Background: Hospital Medicine (HM) continues to be a rapidly evolving field. Within our own institution, 15-20% of our graduates in the Internal Medicine Residency Program have pursued careers in HM in recent years.
Purpose: The goal of this project is to provide residents with better preparation for careers in HM by implementing a HM Pathway.
Description: The curriculum is a 1-2 year program during the PGY-2 and/or PGY-3 year for up to four residents per year. The flexibility of the pathway allows residents to enter the pathway at the beginning of the PGY-2 or PGY-3 year. During the PGY-3 year, residents rotate as a cohort on a 4-week “Junior Hospitalist” block, where they work one-on-one with faculty hospitalists. The 4-week block is comprised of 2-weeks of general wards, 1-week of admitting/consults, and 1-week on the joint hospitalist and palliative care team. During the block, there are twice-weekly HM didactics on topics including patient safety, billing/coding, business of HM, oncologic emergencies, perioperative medicine, practicing evidence-based medicine, inpatient consultation, and medical ethics. Additionally, the block includes weekly ultrasound rounds to further develop each resident’s ultrasound skills. All residents entering the pathway are assigned a mentor who is a member of the division of HM, with the goal of providing individual career guidance and mentorship during residency. Residents have opportunities to attend HM grand rounds, present a hospital-medicine focused journal club, and receive paid membership and conference registration for the Society of Hospital Medicine (SHM). Additional subspecialty rotations for pathway participants include 2-weeks of neuro stroke and 2-weeks of neuro critical care.
Conclusions: In the first year of implementing this pathway, we encountered many challenges. The first challenge was that there was no pre-existing, well-defined model. To build our own curriculum, we utilized the SHM’s published Core Competencies in HM (2017) as a framework, in addition to a program self-assessment of gaps that we felt existed within the current residency curriculum through focus groups and discussion with our hospitalist faculty and residents. The second challenge was finding a way to fit the new curriculum into the existing residency program structure. At our institution, PGY-2/PGY-3 residents rotate one-on-one with a faculty hospitalist at one of our hospital sites with structured weekly afternoon teaching conferences. We took this model and placed all our pathway residents on the same cohort to rotate together and replaced the afternoon conferences with HM sessions.The third challenge was securing funding. In our framework of creating this pathway, our goal was to provide our residents with paid SHM membership and registration for the annual SHM conference. Membership would give residents access to the HM learning modules, opportunities to present posters, and to make them feel welcomed as future hospitalists. The division of HM at our institution enthusiastically provided financial support on the basis that the pathway will benefit the division with teaching opportunities, potential of generating added RVU’s by having residents on service, and recruiting residents as hospitalists within our institution.As this is the first year of our pathway, we hope to make this pilot successful, and to be able to share our challenges, curriculum, didactics, inpatient rotation model, and primary outcome results with other residency programs interested in starting a HM pathway.