Background: The transition from internal medicine resident to early-career hospitalist signals the end of structured clinical feedback in the residency training model. This abrupt transition can impact well-being and the continued formation of self-directed learning skills. In addition, studies have shown an association between practicing in the first year as a hospitalist and inferior patient outcomes. We developed a new clinical coaching program to ease this transition and aimed to support, assess, and improve clinical skills. We sought to understand the primary concerns within clinical work of first-year hospitalists at an academic institution.

Methods: All hospitalists in their first year at our single academic tertiary care center (“coachees”) were assigned a coach as part of the clinical coaching program. Coaches (mid- to senior-level faculty) scheduled check-ins during each coachee’s clinical blocks, provided availability for real-time clinical feedback, and met to discuss coachee development every 4 months from November 2021 – October 2022. After meeting with a coachee, coaches logged each coaching encounter using a REDCap survey form, which included a list of 22 clinical themes previously compiled through literature review and group consensus by the study investigators, coaching director, and coaches. After selecting a theme, coaches submitted a brief description of the coaching interaction using a free text box. Descriptive statistics were used to assess the most common clinical themes. The associated free text descriptions for the top 2 themes were analyzed using content analysis.

Results: Twenty-five new faculty participated in the coaching program and were paired with one of 5 coaches. Over the course of the 12-month program, coaches logged 239 entries of primary clinical themes during clinical coaching encounters. The 5 most commonly selected themes included: Diagnostic Accuracy/Managing Diagnostic Uncertainty (22%), Other (16%), Clinical Management Change (8%), Assessing Readiness for Discharge (6%), and Emotional Support/Strategies (6%) (Table 1). Descriptive texts from “Diagnostic Accuracy” described complex medical case scenarios with diagnostic uncertainty and clinical reasoning challenges. Descriptive texts from “Other” described coach guidance regarding career planning and reflection, teaching methods, developing residents’ autonomy/leadership, and work/life balance among others. See Table 2 for representative texts.

Conclusions: Challenges for first-year hospitalists at an academic institution span a wide range of themes from developing emotional coping strategies to assessing discharge readiness. Within a program that assigns a longitudinal coach designed to support, assess, and improve clinical skills, our data highlight the diagnostic uncertainty and management queries that new hospitalists have. In addition to these clinical care-related themes, prominent “Other” themes show that a coaching relationship can be leveraged to discuss new hospitalists’ career planning and teaching roles, among other topics. Additional studies are needed to assess the impact of a clinical coach on specific skill development, deliberate practice, and clinical outcomes. These results offer insight for ways hospital medicine programs can target faculty development for new hospitalists to improve both patient care and the hospitalist experience. These results will also be used for ongoing program and coach development in order to address new hospitalist challenges.

IMAGE 1: Table 1. Top 5 Primary Themes of Coaching Encounters

IMAGE 2: Table 2. Representative Texts from Top 2 Themes