Hospital Medicine is a rapidly growing specialty and a higher percentage of patients are under the care of hospitalists across the country. Like other internal medicine subspecialties, an increasing number of residents have expressed interest in a career in hospital medicine and have requested an elective in the field. In prior years our Hospitalist Elective consisted of little more than a traditional inpatient medicine rotation and was often viewed as just another floor month. The challenge facing programs is how to design an elective experience that showcases both the clinical and non-clinical aspects of academic hospital medicine. As the need for new hospitalists grows, divisions need to find high quality applicants with an understanding of what academic hospital medicine entails. Our goal was to improve our Hospitalist Elective to move from a more traditional floor rotation to more accurately depict the day to day experience of an Academic Hospitalist.
Methods:
The new elective includes clinical time on a non-resident covered accountable care unit, orthopedic surgical perioperative comanagement, and medical management of psychiatric patients at an inpatient psychiatric facility. Additionally rotators participate in committee work and attend a series of short lectures in areas of hospital medicine, i.e. an introduction to quality improvement, medical clearance for the surgical patient, and pain management in the inpatient setting. Rotators also attend our division’s weekly academic conference on topics pertinent to hospital medicine.
Results:
Residents who completed the revamped elective were surveyed (response rate = 78.6%). Residents were asked to rate their comfort level with various aspects of hospital medicine as compared with prior to the elective. The percentage of residents who felt comfortable or very comfortable in these aspects were: Surgical comanagement – 73%; Perioperative care – 73%; Inpatient consultations – 82%; Psychiatric comanagement – 73%. 82% reported good or very good understanding of the non-clinical aspects of hospital medicine and how the non-teaching service functions. Resident satisfaction with the elective was 91% and the same percentage rated good or very good understanding of what a career in hospital medicine entails.
Conclusions:
We developed an innovative and highly-rated Hospital Medicine elective that lead to high comfort levels among resident rotators in the areas of surgical and psychiatric comanagement, perioperative care, and inpatient consultations. Additionally a high number of rotators reported a good understanding of careers in hospital medicine. Our hope is that this experience allows trainees to be more confident with a career choice in hospital medicine and helps our division retain more graduating residents. Future directions include expansion into other venues of hospital medicine i.e. discussion of hospitalist metrics, billing, teaching to teach, and patient satisfaction.