Background:
As the hospital medicine specialty expands, internal medicine residency programs are building hospitalist-specific rotations that teach skills and knowledge relevant to the field. To date, little is known of the prevalence and characteristics of hospitalist rotations. We surveyed internal medicine training programs to better understand the prevalence, objectives, and structure of hospitalist rotations in the United States.
Methods:
An 18-question survey was sent electronically to residency leadership of the 100 largest ACGME internal medicine residency programs. Each program had at least 81 residents. The survey contained items that assessed the goals, structure, and perceived benefits of hospitalist rotations.
Results:
Eighty-two residency program leaders responded to the survey (82% response rate). Among responders, the prevalence of hospitalist-specific rotations was 50% (41/82), of which 85% (35/41) were elective rotations and 15% (6/41) were mandatory rotations. A lack of a well-defined model was the most frequently reported barrier for programs without a hospitalist-specific rotation (Figure 1).
The most common clinical responsibilities were admitting new patients, and the most common curricular elements were teaching evidence-based practice, career counseling, and quality improvement. Clinical activities, non-clinical activities, and curricular elements varied across institutions (Table 1).
Most programs with rotations (95%, 39/41) felt their hospitalist rotation filled at least one gap in traditional residency curriculum, and identified gaps as the need for progressive clinical autonomy (59%, 24/41), learning about quality improvement and high value care (41%, 17/41), and preparation in becoming a hospitalist physician (39%, 16/41). Most respondents (66%, 27/41) felt that the rotation helped to prepare trainees for their first year as an attending.
Conclusions:
In our national survey of the largest internal medicine residency programs, the majority reported either having a hospitalist-specific rotation or interest in starting one. Further evaluation of these rotations may inform a framework for hospitalist training, elucidate best practices, and assess the effectiveness of these rotations in promoting career development in hospital medicine. Hospitalist-specific rotations may supplement traditional inpatient rotations and teach skills that facilitate the transition from residency to a career in hospital medicine.