Background:
Medical schools and residency programs have competency and milestone-based frameworks to assess trainees. A parallel framework does not exist for the assessment of hospital medicine fellows and faculty in their initial years of practice. This study aimed to develop consensus among hospitalists on the most important clinical competencies for early career hospitalists.
Methods:
The Core Competencies in Hospital Medicine defines key competencies for hospital medicine providers, with 51 chapters in three sections: clinical conditions, procedures and healthcare systems. Each chapter includes skills-based learning objectives. We performed a modified Delphi study to identify the most important skills-based competencies for early career hospitalists. Three senior hospitalists convened and by negotiated consensus narrowed the list from 454 to 90 by the following criteria: 1) relevance for the first year of practice and 2) feasibility of evaluation by either direct observation, peer/mentor feedback or medical record review. Hospitalists at three hospitals (tertiary medical center, county hospital and VA medical center) who had completed at least one year of practice were surveyed and asked to rate the importance of the remaining competencies using a 7-point Likert scale. Agreement on importance was determined when at least 85% or more hospitalists at each center rated the competency ‘important’ or ‘definitely important’.
Results:
A total of 69 hospitalists were surveyed and 53 responded (77%). For all hospitals the highest rated competencies addressed communication with patients, palliative care, transitions of care, supervision and collaboration within multidisciplinary teams. These highly rated competencies varied considerably by hospital (Table 1). Only two competencies were common across all three hospitals: “Communicate effectively with patients and families about patients values and goals of care” and “Communicate effectively and efficiently during patient sign-out.” Hospitalists at the tertiary care hospital highly rated competencies in palliative care, while hospitalists at the county hospital identified transitions of care and hospitalists at the VA hospital prioritized geriatric-focused competencies.
Conclusions:
Practicing hospitalists were able to identify the most important competencies for early career hospitalists, focusing on five key domains. There was substantial variability in clinical skills that were prioritized at different sites of practice. This suggests while there may be some universal competencies, some skills may be unique to the hospital type and patient population. These results can be used to optimally assess early career hospitalists as well as build faculty development curricula.