Back to Basics

The Hospitalist. 2008 December;2008(12):

December 1, 2008 | The Hospitalist

Kevin Leary, MD, internal medicine faculty at Walter Reed Army Medical Center in Washington, D.C., is not a hospitalist, although his position with the teaching service is similar in many ways. “My goal in coming here is to learn more about the field of hospital medicine and to meet physicians who are hospitalists,” Dr. Leary explains. “When I leave my role in the military service, I would get a lot of job satisfaction out of becoming a hospitalist.”

Julio Rivera, MD, of Ben Archer Health Center, Truth or Consequences, N.M., (left) and Dr. Leary (center) practice paracentesis technique with the help of Nima Afshar, MD, an emergency physician and hospitalist practicing at San Francisco General Hospital and UCSF. A patient volunteer with ascites was present to allow hospitalists to practice the use of ultrasound in locating the condition.

Charles Oppong, MD, a native of Ghana who now lives in Los Angeles with his wife and infant daughter, is waiting for his application for a California medical license to be processed and currently works part-time as a hospitalist in Circleville, Ohio, and in LaCrosse, Wis. “Personally, I enjoy caring for patients in the inpatient setting. I like the challenges of keeping my medical skills current,” he says. “I heard about UCSF and its famous hospitalist program, and when they sent me a flyer, I saw all of these topics to improve my inpatient management skills.”

Organizers of the mini-college are attempting to give participants an opportunity to re-experience “what it was like in residency to participate in rounds with a truly spectacular teacher. With the teaching resources we have here at UCSF, we have the capacity to offer that kind of experience,” Dr. Wachter says.

“Those of us who stay in academic settings are constantly jazzed by our interactions with young people, who tend to ask a lot of questions,” he adds. “For many other hospitalists, they don’t have much opportunity to step back and recapture what brought them to the field in the first place. That’s what I hoped to capture with the mini-college. If we can do that, then we’ve succeeded.” TH

Small Groups Foster Interactive Learning

The rapid growth of the hospitalist field has been an exciting development for Dr. Wachter. “But I’ve been struck by how the field’s educational needs are becoming more diverse. There is a whole bunch of stuff [in routine practice] that we were trained poorly in,” he said in a pre-mini-college interview.

The mini-college was established to respond to those emerging needs, both as a statement of the areas in which hospitalists say they want more help and as way for those in mid-career to get back to their roots and re-experience the best aspects of residency training. The sold-out course was limited to 27 participants; each paid $2,500 for the opportunity to interact with the highly regarded UCSF faculty in a number of disciplines.

The three-day course is promoted as a departure from typical medical education, including Dr. Wachter’s “Managing the Hospitalized Patient” conference. Presented in San Francisco the past 12 years, the conference is co-sponsored by UCSF and SHM. “It’s one thing to hear the experts’ PowerPoint-based stump speeches, and another to roll up your sleeves with hospitalist faculty and learn in a very personal way,” Dr. Wachter said. “What we know about adult learning is that active is better than passive. We also know that something unique happens in the clinical context of the hospital setting.”

Some topics not covered during the mini-college agenda included reading EKGs, managing complex cardiac events, pain management, and palliative care. “Hospitalists need to become more educated in the methodology of performance improvement, since that is going to become part of how hospitals get reimbursed,” said Elizabeth Olberding, MD, a mini-college participant and hospitalist with St. Luke’s Boise Medical Center in Idaho. “Another thing not covered is the hospital care of pregnant patients. Whenever I get a call from the obstetrician, my heart skips a beat.”

Where UCSF’s intensive approach to hospitalist training goes from here will depend, in part, on feedback from the first group of participants. “We have talked about how to scale up from this session and what will happen next,” says course co-chair Niraj L. Sehgal, MD, a member of Dr. Wachter’s group and medical director of UCSF at Mount Zion Hospital in San Francisco. “Do we target other organizations or academic medical centers with whom to partner?”

Although much of the spade work is done, the logistical demands and enriched student-teacher ratios make it hard to recreate the hands-on course frequently. At least one and possibly two mini-colleges are being planned at UCSF over the next year.—LB