Background:
Hospital medicine is an evolving and expanding field, with a large proportion of internal medicine graduates choosing to pursue careers in hospital medicine. While future hospitalists receive extensive clinical education during their post-graduate years, they often leave their training programs with limited knowledge of the structure of the field and the value that hospitalists bring to their institutions beyond clinical care. A formal curriculum is needed to better prepare residents to enter the field and define their career paths. Though some programs have created hospital medicine tracks, options are limited for programs that do not have the necessary resources to do this. We designed a single rotation to help prepare our residents who are entering hospital medicine.
Purpose: This course aims to provide residents with the knowledge that they will need to succeed both as an early career hospitalist and also as an administrator within a hospitalist program.
Description:
The course is a two-week elective for internal medicine residents. There are four main components to the elective:
1) Group tutorials to provide context, using a flipped-classroom approach to promote active learning:
- The field of hospital medicine and factors that allowed and encouraged its development
- Hospital medicine budgeting: revenue, expenses and the costs of care
- Quality and the value argument for a hospitalist program
- Leadership in hospital medicine
2) Supplementary sessions to support specific skills:
- Hospitalists and quality improvement
- Post-acute care
- Billing and coding
- Surgical co-management
- Financial planning for hospitalists
3) Site visits: Residents visit three hospital medicine programs outside of our academic medical for exposure to the diversity of practices and to conduct market research which will inform their final project.
4) Final project: Residents receive a case of a failing hospital medicine program and are asked to redesign the program with a focus on making the value argument for hospital medicine. They compete in two teams to provide details on the budget, schedule, services offered, and a specific high value care project for the hospitalist group. The teams each present to a group of hospital medicine faculty (the “Board of Directors”) who vote on the best program design.
The elective is consistently requested and enrolled to capacity. Resources required have included a one-time investment for a text library and 1-2 core faculty to run the elective. We have heard from local hospital medicine leaders that our residents are mature in the interview process and in defining their future career aspirations. Anecdotally, alumni of the course report that the course has better prepared them for their new roles. The results of a survey of residents who recently completed the elective is shown in Figure 1.
Conclusions: we have delivered a low-resource, high yield elective in hospital medicine that has shown to be effective in educating our residents in the field and better preparing them for a career in hospital medicine.