Despite recent buzz about shifting resident education to community health centers, hospital based education is here to stay. The model of education, though outmoded, is simple. Get residents exposed to as much disease as possible, in the shortest amount of time. The future of American health care is not in acute management of tertiary care; but in integrated, team-based care. To get there involves focusing not only on educational content, but also on the process of how we teach and learn.

Consider a typical inpatient medicine service, with ten members to a team: an attending, senior resident, three interns, three medical students, a pharmacist and a pharmacy student.

First, some numbers:

Combined years of training: 50
Hours spent on clinical rounds (weekly): 30
Hours devoted to education (weekly): 5
Hours devoted to team building, quality improvement, and longitudinal care: 0

The numbers speak for themselves. Clearly, as a system, we have chosen to devalue team-based education in favor of teaching isolated knowledge to different training levels. This is the issue of content. But what about the process of rounding? Two simple concepts would go a long way.

1. Teach clinicians cognitive skills. This idea comes from the Right Question Institute, an organization dedicated to teaching students to ask critical questions. The cognitive skills involve three types of thinking:

Convergent thinking.  This involves integrating a host of information for a single purpose. For instance, looking at a list of medication and deciding which contributes to delirium. 

Divergent thinking. This looks at the process from the opposing spectrum: given that a patient has confusion, what medications could be causing this? 

Metacognition.  This is the process by which we “think about thinking” — evaluating, judging, and gauging our strategies to approach clinical thinking. This could involve asking: we approached the diagnosis of heart failure physiologically; how else could we have approached it?”

Hospital-based models of care involves all three capacities, though highly skews towards convergent thinking. The divergent process of generating differential diagnoses is quickly losing importance as technological tests proliferate. If you can read the CT scan of a patient with abdominal pain prior to seeing them in the flesh, you need not think divergently. The highest yield change may be to teach tools of metacognition, as these lead to new approaches to patient care, and sparks curiosity.

2. Create opportunities for deep learning. One model of education describes learners as superficial, strategic and deep. The superficial learner does purely what is needed to get by — in the case of the hospital intern, maximizing the efficiency of computerized orders. The strategic learner focuses on what he needs to get ahead; presenting information clearly and looking up facts about a case. The deep learner, in contrast, often asks bigger “why” questions about approach to medication management, physiology, or the social lives of patients. Incentivizing deep learning involves permitting time for intensive reading, encouraging development of multiple cognitive skills, and mobilizing knowledge from each team member.

As healthcare transitions to a team-based model of care, medical education must follow. Creating conditions for deep learning may be this leverage point, if we dare to think differently.

Tom Peteet is a board-certified internal medicine physician, educator, and writer. For nearly a decade, he has practiced at Commonwealth Care Alliance, focusing on home-based care for patients with complex disabilities. He also cares for patients in long-term care facilities and works with InstED, a mobile health program that brings acute care into patients’ homes.

As an adjunct professor at Massachusetts College of Pharmacy and Health Sciences, he directs a year-long pharmacology course for physician assistant students. At Boston University, he has taught more than ten courses through its prison education program and is developing courses in neuroscience and medical anthropology.

His scholarship spans medical ethics, medical education, and health equity, including work on the treatment rights of incarcerated patients, the role of theory and the humanities in medical training, and the intersection of quality improvement and equity in residency. His writing has appeared in the AMA Journal of Ethics, Medical Teacher, and the Journal of Family Medicine, and he authored a 2025 textbook chapter on renal disorders in Pathophysiology in Focus.

His writing explores health care ethics, medical education, and the overlooked paradoxes of human physiology. He writes Against Medical Advice, a Substack on the hidden science of medicine, and is working on a nonfiction book about the strange science of blood pressure. More of his work is available on his personal website.