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Jain PN, Hametz P, Banker SL, Escalante E, Gutierrez F, Dodoo C, Dwivedi AK, Beck J, Fromme HB. Flying Solo: Effectiveness of Attendingless Family-Centered Rounds on Improving Resident Autonomy. Hosp Pediatr 2021; 11:e218-e230. [PMID: 34588174 DOI: 10.1542/hpeds.2021-005971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education requires that residents demonstrate increasing autonomy during their training. Although residents report a better educational environment with hospitalists present during family-centered rounds (FCRs), there is a concern that attending presence may reduce resident autonomy. We aim to determine the effect of FCRs without an attending during rounds on senior residents' sense of autonomy. METHODS We conducted a multicenter, retrospective, preintervention-postintervention study at 5 children's hospitals to evaluate the effect of rounding without an attending on senior residents' self-efficacy, using a questionnaire developed by using Bandura's principles of self-efficacy and Accreditation Council for Graduate Medical Education milestones. Questions addressed skills of diagnosis and/or management, communication, teaching, and team management. We compared preintervention and postintervention results using paired t tests and Wilcoxon rank tests. One-way analysis of variance tests were used to compare means among >2 groups. RESULTS 116 (82% response rate) of 142 eligible senior residents completed the questionnaire, which yielded a high reliability (α = 0.80) with a 1-factor score. The average composite score of self-efficacy significantly improved after intervention compared with the preintervention score (66.71 ± 6.95 vs 60.91 ± 6.82; P < .001). Additional analyses revealed meaningful improvement of each individual item postintervention. The highest gain was reported in directing bedside teaching (71.8% vs 42.5%; P < .001) and answering learner questions on rounds (70.7% vs 47.0%; P < .001). CONCLUSIONS Conducting FCRs without an attending increases resident reported self-efficacy regarding core elements of patient care and team leadership. In future studies, researchers should examine the impact of rounding without the attending on other stakeholders, such as students, interns, patients and/or families.
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Affiliation(s)
- Priya N Jain
- Children's Hospital at Montefiore, Bronx, New York .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Patricia Hametz
- Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Sumeet L Banker
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York.,Columbia University Irving Medical Center, New York, New York
| | - Enrique Escalante
- Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Fatima Gutierrez
- El Paso Children's Hospital, El Paso, Texas.,Texas Tech University Health Sciences Center, El Paso, Texas
| | | | - Alok K Dwivedi
- Texas Tech University Health Sciences Center, El Paso, Texas
| | - Jimmy Beck
- Seattle Children's Hospital, Seattle, Washington and.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - H Barrett Fromme
- Comer Children's Hospital, Chicago, Illinois.,Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Tseng AS, Fromme HB, Maniscalco J, Jerardi KE, Lockeman KS, Ryan MS. How Do Pediatric Hospital Medicine Fellowships Prepare Graduates as Educators? A Survey of Program Directors and Graduates in the United States. MEDICAL SCIENCE EDUCATOR 2020; 30:749-765. [PMID: 34457733 PMCID: PMC8368768 DOI: 10.1007/s40670-020-00945-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pediatric hospital medicine (PHM) is the newest recognized subspecialty in pediatrics within the United States. While fellowships in PHM have been available for several years, completion of a 2-year fellowship has become a requirement for subspecialty certification. Pediatric hospitalists provide substantial teaching to trainees, and therefore, PHM fellowships must include dedicated training around teaching and medical education. The purpose of this study was to determine how current PHM fellowships prepare graduates for their roles as medical educators. Two surveys were developed from the published PHM core competencies and Entrustable Professional Activities for pediatric subspecialties. One survey was disseminated to all active PHM program directors and the second was disseminated to all PHM fellowship graduates who completed training between 2012 and 2016. Items included those related to program structure and training/assessment in medical education. A total of 21 program directors (response rate = 58%) and 46 fellowship graduates (response rate = 46%) participated in the survey. All graduates (100%) reported teaching learners in their current setting. Many (67%) fellowship programs offered formal training in medical education, and this is greater than the 50% that was previously described. Direct observation (71%) was the most common method of assessment. Most graduates reported their fellowship provided optimal training in feedback and teaching during family centered rounds but suboptimal training in other skills such as curriculum development. The results of this study highlight areas for improvement in fellowship curriculum and assessment to better prepare fellows for their roles as educators.
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Affiliation(s)
- Ashlie S. Tseng
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, PO Box 980325, Richmond, VA 23298 USA
| | - H. Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Jennifer Maniscalco
- Department of Pediatrics, Johns Hopkins-All Children’s Hospital, St. Petersburg, FL USA
| | - Karen E. Jerardi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Kelly S. Lockeman
- Office of Assessment, Evaluation, and Scholarship, Virginia Commonwealth University School Medicine, Richmond, VA USA
| | - Michael S. Ryan
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, PO Box 980325, Richmond, VA 23298 USA
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3
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Allen M, Gawad N, Park L, Raîche I. The Educational Role of Autonomy in Medical Training: A Scoping Review. J Surg Res 2019; 240:1-16. [DOI: 10.1016/j.jss.2019.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/30/2019] [Accepted: 02/22/2019] [Indexed: 12/18/2022]
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Barrett DJ, McGuinness GA, Cunha CA, Emans SJ, Gerson WT, Hazinski MF, Lister G, Murray KF, St Geme JW, Whitley-Williams PN. Pediatric Hospital Medicine: A Proposed New Subspecialty. Pediatrics 2017; 139:peds.2016-1823. [PMID: 28246349 DOI: 10.1542/peds.2016-1823] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 11/24/2022] Open
Abstract
Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine (PHM) be recognized as a distinct new subspecialty. PHM as a formal subspecialty raises important considerations related to: (1) quality, cost, and access to pediatric health care; (2) current pediatric residency training; (3) the evolving body of knowledge in pediatrics; and (4) the impact on both primary care generalists and existing subspecialists. After a comprehensive and iterative review process, the ABP recommended that the American Board of Medical Specialties approve PHM as a new subspecialty. This article describes the broad array of challenges and certain unique opportunities that were considered by the ABP in supporting PHM as a new pediatric subspecialty.
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Affiliation(s)
- Douglas J Barrett
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida;
| | | | | | - S Jean Emans
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Mary F Hazinski
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - George Lister
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Karen F Murray
- Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Joseph W St Geme
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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5
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Beck JB, Tieder JS. Electronic resources preferred by pediatric hospitalists for clinical care. J Med Libr Assoc 2016; 103:177-83. [PMID: 26512215 DOI: 10.3163/1536-5050.103.4.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There is little research on pediatric hospitalists' use of evidence-based resources. The aim of this study was to determine the electronic resources that pediatric hospitalists prefer. METHODS Using a web-based survey, the authors determined hospitalists' preferred electronic resources, as well as their attitudes toward lifelong learning, practice, and experience characteristics. RESULTS One hundred sixteen hospitalists completed the survey. The most preferred resource for general information, patient handouts, and treatment was UpToDate. Online search engines were ranked second for general information and patient handouts. CONCLUSIONS Pediatric hospitalists tend to utilize less rigorous electronic resources such as UpToDate and Google. These results can set a platform for discussing the quality of resources that pediatric hospitalists use.
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Hollier JM, Wilson SD. No Variation in Patient Care Outcomes After Implementation of Resident Shift Work Duty Hour Limitations and a Hospitalist Model System. Am J Med Qual 2016; 32:27-33. [PMID: 26635330 DOI: 10.1177/1062860615613157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines whether implementing a resident shift work schedule (RSWS) alone or combined with a hospitalist-led model system (HMS/RSWS) affects patient care outcomes or costs at a pediatric tertiary care teaching hospital. A retrospective sample compared pre- and postintervention groups for the most common primary discharge diagnoses, including asthma and cellulitis (RSWS intervention) and inflammatory bowel disease and diabetic ketoacidosis (HMS/RSWS intervention). Outcome variables included length of stay, number of subspecialty consultations, and hospitalization charges. For the RSWS intervention, the preintervention (n = 107) and postintervention (n = 92) groups showed no difference in any of the outcome variables. For the HMS/RSWS intervention, the preintervention (n = 98) and postintervention (n = 69) groups did not differ in demographics or length of stay. However, subspecialty consultations increased significantly during postintervention from 0.83 to 1.52 consults/hospitalization ( P < .01) without significantly increasing hospitalization charges. Neither the RSWS nor HMS/RSWS intervention affected patient care outcomes at a pediatric tertiary care teaching hospital.
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Affiliation(s)
- John M Hollier
- 1 Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Stephen D Wilson
- 2 Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Affiliation(s)
- Sanjay Mahant
- Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Michael Weinstein
- Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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8
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Seltz LB, Montgomery A, Lane JL, Soep J, Hanson JL. Medical students' experiences working with frequently rotating pediatric inpatient attending physicians. Hosp Pediatr 2014; 4:239-246. [PMID: 24986994 DOI: 10.1542/hpeds.2014-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore medical students' experiences working with frequently rotating pediatric inpatient attending physicians. METHODS We performed a qualitative study using focus groups and individual interviews of medical students who rotated on the general pediatric inpatient service at Children's Hospital Colorado. The majority of inpatient pediatric attending physicians worked 1-week blocks. We used a semistructured interview guide and analyzed data using the constant comparative method. In accordance with the grounded theory method, codes were developed using an iterative approach, and major themes were identified. Analysis indicated theoretical saturation was achieved. We created a theory that arose from analysis of the data. RESULTS Twenty-seven medical students participated. Data analysis yielded 6 themes: learning climate, continuity, student resilience, opportunity to progress, growth into a physician, and evaluation. In the learning climate, the emotional environment was often stressful, although students valued exposure to different patient care and teaching styles. Senior resident continuity promoted student function; lack of continuity with attending physicians inhibited relationship development. Students were resilient in adjusting to changing faculty with different expectations. In the context of frequently rotating faculty, students had difficulty showing improvement to a single attending physician after feedback, which limited students' opportunities to progress. Students perceived summative evaluation as less meaningful in the absence of having a relationship with their attending physicians. CONCLUSIONS Medical students valued exposure to different patient care and teaching styles. However, frequently changing attending physicians caused students stress and limited students' perceived ability to achieve and show professional growth.
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Affiliation(s)
- L Barry Seltz
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - Alison Montgomery
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - J Lindsey Lane
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - Jennifer Soep
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - Janice L Hanson
- Children's Hospital Colorado and University of Colorado School of Medicine
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Gosdin C, Simmons J, Yau C, Sucharew H, Carlson D, Paciorkowski N. Survey of academic pediatric hospitalist programs in the US: organizational, administrative, and financial factors. J Hosp Med 2013; 8:285-91. [PMID: 23447445 DOI: 10.1002/jhm.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/23/2012] [Accepted: 01/12/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure. OBJECTIVE To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM). METHODS This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV. RESULTS The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site). CONCLUSIONS PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development.
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Affiliation(s)
- Craig Gosdin
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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10
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Barone MA, Dudas RA, Stewart RW, McMillan JA, Dover GJ, Serwint JR. Improving teaching on an inpatient pediatrics service: a retrospective analysis of a program change. BMC MEDICAL EDUCATION 2012; 12:92. [PMID: 23020896 PMCID: PMC3508912 DOI: 10.1186/1472-6920-12-92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/26/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The traditional role of the faculty inpatient attending providing clinical care and effectively teaching residents and medical students is threatened by increasing documentation requirements, pressures to increase clinical productivity, and insufficient funding available for medical education. In order to sustain and improve clinical education on a general pediatric inpatient service, we instituted a comprehensive program change. Our program consisted of creating detailed job descriptions, setting clear expectations, and providing salary support for faculty inpatient attending physicians serving in clinical and educational roles. This study was aimed at assessing the impact of this program change on the learners' perceptions of their faculty attending physicians and learners' experiences on the inpatient rotations. METHODS We analyzed resident and medical student electronic evaluations of both clinical and teaching faculty attending physician characteristics, as well as resident evaluations of an inpatient rotation experience. We compared the proportions of "superior" ratings versus all other ratings prior to the educational intervention (2005-2006, baseline) with the two subsequent years post intervention (2006-2007, year 1; 2007-2008, year 2). We also compared medical student scores on a comprehensive National Board of Medical Examiners clinical subject examination pre and post intervention. RESULTS When compared to the baseline year, pediatric residents were more likely to rate as superior the quality of didactic teaching (OR=1.7 [1.0-2.8] year 1; OR=2.0 [1.1-3.5] year 2) and attendings' appeal as a role model (OR=1.9 [1.1-3.3] year 2). Residents were also more likely to rate as superior the quality of feedback and evaluation they received from the attending (OR=2.1 [1.2-3.7] year 1; OR=3.9 [2.2-7.1] year 2). Similar improvements were also noted in medical student evaluations of faculty attendings. Most notably, medical students were significantly more likely to rate feedback on their data gathering and physical examination skills as superior (OR=4.2 [2.0-8.6] year 1; OR=6.4 [3.0-13.6] year 2). CONCLUSIONS A comprehensive program which includes clear role descriptions along with faculty expectations, as well as salary support for faculty in clinical and educational roles, can improve resident and medical student experiences on a general pediatric inpatient service. The authors provide sufficient detail to replicate this program to other settings.
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Affiliation(s)
- Michael A Barone
- Johns Hopkins University School of Medicine, BRB 137 733 North Broadway, Baltimore, MD, 21205, USA
| | - Robert A Dudas
- Johns Hopkins University School of Medicine, BRB 137 733 North Broadway, Baltimore, MD, 21205, USA
| | - Rosalyn W Stewart
- Johns Hopkins University School of Medicine, BRB 137 733 North Broadway, Baltimore, MD, 21205, USA
| | - Julia A McMillan
- Johns Hopkins University School of Medicine, BRB 137 733 North Broadway, Baltimore, MD, 21205, USA
| | - George J Dover
- Johns Hopkins University School of Medicine, BRB 137 733 North Broadway, Baltimore, MD, 21205, USA
| | - Janet R Serwint
- Johns Hopkins University School of Medicine, BRB 137 733 North Broadway, Baltimore, MD, 21205, USA
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Burgis JC, Lockspeiser TM, Stumpf EC, Wilson SD. Resident perceptions of autonomy in a complex tertiary care environment improve when supervised by hospitalists. Hosp Pediatr 2012; 2:228-234. [PMID: 24313030 DOI: 10.1542/hpeds.2011-0012-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Increasingly, academic hospitals have adopted hospitalist-based systems of inpatient pediatric care. Some studies comparing hospitalists with other attending physicians have suggested trainees are more satisfied with education from hospitalists. However, there are published concerns that the increased presence of hospitalists may reduce residents' autonomy. The objective of the current study was to evaluate pediatric residents' perceptions of their own autonomy after a broad ward restructuring to hospitalist-led teams. METHODS We analyzed data from standardized attending evaluations before and after a pediatric ward restructuring at an academic tertiary care hospital. Provision of most inpatient pediatric care changed from subspecialist-led teams to hospitalist-led teams. Numerical scores from evaluations before and after the restructuring were compared quantitatively. Comments from the evaluations were analyzed qualitatively to identify key themes. RESULTS Before the restructuring, there were 65 evaluations of 5 hospitalists and 602 evaluations of 32 subspecialists. After the restructuring, there were 188 evaluations of 8 hospitalists. Hospitalists were rated significantly higher on all teaching attributes compared with all attending physicians before the restructuring. The attending role in promoting autonomy was mentioned infrequently and reflected residents' perceived lack of autonomy before the restructuring. The primary theme after the restructuring was autonomy, specifically emphasizing resident leadership and decision-making and the appropriate balance of resident autonomy and supervision. CONCLUSIONS Although patient complexity was unchanged, a comparison of numerical ratings and resident comments before and after the restructuring indicates that hospitalists lead teams differently from subspecialists, with more emphasis on resident decision-making and autonomy.
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Affiliation(s)
- Jennifer C Burgis
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California 94304, USA.
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Srinivas SK, Lorch SA. The laborist model of obstetric care: we need more evidence. Am J Obstet Gynecol 2012; 207:30-5. [PMID: 22138138 DOI: 10.1016/j.ajog.2011.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/16/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
Abstract
Literature suggesting improved patient outcomes and patient satisfaction with the hospitalist model of inpatient medical care coupled with the desire to improve provider satisfaction led to the introduction of the laborist in obstetrics. This represents a significant change in the way obstetrics has been experienced and practiced from both a patient and provider perspective. The laborist was designed as a plausible model of obstetric care delivery where hospitals employ physicians to provide continuous coverage of labor and delivery units without other competing clinical duties. Anecdotal use of the laborist model in the provision of obstetric care is growing rapidly, despite the lack of research regarding its impact on maternal outcomes, neonatal outcomes, patient and provider satisfaction, and graduate medical education. We provide an overview of both the positive and negative attributes of this model of obstetric care delivery, discuss the current state of research addressing these attributes, and propose a research strategy to improve understanding of the impact of this model of care delivery.
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Heydarian C, Maniscalco J. Pediatric hospitalists in medical education: current roles and future directions. Curr Probl Pediatr Adolesc Health Care 2012; 42:120-6. [PMID: 22483082 DOI: 10.1016/j.cppeds.2012.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/16/2012] [Indexed: 11/25/2022]
Abstract
As the field of pediatric hospital medicine has evolved, pediatric hospitalists have become increasingly involved in medical student and resident education--providing direct education during clinical rotations, developing novel curricula to meet the demands of the new educational environment, occupying leadership roles in medical education, and more. The literature suggests that hospitalists possess the essential skills for teaching effectively, yet most hospitalists feel that additional training beyond residency is necessary to refine their knowledge and skills in education and in other essential domains. Several pediatric hospital medicine fellowships and continuing medical education activities have been developed in the last decade to meet this growing need. The recent publication of the Pediatric Hospital Medicine Core Competencies will help define the roles and expectations of practicing pediatric hospitalists, and will serve as a framework for future curriculum development in both graduate and continuing medical education.
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Affiliation(s)
- Cyrus Heydarian
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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14
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Fisher ES. Pediatric hospital medicine: historical perspectives, inspired future. Curr Probl Pediatr Adolesc Health Care 2012; 42:107-12. [PMID: 22483080 DOI: 10.1016/j.cppeds.2012.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/16/2012] [Indexed: 11/30/2022]
Abstract
Pediatric hospital medicine (PHM) is in an accelerated growth phase. Multiple elements have combined to affect the current state of the field. PHM is similar to other geographic specialties such as pediatric emergency medicine and pediatric critical care that deliver general, comprehensive care to patients based on hospital site. Pediatric hospitalists have been molded by changes in medicine, consumer expectations, and training program modifications. The history of PHM dates back for more than 3 decades, when unwitting pediatricians began to focus on delivering care for the hospitalized child. The ensuing years allowed for natural responses to external pressures that resulted in much of the field's initial development. In more recent years, however, pediatric hospitalists have been catalysts for change and driving forces for health care systems' improvements. Simultaneous with this has been the nearly exponential surge of energy focused on targeted initiatives, which have further defined the field and brought attention on a national level. PHM is at a critical but brilliant juncture in development. Further decisions regarding scope and demonstration of competencies are important to make with clarity of purpose. Pediatric hospitalists are advancing child health in the inpatient setting through evidence-based care, research, education, clinical excellence, advocacy, and health care business acumen. With a strong community sense and leadership evident, PHM has a bright future.
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Affiliation(s)
- Erin Stucky Fisher
- Rady Children's Hospital San Diego, Department of Pediatrics, University of California San Diego, San Diego, California, USA
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15
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Daru JA, Holmes A, Starmer AJ, Aquino J, Rauch DA. Pediatric hospitalists' influences on education and career plans. J Hosp Med 2012; 7:282-6. [PMID: 21997893 DOI: 10.1002/jhm.962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/23/2011] [Accepted: 07/02/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric hospitalist (PH) presence is rapidly increasing, yet little is known about pediatric resident exposure to hospitalists, or how this affects resident education/career decisions. OBJECTIVES To determine resident exposure to pediatric hospitalists; examine resident opinions regarding hospitalists' roles; examine resident opinion of hospital medicine career training needs; explore how resident exposure to hospitalists affects career choices. METHODS Survey of random sample of 300 residents from the American Academy of Pediatrics Section on Residents database. RESULTS Two-hundred seventy-nine pediatric residents surveyed; 120(43%) responded with variance by question; 90% work with hospitalists during residency. Of this national sample, 82% cite hospitalists as enhancing education. A majority (64%) believe pediatric hospitalists are better than primary care physicians at caring for complex inpatients; 28% felt PH provided better care for routine admissions. Over one-third surveyed are considering a career in Pediatric Hospital Medicine (PHM); 7% plan to enter the field upon graduation. Residents cited opportunities to participate in education, flexible hours, and better salaries as the top 3 reasons to become a hospitalist. Ten percent felt there was no difference between resident and hospitalist positions; 21% see PHM as a short-term job without long-term potential. Of residents entering Primary Care, a majority (59%) stated that the availability of hospitalists would positively influence their choice of a practice position; 7% said they were "less likely to choose to practice Primary Care Pediatrics because of hospitalists." CONCLUSIONS PH have a role in physician training. While PHM has become a career consideration for trainees, more work needs to be done to improve the perception of PHM as a viable long-term career.
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Affiliation(s)
- Jennifer A Daru
- Division of Pediatric Hospital Medicine, California Pacific Medical Center, San Francisco, California 94118, USA.
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16
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Lee BC, Flores G. The hybrid hospitalist teaching service: an innovative model for individualized learning, patient case-mix, and medical student and resident education. Clin Pediatr (Phila) 2012; 51:321-31. [PMID: 21946252 DOI: 10.1177/0009922811423416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alternative inpatient teams are increasing, but little is known about their impact on patient care and trainee education. PURPOSE To evaluate whether a hybrid hospitalist teaching service meets trainee and attending educational, clinical, support, patient-mix, autonomy, and efficiency needs. METHODS Post pediatric rotations, team members anonymously completed surveys with Likert-scale and open-ended questions. RESULTS In total, 78 of 80 surveys were completed. Trainees rated educational, clinical, support, and case-mix domains highly. Senior residents responded positively for autonomy, education, and opinions of hospitalists, but neutrally on leadership. Attending scores varied for efficiency, teaching, and clinical duties; the service resulted in direct observation and teaching outside of rounds, but poor delineation of roles and expectations impeded clinical task completion, teaching on rounds, and attending meetings. CONCLUSIONS This model is a satisfying, well-accepted means of enhancing trainee education and patient care, but roles and expectations must be clearly defined to maximize efficiency and satisfaction.
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Affiliation(s)
- Benjamin C Lee
- University of Texas Southwestern, Dallas, TX 75235, USA.
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Fromme HB, Bhansali P, Singhal G, Yudkowsky R, Humphrey H, Harris I. The qualities and skills of exemplary pediatric hospitalist educators: a qualitative study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1905-1913. [PMID: 20978425 DOI: 10.1097/acm.0b013e3181fa3560] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To identify the qualities and skills of exemplary and ideal pediatric hospitalist educators. METHOD The authors conducted a prospective, multi-institutional qualitative study from November 2008 through January 2009 in which they interviewed pediatric hospitalists who were identified as exemplary educators at three academic pediatric residency programs. They then conducted focus groups with residents and medical students who had recently worked with these hospitalists. Qualitative analysis was used to identify themes. RESULTS All six hospitalists identified as exemplary participated. Among invited learners, 14/18 residents (78%) and 16/18 medical students (89%) participated. Together, the participants contributed 266 comments, which the authors categorized into 36 themes within the four domains of teaching skills, personal qualities, patient care skills, and role modeling. New qualities and skills--including self-reflection/insight, encouraging autonomy, time management, knowledge acquisition, and systems knowledge--and differences in perceptions among hospitalists, residents, and students were identified. Differences between the qualities and skills of actual exemplary hospitalist educators and perceptions of those of an ideal hospitalist educator were also identified. CONCLUSIONS Pediatric hospitalists in academic residency programs have unique opportunities to significantly affect the education of medical students and residents. This study validates and expands on prior studies of the qualities and skills needed to be a successful hospitalist educator. Researchers and educators designing faculty development programs to train more successful hospitalist educators may wish to target these qualities and skills as well as the differences in medical student and resident needs.
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Affiliation(s)
- H Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
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Abstract
PURPOSE OF REVIEW The present review focuses on the latest evidence from the past 18 months related to pediatric hospitalist medicine. RECENT FINDINGS The number of hospitalists continues to increase despite many programs not being financially self-supporting. Reports in the past have shown decreased length of stay, resource utilization, and costs with the hospitalist model. There are an increasing number of studies examining patient safety, quality initiatives, and communication issues such as 'handoffs' and family-centered rounds. The teaching role continues to broaden in scope and is highly valued by trainees. Pediatric hospitalist fellowship training programs are in an early stage of development. A list of core competencies as a framework for a pediatric hospital medicine curriculum has recently been published and should help to facilitate and standardize training. Recent publications suggest that there is still significant variation in the approach to and management of many common inpatient illnesses. SUMMARY In general, there continue to be reports of positive outcomes as a result of the introduction of the hospitalist model in pediatrics. Much of the current literature is geared toward reporting on alternative models of care, inpatient quality and safety initiatives, and hospitalist teaching. What is still somewhat lacking is multicenter collaborative prospective clinical trials for common inpatient general pediatric conditions. The variation reported in the management of common conditions presents an opportunity for improving the quality, safety, resource utilization, and appropriateness of care.
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Bibliography. Genetics. Current world literature. Curr Opin Pediatr 2010; 22:833-5. [PMID: 21610333 DOI: 10.1097/mop.0b013e32834179f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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