Background: In an era of value-based purchasing, healthcare providers like Internal Medicine (IM) residents will require advancing knowledge on performance measures for quality and efficiency of patient care. In the hospital-based care setting, many large health care systems have incorporated enhanced approaches to provide multidisciplinary care. The system is also being designed to penalize caregivers for poor outcomes, medical errors or increased cost utilization.
Purpose: To design and implement an educational opportunity for IM residents to improve their ability to provide care in a multi-disciplinary approach including working with Advanced Practice Providers (APPs), increase their awareness/knowledge of hospital performance metrics/patient satisfaction and improve their comfort level in performing as an independent hospital medicine provider.
Description: Starting in July 2015, our IM residency training program converted a traditional inpatient general medicine ward team to a new, inventive team model. The new structure was developed with the purpose of providing a senior IM resident with the opportunity to manage an inpatient medical service as an independent hospitalist, working with APPs. The senior residents were PGY 2 or 3 residents that expressed interest in hospital based medicine as a career. The residents were paired with a select group of our IM hospitalist faculty with highly positive educational track records. The senior resident, under supervision, coordinated the care of the entire service including the care, supervision and direction of care that were seen by the APPs. The senior resident performed Care Coordination Rounds (CCRs) on all patients. CCRs are daily multi-disciplinary rounds involving a discharge flow coordinator, social worker, case manager, pharmacist, dietician, physical/occupational therapist, nurses and the providers. The residents function as a daytime provider, allowing them to admit and discharge patients on daily basis up to their appropriate census caps and duty hours allowed by ACGME. The education the residents receive involves bedside teaching, didactic lectures identified to match the Society of Hospital Medicine core curricula and attending all other IM program activities. For evaluation of the rotation’s objectives, the residents complete a pre and post survey. For the rotation, the residents fill out an evaluation of the rotation at the end of month.
Conclusions: Since inception, 5 IM residents have completed the new hospitalist elective. The pre and post survey results are measured on a 5 point scale. Residents have improved their comfort level as an independent provider, increasing from 3 to 4. Residents have improved their comfort level working with APPs, from 2 to 3. Residents have improved awareness of hospital metrics, patient satisfaction, level of documentation and billing regulations from 2 to 3. Residents have improved comfort with triage care from 2.7 to 3.5. Residents increased their awareness of risk stratification scales from 2 to 2.5. Qualitative feedback from the residents indicate a positive experience, including “I have developed a greater comfort level” and “great rotation to give taste of what’s like to be a hospitalist.” Areas of improvement are currently being identified by a targeted needs assessment with the residents.