Background: The abrupt transition from internal medicine resident to early-career hospitalist marks the end of routine clinical feedback in the apprenticeship model. A new hospitalist’s experience during this transition can impact well-being and the ongoing development of self-directed learning skills. In addition, practicing in the first year as a hospitalist has been associated with inferior patient outcomes. We implemented a new clinical coaching program to ease this transition and surveyed new faculty to understand their needs through self-perceived competency and confidence levels.

Methods: All hospitalists in their first year with a long-term interest in a hospitalist career at our single academic tertiary care center (“coachees”) were assigned a coach as part of the clinical coaching program. Before the program began, coachees were asked to complete a survey assessing 1) their perceived skill level within the 6 ACGME core competencies and 2) confidence level (scale 0-10) in 18 clinical domains selected through group consensus by the study investigators, coaching director, and coaches. Additionally, coachees rated their preferences on timing and frequency of coaching encounters. For the 18 clinical domains, paired Wilcoxon rank-sum tests were used to compare all median confidence ratings to the rating for “Overall clinical skills as a hospitalist.” Finally, stratified analyses (chi square, Wilcoxon rank-sum, Kruskal-Wallis rank tests) were performed to assess for differences by reported gender and years since residency.

Results: Twenty-two coachees responded to the survey (88%). Coachees rated their skill levels highest within the core competencies of professionalism and interpersonal and communication skills (Table 1). Within the other clinical domains, coachees were most confident in their ability to communicate with interdisciplinary team members and consultants (Table 2). The median (IQR) confidence rating of their overall clinical skills was 7 (6-8). Compared to that result, coachees had significantly lower confidence ratings in the following skills: understanding strategies to grow clinical skills [6.5(4-7), p=0.031], navigating complex ethical dilemmas [6.5(5-7), p=0.048], and navigating behaviorally challenging patient and/or caregiver scenarios [6.0(4-7), p=0.015]. In stratified analysis, coachees identifying as women had a significantly lower confidence rating for “deciding when to call a consultant” as compared to those identifying as men [7(6-7.5) v. 8(7-8), p=0.038]. All other comparisons by gender or years since residency were not significant. Coachees viewed having a clinical coach available for real-time feedback as the most helpful timing option followed by the use of quarterly meetings to develop individualized growth plans.

Conclusions: Early-career hospitalists report lower confidence in domains of self-directed learning, the navigation of ethical dilemmas, and management of patient/caregiver behavioral challenges as compared to their overall clinical skills. In contrast, they feel most confident in their professionalism and interpersonal skills. These results will be leveraged to design a clinical coaching program to target skill development and fit the needs of new faculty.

IMAGE 1: Table 1. Coachees’ self-rated skill level in 6 core competencies

IMAGE 2: Table 2. Coachees’ confidence levels in 18 clinical domains