Background: Hospital Medicine has been the fastest-growing field of physician practice over the past two decades in the United States, and hospitalists practice in a variety of institutional and geographical settings. The role of the “academic hospitalist” has arisen in response to the needs of academic medical centers and their associated medical schools and Internal Medicine residency training programs. While the career of the academic hospitalist can be attractive to many resident physicians, the barrier to entry into an academically-focused hospitalist position for a trainee coming out of a residency program can be quite imposing for a variety of factors, such as training at a community-based residency program or having limited experience in more autonomous inpatient care.

Purpose: Our innovation seeks to immerse senior trainees at US Internal Medicine residency programs in the work of an academic hospitalist to both help prepare them to be competitive applicants for early-career academic hospitalist faculty positions and to be more professionally prepared for stepping into that clinical role. Our innovation especially provides a venue for talented senior trainees at community-based residency programs to experience the practice of inpatient medicine within the medically complex, well-resourced setting of a major urban academic referral center.

Description: We implemented a 4-week clinical elective for PGY-3 Internal Medicine resident physicians coming in from residency programs external to our own tertiary teaching hospital. The elective involves two principal components. Firstly, the elective puts the rotating resident directly onto an inpatient Hospital Medicine service where the resident works one-on-one under the clinical supervision of a faculty academic hospitalist. In this setting, the resident is given a very high degree of autonomy (compared to a typical inpatient teaching service with multiple levels of trainees involved) in order to simulate the daily work of an attending physician. And secondly, the elective includes didactics (in the form of seminars and workshops) focused on topics relevant to the early-career academic hospitalist. These topics of focus are: High-value care, Antibiotic stewardship, Hospital economics, Inpatient coding/billing & reimbursement, Medicine consults & perioperative medicine, Interfacility triage & utilization management, Discharge & post-hospitalization planning, and Contract negotiation & career development in the field of Hospital Medicine.

Conclusions: Our innovation has successfully demonstrated that an elective focused on Hospital Medicine as an academic discipline and career path can garner interest and participation from trainees based in a wide range of residency programs – from small community-based programs to tertiary well-resourced academic programs. Working in the field of academic Hospital Medicine requires thorough training in and understanding of the complex networks that underlie inpatient care at teaching hospitals, and we are pleased to see our elective already contributing to the ranks of the next generation of early-career academic hospitalists.

IMAGE 1: Topics of focus in academic hospital medicine addressed in our innovation