Background: Advanced Practice Providers (APP) are an expanding workforce within hospital medicine. Training and onboarding APPs is essential for developing a confident and competent workforce. However, onboarding options for APP training in hospital-based medicine have been limited due to the breadth and complexity of knowledge required to practice.

Purpose: To develop an inpatient hospital medicine post-graduate training program (e.g., fellowship) for physician assistants (PAs) across a range of inpatient practice environments, with a secondary goal of retention of graduates within the institution.

Description: A 12-month Hospital Medicine PA fellowship was designed by a team of PA Directors, a physician Medical Director, and a hospital administrator. The fellowship is comprised of four 10-week core rotations in General Medicine, Cardiology, Oncology, and Critical Care, and a 4-week elective rotation (e.g., Geriatrics, Renal transplant medicine) chosen by the fellow. Rotations are hosted at a quaternary care center, a community hospital, and an inpatient cancer center. On each rotation, fellows serve as the responding clinician in partnership with a PA preceptor. During the rotation, the number of patients they cover is progressively increased commensurate with their clinical development. Both fellows and preceptors complete post-rotation evaluation forms. Over the course of the year, fellows also engage in over 300 hours of protected didactic time comprised of department-wide education sessions, weekly fellowship-specific teaching, and over 25 hours of simulation education on critical care topics and crisis resource management techniques. Each fellow receives individual professional development and mentorship throughout the duration of the program. Fellows also complete a longitudinal capstone project of their choosing. Since its launch in 2021, eight fellows have participated in the program, including two graduates, four currently enrolled fellows, and two accepted fellows. Of the 19 completed post-rotation fellow surveys, 19 (100%) report improved clinical skills, fund of knowledge, and professional growth. All four current and graduated fellows report satisfaction in the program expectations, support provided, and feedback. Of the 10 completed post-rotation preceptor surveys, 10 (100%) report they would precept again; 9 (90%) rated greater job satisfaction due to their role as a preceptor; and 6 (60%) said they are more likely to stay in their current role because of the opportunity to precept. Examples of capstone projects completed by fellows include: leading quality improvement work in patient access to their electronic medical records; development of a renal medicine curriculum with didactic and simulation components; and improving a recruitment pipeline for PAs underrepresented in medicine. To date 100% (2 of 2) graduating fellows have been retained at PA positions within our institution.

Conclusions: We developed a successful fellowship opportunity for PAs in Hospital Medicine. The program has achieved its aims of creating highly competent PAs practicing in a variety of clinical areas and retaining trained PAs within the institution. Additionally, the program demonstrates improved job satisfaction of existing (preceptor) PAs, which we anticipate will lead to greater retention. Due to its initial success, the hospital has provided ongoing support for the fellowship program, with plans to foster expansion of the fellowship into other departments.