalist experience.
Acknowledgments
The authors would like to thank Matthew Russell, MD (instructor in Otolaryngology—Head and Neck Surgery, Harvard Medical School; Physician and Surgeon, Mass Eye and Ear), Richard Goldman, MD (associate professor, Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University), and Christopher Rassekh, MD (professor, Department of Otorhinolaryngology—Head and Neck Surgery, University of Pennsylvania).
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1: List of survey questions and responses based on Likert‐scale ratings.
Figure S1: Distributions of hospitalist and rotating coverage experiences with differences between junior and senior residents across: (A) overall education‐to‐service balance, (B) overall educational experience, and (C) quality of instruction of emergent clinical skills. Differences in hospitalist and rotating model scores were calculated between junior and senior residents, with positive values favoring hospitalist experience. There were no significant differences.
Figure S2: Distributions of hospitalist and rotating coverage experiences with differences in between those with more hospitalist (≥ 60%) versus more rotating coverage experience across: (A) clinical instruction, (B) surgical instruction, and (C) timeliness of staffing high acuity cases. Differences in hospitalist and rotating model scores were calculated between those with more or less hospitalist experience, with positive values favoring the hospitalist experience.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.