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Learning about discharging

During my first clinical rotation as a third-year medical student, the biggest challenge to me was not about physical exams and coming up with differentials. What I struggled with the most was understanding the hospital system and discharge process. As a trainee, I want to be fully involved with patient care to help the team. Many questions came up along the way, and I wish that they were addressed at some point of my medical education path. They include, but not limited to: What criteria do we use for discharge? Where can the patient be placed besides home? What supportive services are available? What information does the primary care doctor need to know? For the last decade, there is a stronger national focus in the US on patient length of stay to ensure we do not waste healthcare resources. However, the discharge process is very complex and involves many obstacles. Even now that I am finished with most of my clinical rotations prior to residency training, I still do not fully comprehend what is available as there was no formal teaching on discharge. Doing a little bit of literature review led me to a study that shows even for the US Internal Medicine residency programs, no more than 16% of them have some sort of formal discharge curriculum in place (Aiyer et al. 2009). Some medical educators have started to develop a transition care curriculum to help trainees better understand healing following hospitalization (Bray-Hall et al. 2010). Despite both Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME) identified care transition as a critical component of medical education, it is still not commonly addressed in the undergraduate and graduate level. Systems-based practice is an important competency for all levels of trainees: teaching about discharge in a practical matter should be a priority for the medical educators.