Background: Residents in Internal Medicine have traditionally taken electives that prepare or position them well for fellowships. Another purpose of elective time during residency is to expose the learner to career opportunities. As Hospital Medicine grows as a specialty, more training programs are offering electives for residents in this field. However, most elective descriptions that have been publicized focus on the clinical role and are often 4-week blocks. We designed a novel 2-week elective in hospital medicine that immerses the resident in both the clinical and the administrative roles that academic hospitalists enjoy. This elective was offered for the first time in the 2017-2018 academic year.
Purpose: This elective exposes residents to the “value-added” that an academic hospitalist contributes as a faculty member. We designed a unique 2-week elective in hospital medicine for senior residents, an intense introduction to all aspects of academic hospital medicine: hospital administration and leadership, procedures, medicine consults, and clinical care.
Description: One week of the elective is clinical, focusing on independent practice. Residency prepares young physicians to care for patients as a team of learners. Most hospitalists practice without a resident team and are responsible for all aspects of the patient’s care. The resident serves as the primary provider for up to 8 patients. They are responsible for developing and executing the plan of care, all orders and documentation, and communication with other multidisciplinary team members. Topics of discussion include clinical quality metrics, hospital throughput and efficiency, high value care, and patient satisfaction, subjects that are not emphasized elsewhere in their training.
One week of the elective is focused on the “added value” that a hospitalist brings to the hospital. Most unique is individualized time with health system leaders, shadowing and one-on-one meeting time with hospitalists in their various leadership roles. The resident is invited to join nursing unit weekly rounds, care redesign committee meetings, patient safety reviews with quality officers, rapid improvement events, etc. This second week also explores less common clinical roles. This includes half-days working with the procedure team and managing hospital-wide clinical emergencies, consulting on patients on other services, and performing triage and independently admitting new patients.
The residents on the elective are also given access to a curated library of articles in hospital medicine, based on the Society of Hospital Medicine’s core competences. They are encouraged to complete online modules on these topics.
Conclusions: The feedback from the residents who have completed this elective has been overwhelmingly positive. The clinical week confirms for the resident that they can find enjoyment in independent clinical practice. The “added value” week emphasizes the critical role of the hospitalist in a health system and showcases potential career trajectories for the resident, potentially creating a pipeline into academic hospital medicine. This “value-added” focus has been rated the most desirable aspect of the rotation and is cited by residents as the motivation for electing this course. As our field of academic hospital medicine finds its footing in the traditional academic medicine community, this unique elective’s emphasis on the “value-added” by hospitalists can make this career option more enticing for senior internal medicine residents.