Background: Within the time constraints of internal medicine (IM) residency curricula at large academic institutions, trainees interested in Hospital Medicine (HM) often lack exposure to the diverse experiences the field has to offer. Many training programs have begun to offer HM elective rotations which incorporate activities such as teaching, research, and quality improvement. At our institution, we offer a two-week HM elective to IM residents. In our traditional model, residents received a templated schedule comprised of one week of traditional rounding and one week of additional clinical and non-clinical activities (Figure 1). Residents expressed wide variability in educational goals and we ultimately felt they would benefit from a more individualized elective structure that also maintains HM-specific curricular components.
Purpose: We restructured our HM elective to prioritize resident preferences by allowing them to choose the content and distribution of activities. Through this redesign, we hoped to empower trainees to pursue diverse career paths, build confidence when applying for jobs, and ultimately disseminate skills to advance the field of HM.
Description: We first asked program leadership to identify relevant educational gaps in the residency curriculum which included perioperative medicine and inpatient billing/coding education. Both topics were standardized for residents planning careers in HM. For the first week of their rotation, trainees were permitted to select one week of either near-autonomous traditional rounding supervised by a hospitalist in the academic or community setting or one week of perioperative medical/surgical co-management paired with a perioperative hospitalist. The second week consisted of various clinical and non-clinical activities. Residents who forwent the rounding or perioperative experience were offered alternative clinical and non-clinical activities for the full two-week duration. We launched our new curriculum in July 2020 (Figure 1). We used an optional post-rotation survey to collect qualitative feedback through June 2022, and identified common themes from the data. In 2023 we initiated a pilot study of the longer-term effects of our elective by inviting graduates currently practicing HM to share additional reflections.Of the 21 residents who completed our elective, 15 became hospitalists. 11 residents provided post-rotation feedback (Table 1). They valued the breadth of experiences, personalization, exposure to activities outside of rounding, and direct faculty interactions. Limited data from four practicing hospitalists who completed the elective suggest that rotation experiences were helpful when applying for jobs and can facilitate dissemination of HM-related knowledge and skills.
Conclusions: As the breadth of HM continues to grow, educational opportunities for trainees are expanding in parallel. Standardized curricula may be insufficient to meet the unique needs of residents interested in HM. Preliminary data on our restructured elective highlight the potential benefits of individualized curricula. Further observation is needed to fully characterize these benefits and identify the most valuable rotation components.
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