Ateaching hospital oruniversity hospital is ahospital or medical center that providesmedical education and training to future and currenthealth professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located withmedical schools.[1][2][3]
Teaching hospitals use aresidency program to educate qualified physicians,podiatrists,dentists, andpharmacists who are receiving training after attaining the degree ofMD,DO,DPM,DDS, DMD,PharmD,BDS,BDent,MBBS, MBChB, or BMed.[4][5][6][7][8] Those that attend a teaching hospital or clinic practicemedicine under the direct or indirect supervision of a senior medical clinician registered in that specialty, such as anattending physician orconsultant. The purpose of these residency programs is to create an environment where new doctors can learn to practice medicine in a safe setting which is supervised by physicians that provide both oversight and education.
The first teaching hospital where students were authorized to methodically practice on patients under the supervision of physicians was reportedly theAcademy of Gundishapur in thePersian Empire during theSassanid era.[9] Some of the earliest teaching hospitals were the IslamicBimaristans, which included the Al-Adudi Hospital founded in Baghdad in 981 and the Al-Fustat Hospital in Cairo founded in 872.[10]
The following definitions are commonly used in connection with teaching hospitals:[11]
Medical student — A person enrolled in a medical degree program at amedical school. In the graduate medical education model used in the United States, medical students must first complete an undergraduate degree from a university or college before being accepted to a medical school. In the undergraduate model traditionally used in countries such as the United Kingdom or Australia, medicine is an undergraduate university degree which students directly enter from high school. In more recent years, the graduate model has increasingly been adopted in the UK and Australia as well, without entirely displacing the traditional undergraduate model – both graduate entry and undergraduate entry programs coexist. (Historically, the undergraduate model used to exist in the US as well, but had been abandoned by the mid-19th century.)
Physician assistant — Medical professionals who have completed training at the master's level. They are trained to practice medicine alongside physicians on a population level allowing them to work in a wide range of specialties.[12] This profession is not traditionally found in most countries outside North America, but in recent years there have been attempts to establish it in some of them, with mixed success.
Intern — A person that has a doctorate of medicine from a graduate medical school, or a Bachelor of Medicine/Bachelor of Surgery (in the British undergraduate model), that only practices with guidance and supervision of a physician/consultant.
Residency or post-graduate program — In the US and Canada, individuals that have completed their first year of a medical internship. Residencies may last anywhere from two to seven years, depending on the specialty. In most Commonwealth countries, the role of specialist registrar is roughly equivalent
Specialist registrar — In the British system, a doctor who is receiving advanced training in a medical specialty in a hospital setting; after four to six years as a specialist registrar, the doctor may then undertake a post-training fellowship, before becoming a consultant.
Attending physician — In the US and Canada, an attending physician (also known as an attending, rendering doc, or staff physician) is aphysician (M.D. orD.O.) who has completedresidency and practicesmedicine in aclinic orhospital, in the specialty learned during residency. An attending physician typically supervisesfellows,residents,medical students, and other practitioners. Attending physicians may also maintain professorships at an affiliated medical school.
Consultant — The equivalent concept to "attending physician" in most Commonwealth countries (except for Canada).
Grand rounds — A methodology ofmedical education and inpatient care, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, pharmacists,residents, and medical students. It was first conceived by clinicians as a way for junior colleagues to round on patients.[14]
Teaching clinic — A teaching clinic is anoutpatient clinic that provides health care for ambulatory patients, as opposed toinpatients, treated in a hospital. Teaching clinics traditionally are operated by educational facilities and provide free or low-cost services to patients.[15]
Nurse education — Some teaching hospitals partner with nursing education institutions to provide in-hospital, practical education for nurses, both graduate and undergraduate.[1]
Many teaching hospitals andmedical centers are known for the medical research that is performed in their hospitals. Close association with medical colleges and universities enhances the research programs at teaching hospitals. Some of the more notable teaching hospitals include:[16]
The AlgerianMinistry of Health, Population and Hospital Reform maintains 15 public university teaching hospital centres (French:Centre Hospitalo-Universitaire orCHU) with 13,755 beds and one public university hospital (EHU) with 773 beds.[17]
Aga Khan University Hospital (Aga Khan Hospital and Medical College)[19] is a 721-bed teaching hospital that trains doctors and hospital administrators with support from American and Canadian universities. The hospital also coordinates a network of over 100 health care units primarily in rural or remote areas.[19]
In France, teaching hospitals are called "CHU" (Centre hospitalier universitaire). They are regional hospitals with an agreement with one or several universities. Some of the medical staff are both medical practitioners and teachers under the multiple-institution agreement, and receive dual compensation.
There is at least one per French administrative region. In the city of Paris and its suburbs, theGreater Paris region, the local public hospital system, called theGreater Paris University Hospitals (in French:Assistance publique - Hôpitaux de Paris, AP-HP), has an agreement with 5 major universities in Paris. However, it is divided into smaller groups of hospitals and universities:
The first teaching hospital in the United States was founded at the College of Philadelphia (now theUniversity of Pennsylvania) in 1765, when medical students at the college began taking bedside instruction at thePennsylvania Hospital (an institution that predated the medical school by several years). Following that wereKing's College of New York in 1768,Harvard University in 1783,Dartmouth College in 1798, andYale University in 1810 to begin the history of notable university-affiliated teaching hospitals in America.[22][23]
Teaching hospitals rose to prevalence in the United States beginning in the early 1900s, largely resembling the model established byJohns Hopkins University, the University of Pennsylvania and the Lakeside Hospital in Cleveland. All were very large, technologically sophisticated and aimed to have a global impact through both patient care and scientific research. Additionally, these hospitals had large patient bases, abundant financial resources, and renowned physicians, advisors and staff. Many of these medical schools associated with a nearby hospital were private institutions that received philanthropic support.[24]
While some funding comes fromMedicaid for the GME process, teaching hospitals must consider paying residents and fellows within their budgets. These additional costs vary between hospitals based on funding by Medicaid and their general salary for residents and fellows. Despite these costs, they are often offset by the prices of procedures, which are elevated in comparison to most non-teaching hospitals. Teaching hospitals often justify this additional cost factor by boasting that their quality of care rises above non-teaching hospitals, or assuring the patient that they are improving the medicine of the future by having their procedure done with medical trainees present.[25]
According to theMedical Journal of Australia, Australian teaching hospitals typically receive less funding for research than they do in similarly situated countries. The late 1800s and early 1900s saw several attempts at instituting a teaching hospital to be affiliated with a medical school, but plans fell through until 1928, whenRoyal Prince Alfred Hospital became Australia's first teaching hospital, to educate students of theUniversity of Sydney.[26]
^Ludmerer, Kenneth M. (October 1983). "The Rise of the Teaching Hospital in America".Journal of the History of Medicine and Allied Sciences.38 (4):389–414.doi:10.1093/jhmas/38.4.389.PMID6358338.
