Training Residents in Hospital Medicine: The Hospitalist Elective National Survey
As the field of hospital medicine expands, internal medicine residency programs can play a role in preparing future hospitalists. To date, little is known of the prevalence and characteristics of hospitalist-focused resident rotations. We surveyed the largest 100 Internal Medicine Residency Programs to better understand the prevalence, objectives, and structure of hospitalist-focused rotations in the United States. Residency leaders from 82 programs responded (82%). The prevalence of hospitalist-focused rotations was 50% (41/82) with an additional 9 programs (11%) planning to start one. Of these 41 rotations, 85% were elective rotations and 15% were mandatory rotations. Rotations involved clinical responsibilities, and most programs incorporated nonclinical curricular activities such as teaching, research, and work on quality improvement and patient safety. Respondents noted that their programs promoted autonomy, mentorship, and “real-world” hospitalist experience. Hospitalist-focused rotations may supplement traditional inpatient rotations and teach skills that facilitate the transition from residency to a career in hospital medicine.
© 2018 Society of Hospital Medicine
DISCUSSION
The Hospital Elective National Survey provides insight into a growing component of hospitalist-focused training and preparation. Fifty percent of ACGME residency programs surveyed in this study had a hospitalist-focused rotation. Rotation characteristics were heterogeneous, perhaps reflecting both the homegrown nature of their development and the lack of national study or data to guide what constitutes an “ideal” rotation. Common functions of rotations included providing career mentorship and allowing for trainees to get experience “being a hospitalist.” Other key elements of the rotations included providing additional clinical autonomy and teaching material outside of traditional residency curricula such as quality improvement, patient safety, billing, and healthcare finances.
Prior research has explored other training for hospitalists such as fellowships, pathways, and faculty development.6-8 A hospital medicine fellowship provides extensive training but without a practice requirement in adult medicine (as now exists in pediatric hospital medicine), the impact of fellowship training may be limited by its scale.12,13 Longitudinal hospitalist residency pathways provide comprehensive skill development and often require an early career commitment from trainees.7 Faculty development can be another tool to foster career growth, though requires local investment from hospitalist groups that may not have the resources or experience to support this.8 Our study has highlighted that hospitalist-focused rotations within residency programs can train physicians for a career in hospital medicine. Hospitalist and residency leaders should consider that these rotations might be the only hospital medicine-focused training that new hospitalists will have. Given the variable nature of these rotations nationally, developing standards around core hospitalist competencies within these rotations should be a key component to career preparation and a goal for the field at large.14,15
Our study has limitations. The survey focused only on internal medicine as it is the most common training background of hospitalists; however, the field has grown to include other specialties including pediatrics, neurology, family medicine, and surgery. In addition, the survey reviewed the largest ACGME Internal Medicine programs to best evaluate prevalence and content—it may be that some smaller programs have rotations with different characteristics that we have not captured. Lastly, the survey reviewed the rotations through the lens of residency program leadership and not trainees. A future survey of trainees or early career hospitalists who participated in these rotations could provide a better understanding of their achievements and effectiveness.
CONCLUSION
We anticipate that the demand for hospitalist-focused training will continue to grow as more residents in training seek to enter the specialty. Hospitalist and residency program leaders have an opportunity within residency training programs to build new or further develop existing hospital medicine-focused rotations. The HENS survey demonstrates that hospitalist-focused rotations are prevalent in residency education and have the potential to play an important role in hospitalist training.
Disclosure
The authors declare no conflicts of interest in relation to this manuscript.
