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Eaton JL, Reed VR, Katsuki MY. Gynecologic Hospitalists: Expanding the "G" in the Obstetrics and Gynecologic Hospitalist Role. Obstet Gynecol Clin North Am 2024; 51:559-566. [PMID: 39098781 DOI: 10.1016/j.ogc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
The obstetrics and gynecology (OB/GYN) hospitalist model designates obstetricians/gynecologists focused on hospitalized women's care. OB/GYN hospitalists engage in diverse activities, encompassing patient care, teaching, research, and inpatient leadership. Primarily, they manage obstetric and gynecologic patients in the hospital, handling emergencies and providing urgent care. Hospitalists oversee the entire continuum of patient care, from the emergency department to post-acute follow-up. This model emphasizes the traditional academic attending physician's role, particularly that of the gynecologic hospitalist, who excels in acute inpatient obstetric and gynecologic medicine, advancing skills in urgent care and medical education, and ensuring quality and safety metrics.
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Affiliation(s)
- Jennifer L Eaton
- Cleveland Clinic, Obstetrics and Gynecology Institute, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Vicki R Reed
- Cleveland Clinic, Obstetrics and Gynecology Institute, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Monique Yoder Katsuki
- Cleveland Clinic, Obstetrics and Gynecology Institute, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Dujari S, Scott BJ, Gold CA, Weng Y, Kvam KA. Education Research: Educational Outcomes Associated With the Introduction of a Neurohospitalist Program. NEUROLOGY. EDUCATION 2024; 3:e200131. [PMID: 39359890 PMCID: PMC11441747 DOI: 10.1212/ne9.0000000000200131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/14/2024] [Indexed: 10/04/2024]
Abstract
Background and Objectives As the prevalence of the neurohospitalist (NH) practice model grows, understanding its effect on trainee education is imperative. We sought to determine the impact of an academic NH program on neurology resident evaluations of faculty teaching. Methods We performed a retrospective study of faculty teaching evaluations before and after the implementation of a full-time NH service. Primary outcomes were neurology resident evaluations of faculty teaching, which were compared in the pre-NH period (August 2010-July 2014) vs the post-NH period (August 2016-July 2018). In a secondary analysis, we used the difference-in-difference approach to analyze the effect of introducing the NH service on resident evaluation of faculty teaching compared with stroke and neurocritical care faculty controls. We performed an additional descriptive analysis of medical student evaluation of faculty teaching and described Residency In-service Training Exam scores and Accreditation Council for Graduate Medical Education (ACGME) resident survey data before and after the intervention. Results There were 368 resident and 360 medical student evaluations of faculty teaching during the study period. Compared to the pre-NH period, the post-NH period had significantly higher resident evaluations of faculty teaching in 19 of 27 questions of faculty teaching, across 5 of the 6 ACGME core competencies. Within the competencies of patient care, practice-based learning and improvement, and systems-based practice, the NH teaching faculty were rated significantly higher across all questions. In the difference-in-difference model, resident evaluations of faculty teaching following the implementation of the NH service remained significantly improved compared with controls in teaching evidence-based medicine, teaching diagnostic algorithms, and explaining rationale for clinical decisions. Medical student ratings of faculty teaching were unchanged in the pre-NH and the post-NH period. Discussion Neurology residents may benefit from the clinical expertise of NHs and their ability to teach evidence-based practice and role model systems-based practice. Given the central role NHs may play in trainee education, additional focus on both the local and national levels should be dedicated to further developing the teaching skills of NHs.
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Affiliation(s)
- Shefali Dujari
- From the Department of Neurology & Neurological Sciences (S.D., B.J.S., C.A.G., K.A.K.), and Quantitative Sciences Unit (Y.W.), Stanford University, CA
| | - Brian J Scott
- From the Department of Neurology & Neurological Sciences (S.D., B.J.S., C.A.G., K.A.K.), and Quantitative Sciences Unit (Y.W.), Stanford University, CA
| | - Carl A Gold
- From the Department of Neurology & Neurological Sciences (S.D., B.J.S., C.A.G., K.A.K.), and Quantitative Sciences Unit (Y.W.), Stanford University, CA
| | - Yingjie Weng
- From the Department of Neurology & Neurological Sciences (S.D., B.J.S., C.A.G., K.A.K.), and Quantitative Sciences Unit (Y.W.), Stanford University, CA
| | - Kathryn A Kvam
- From the Department of Neurology & Neurological Sciences (S.D., B.J.S., C.A.G., K.A.K.), and Quantitative Sciences Unit (Y.W.), Stanford University, CA
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Sader J, Cerutti B, Meynard L, Geoffroy F, Meister V, Paignon A, Junod Perron N. The pedagogical value of near-peer feedback in online OSCEs. BMC MEDICAL EDUCATION 2022; 22:572. [PMID: 35879752 PMCID: PMC9310367 DOI: 10.1186/s12909-022-03629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE OF THE ARTICLE During the Covid-19 pandemic, formative OSCE were transformed into online OSCE, and senior students (near peers) substituted experienced clinical teachers. The aims of the study were to evaluate quality of the feedbacks given by near peers during online OSCEs and explore the experience of near-peer feedback from both learner's and near peer's perspectives. MATERIALS AND METHODS All 2nd year medical students (n = 158) attended an online OSCE under the supervision of twelve senior medical students. Outcome measures were 1) students' perception of the quality of the feedback through an online survey (Likert 1-5); 2) objective assessment of the quality of the feedback focusing on both the process and the content using a feedback scale (Likert 1-5); 3) experience of near peer feedback in two different focus groups. RESULTS One hundred six medical students answered the questionnaire and had their feedback session videotaped. The mean perceived overall quality of senior students' overall feedback was 4.75 SD 0.52. They especially valued self-evaluation (mean 4.80 SD 0.67), balanced feedback (mean 4.93 SD 0.29) and provision of simulated patient's feedback (mean 4.97 SD 0.17). The overall objective assessment of the feedback quality was 3.73 SD 0.38: highly scored skills were subjectivity (mean 3.95 SD 1.12) and taking into account student's self-evaluation (mean 3.71 (SD 0.87). Senior students mainly addressed history taking issues (mean items 3.53 SD 2.37) and communication skills (mean items 4.89 SD 2.43) during feedback. Participants reported that near peer feedback was less stressful and more tailored to learning needs- challenges for senior students included to remain objective and to provide negative feedback. CONCLUSION Increased involvement of near peers in teaching activities is strongly supported for formative OSCE and should be implemented in parallel even if experience teachers are again involved in such teaching activities. However, it requires training not only on feedback skills but also on the specific content of the formative OSCE.
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Affiliation(s)
- Julia Sader
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1- CMU 5-6, Geneva, Switzerland.
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1- CMU 5-6, Geneva, Switzerland
| | - Louise Meynard
- Interprofessional Centre of Simulation - CIS, Geneva, Switzerland
| | - Frédéric Geoffroy
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1- CMU 5-6, Geneva, Switzerland
| | | | - Adeline Paignon
- Interprofessional Centre of Simulation - CIS, Geneva, Switzerland
- HES-SO University of Applied Sciences and Arts of Western Switzerland, School of Health Sciences Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1- CMU 5-6, Geneva, Switzerland
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Okereke I. Reply: Point the microscope toward the educator. JTCVS OPEN 2021; 8:545. [PMID: 36004093 PMCID: PMC9390654 DOI: 10.1016/j.xjon.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ikenna Okereke
- Department of Surgery, Henry Ford Health System, Detroit, Mich
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McCarthy MW. Harnessing the potential of CRISPR-based platforms to advance the field of hospital medicine. Expert Rev Anti Infect Ther 2020; 18:799-805. [PMID: 32366131 PMCID: PMC7212535 DOI: 10.1080/14787210.2020.1761333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Clustered regularly interspaced short palindromic repeats (CRISPR) are segments of nucleic acid that play a role in prokaryotic defense and form the basis of a genome editing technology that allows permanent alteration of genetic material. This methodology, known as CRISPR-Cas9, is poised to revolutionize molecular biology, but no literature yet exists on how these advances will affect hospitalists. AREAS COVERED These specialists in inpatient medicine care for a wide variety of hospitalized patients, including those with infectious disease, cancer, cardiovascular disease, autoimmune disease, hematologic disease, and a variety of other conditions that may soon be impacted by advances in gene-modifying technology provided by CRISPR-Cas9. A Literature search was performed using PubMed [1 December 2019-17 April 2020]. EXPERT OPINION This paper reviews the remarkable diagnostic and therapeutic potential of the CRISPR-Cas9 platform and concludes with a look at ethical issues and technical hurdles pertaining to the implementation of permanent gene modification in the practice of Hospital Medicine.
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Affiliation(s)
- Matthew W. McCarthy
- Weill Cornell Medical College, Division of General Internal Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Internal Medicine Student Education on Direct-Care Hospital Medicine Services: Results of a National Survey. Am J Med 2020; 133:868-875. [PMID: 32278844 DOI: 10.1016/j.amjmed.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/27/2020] [Accepted: 03/27/2020] [Indexed: 11/22/2022]
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Pedram K, Brooks MN, Marcelo C, Kurbanova N, Paletta-Hobbs L, Garber AM, Wong A, Qayyum R. Peer Observations: Enhancing Bedside Clinical Teaching Behaviors. Cureus 2020; 12:e7076. [PMID: 32226677 PMCID: PMC7093940 DOI: 10.7759/cureus.7076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Medical training relies on direct observations and formative feedback. After residency graduation, opportunities to receive feedback on clinical teaching diminish. Although feedback through learner evaluations is common, these evaluations can be untimely, non-specific, and potentially biased. On the other hand, peer feedback in a small group setting or lecture format has been shown to be beneficial to teaching behaviors, however, little is known if peer observation using a standardized tool followed by feedback results in improved teaching behaviors. Therefore, the objective of this study was to examine if feedback after peer observation results in improved inpatient teaching behaviors. Methods This study was conducted at a tertiary care hospital. Academic hospitalists in the Division of Hospital Medicine developed a standardized 28-item peer observation tool based on the Stanford Faculty Development Program to observe their peers during bedside teaching rounds and provide timely feedback after observation. The tool focused on five teaching domains (learning climate, control of session, promotion of understanding and retention, evaluation, and feedback) relevant to the inpatient teaching environment. Teaching hospitalists were observed at the beginning of a two-week teaching rotation, given feedback, and then observed at the end of the rotation. Furthermore, we utilized a post-observation survey to assess the teaching and observing hospitalists’ comfort with observation and the usefulness of the feedback. We used mixed linear models with crossed design to account for correlations between the observations. Models were adjusted for gender, age, and years of experience. We tested the internal validity of the instrument with Cronbach’s alpha. Results Seventy (range: one to four observations per faculty) observations were performed involving 27 teaching attendings. A high proportion of teachers were comfortable with the observation (79%) and found the feedback helpful (92%), and useful for their own teaching (88%). Mean scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach’s alpha of 0.81 showing high internal validity. Conclusions Peer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors. The success of this approach resulted in the expansion of peer observation to other Divisions within the Department of Internal Medicine at our Institution.
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Affiliation(s)
- Kimberly Pedram
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Michelle N Brooks
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Carolyn Marcelo
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Nargiza Kurbanova
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Laura Paletta-Hobbs
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Adam M Garber
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Alice Wong
- Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Rehan Qayyum
- Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
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van der Meulen MW, Smirnova A, Heeneman S, Oude Egbrink MGA, van der Vleuten CPM, Lombarts KMJMH. Exploring Validity Evidence Associated With Questionnaire-Based Tools for Assessing the Professional Performance of Physicians: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1384-1397. [PMID: 31460937 DOI: 10.1097/acm.0000000000002767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To collect and examine-using an argument-based validity approach-validity evidence of questionnaire-based tools used to assess physicians' clinical, teaching, and research performance. METHOD In October 2016, the authors conducted a systematic search of the literature seeking articles about questionnaire-based tools for assessing physicians' professional performance published from inception to October 2016. They included studies reporting on the validity evidence of tools used to assess physicians' clinical, teaching, and research performance. Using Kane's validity framework, they conducted data extraction based on four inferences in the validity argument: scoring, generalization, extrapolation, and implications. RESULTS They included 46 articles on 15 tools assessing clinical performance and 72 articles on 38 tools assessing teaching performance. They found no studies on research performance tools. Only 12 of the tools (23%) gathered evidence on all four components of Kane's validity argument. Validity evidence focused mostly on generalization and extrapolation inferences. Scoring evidence showed mixed results. Evidence on implications was generally missing. CONCLUSIONS Based on the argument-based approach to validity, not all questionnaire-based tools seem to support their intended use. Evidence concerning implications of questionnaire-based tools is mostly lacking, thus weakening the argument to use these tools for formative and, especially, for summative assessments of physicians' clinical and teaching performance. More research on implications is needed to strengthen the argument and to provide support for decisions based on these tools, particularly for high-stakes, summative decisions. To meaningfully assess academic physicians in their tripartite role as doctor, teacher, and researcher, additional assessment tools are needed.
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Affiliation(s)
- Mirja W van der Meulen
- M.W. van der Meulen is PhD candidate, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands, and member, Professional Performance Research Group, Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0003-3636-5469. A. Smirnova is PhD graduate and researcher, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands, and member, Professional Performance Research Group, Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0003-4491-3007. S. Heeneman is professor, Department of Pathology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0002-6103-8075. M.G.A. oude Egbrink is professor, Department of Physiology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0002-5530-6598. C.P.M. van der Vleuten is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0001-6802-3119. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0001-6167-0620
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Salim SA, Elmaraezy A, Pamarthy A, Thongprayoon C, Cheungpasitporn W, Palabindala V. Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis. J Community Hosp Intern Med Perspect 2019; 9:121-134. [PMID: 31044043 PMCID: PMC6484472 DOI: 10.1080/20009666.2019.1591901] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Over the past 20 years, hospitalists have assumed a greater portion of healthcare service for hospitalized patients. This was mainly due to reducing the length of stay (LOS) and hospital costs shown by many studies. In contrast, other studies suggested increased cost and resources utilization associated with hospitalist-run care models. Aim: We aimed to provide class 1 evidence regarding the effect of hospitalist-run care models on the efficiency of care and patient satisfaction. Design: Meta-analysis. Methods: Four electronic medical databases were searched to retrieve all relevant studies. Two authors screened titles and abstracts of search results for eligibility according to predefined criteria. Initially eligible studies were screened for full text inclusion. Included studies were reviewed for data on LOS, hospital cost, readmission, mortality, and patient satisfaction. Available data were abstracted and analyzed using Comprehensive Meta-Analysis. Results: Sixty-one studies were included for analysis. The overall effect size favored hospitalist-run care models in terms of LOS (MD = -0.67 day, 95% CI [-0.78, -0.56], p < 0.001). There was no significant difference in terms of hospital cost (MD = $92.1, 95% CI [-910.4, 1094.6], p = 0.86) whereas patient satisfaction was similar or even better in hospitalist compared to non-hospitalist (NH) service. Conclusion: Our analysis showed that hospitalist care is associated with decreased LOS and increased patient satisfaction compared to NH. This indicates an increase in the efficiency of care that does not come at the expense of care quality.
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Affiliation(s)
- Sohail Abdul Salim
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ahmed Elmaraezy
- Global Clinical Scholars Research Training (GCSRT) Program, Harvard Medical School, Boston, MA, USA.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Al-Razi Medical Research Academy, Cairo, Egypt
| | - Amaleswari Pamarthy
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
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Bhandari S, Jha P, Thakur A, Gooley BT, Lange JJ, Paudel H, Frank M. Perceptions of Third-year Medical Students of a Non-resident Hospitalist Rotation. Cureus 2019; 11:e4214. [PMID: 31114733 PMCID: PMC6505734 DOI: 10.7759/cureus.4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Although medical students in the United States frequently rotate on a non-resident hospitalist team, there is a paucity of literature on their perceptions regarding such rotation. We sought to assess the perceptions of third-year medical students (M3s) regarding a non-resident hospitalist rotation. Methods We conducted a web-based survey of M3s who had previously rotated on a non-resident hospitalist service. We assessed their perceptions regarding patient assignments and complexities, rounding preferences, barriers to learning, and the benefits of the rotation. A descriptive analysis was performed on the responses. Results Out of 49 respondents, 47% preferred carrying a maximum of three patients during rounds and 57% preferred patients with fewer comorbidities. Fifty-one percent preferred rounding on all patients covered by the team as opposed to rounding on their assigned patients only. Despite several perceived benefits of the rotation, students also identified various barriers to learning while rotating in a non-resident hospitalist rotation. Conclusions Our study evaluated the perceptions of M3s regarding the ideal patient load, patient complexities, barriers to learning and various benefits of a non-resident hospitalist rotation. The students' perceptions can potentially be addressed and incorporated to make the non-resident hospitalist rotation more educational for the students.
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Affiliation(s)
- Sanjay Bhandari
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Pinky Jha
- Internal Medicine, Brookfield Heart and Vascular Clinic and Medical College of Wisconsin, Brookfield, USA
| | - Abhishek Thakur
- Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA
| | - Brian T Gooley
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Joel J Lange
- Emergency Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Hari Paudel
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Michael Frank
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
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Dalen JE, Ryan KJ, Waterbrook AL, Alpert JS. Hospitalists, Medical Education, and U.S. Health Care Costs. Am J Med 2018; 131:1267-1269. [PMID: 29864414 DOI: 10.1016/j.amjmed.2018.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022]
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Ratcliffe TA, Crabtree MA, Palmer RF, Pugh JA, Lanham HJ, Leykum LK. Service and Education: The Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services. J Gen Intern Med 2018; 33:449-454. [PMID: 29392597 PMCID: PMC5880780 DOI: 10.1007/s11606-017-4302-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Attending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds. OBJECTIVE To explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables. DESIGN Observational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4 weeks. PARTICIPANTS Twelve medicine teaching teams consisting of one attending, one second- or third-year resident, two to three interns, and two to three medical students. MAIN MEASURES The study examined relationships between patient complexity (comorbidities, complications) and clinical workload variables (census, turnover) with educational measures. Teams were clustered based on clinical workload and patient complexity. Educational measures of interest were time spent teaching and number of teaching topics. Data were analyzed both at the daily observation level and across a given patient's admission. KEY RESULTS We observed 12 teams, 1994 discussions (approximately 373 h of rounds) of 563 patients over 244 observation days. Teams clustered into three groups: low patient complexity/high clinical workload, average patient complexity/low clinical workload, and high patient complexity/high clinical workload. Modest associations for team, patient complexity, and clinical workload variables were noted with total time spent teaching (9.1% of the variance in time spent teaching during a patient's admission; F[8,549] = 6.90, p < 0.001) and number of teaching topics (16% of the variance in the total number of teaching topics during a patient's admission; F[8,548] = 14.18, p < 0.001). CONCLUSIONS Clinical workload and patient complexity characteristics among teams were only modestly associated with total teaching time and teaching topics.
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Affiliation(s)
- Temple A Ratcliffe
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA. .,South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Raymond F Palmer
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Jacqueline A Pugh
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Holly J Lanham
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas at Austin, Austin, TX, USA
| | - Luci K Leykum
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas at Austin, Austin, TX, USA
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Junod Perron N, Louis-Simonet M, Cerutti B, Pfarrwaller E, Sommer J, Nendaz M. The quality of feedback during formative OSCEs depends on the tutors' profile. BMC MEDICAL EDUCATION 2016; 16:293. [PMID: 27846882 PMCID: PMC5111213 DOI: 10.1186/s12909-016-0815-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND During their pre-clinical years, medical students are given the opportunity to practice clinical skills with simulated patients. During these formative objective structured clinical encounters (OSCEs), tutors from various backgrounds give feedback on students' history taking, physical exam, and communication skills. The aim of the study was to evaluate whether the content and process of feedback varied according to the tutors' profile. METHODS During 2013, all 2nd and 3rd year medical students and tutors involved in three formative OSCEs were asked to fill in questionnaires, and their feedback sessions were audiotaped. Tutors were divided into two groups: 1) generalists: primary care, general internist and educationalist physicians 2) specialists involved in the OSCE related to their field of expertise. Outcome measures included the students' perceptions of feedback quality and utility and objective assessment of feedback quality. RESULTS Participants included 251 medical students and 38 tutors (22 generalists and 16 specialists). Students self-reported that feedback was useful to improve history taking, physical exam and communication skills. Objective assessment showed that feedback content essentially focused on history taking and physical exam skills, and that elaboration on clinical reasoning or communication/professionalism issues was uncommon. Multivariate analyses showed that generalist tutors used more learner-centered feedback skills than specialist tutors (stimulating student's self-assessment (p < .001; making the student active in finding solutions, p < .001; checking student's understanding, p < .001) and elaborated more on communication and professionalism issues (p < 0.001). Specialists reported less training in how to provide feedback than generalists. CONCLUSION These findings suggest that generalist tutors are more learner-centered and pay more attention to communication and professionalism during feedback than specialist tutors. Such differences may be explained by differences in feedback training but also by differences in practice styles and frames of references that should be further explored.
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Affiliation(s)
- Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergencies, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Martine Louis-Simonet
- Service of General Internal Medicine, Department of General Internal Medicine, Rehabilitation and Geriatric Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eva Pfarrwaller
- Unit of Primary Care Teaching and Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- Unit of Primary Care Teaching and Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Service of General Internal Medicine, Department of General Internal Medicine, Rehabilitation and Geriatric Medicine, Geneva University Hospitals, Geneva, Switzerland
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Robinson RL. Hospitalist workload influences faculty evaluations by internal medicine clerkship students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2015; 6:93-8. [PMID: 25709514 PMCID: PMC4330005 DOI: 10.2147/amep.s77216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. OBJECTIVE The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. DESIGN A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. PARTICIPANTS Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. MEASURES Clinical service intensity data in terms of work relative value units (RVUs), patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. RESULTS Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation with sharing knowledge/skills and encouraging student initiative. Higher work RVUs and total patient encounters were negatively correlated with timely feedback and constructive criticism. CONCLUSION The results suggest that internal medicine clerkship student evaluations of hospitalist faculty are negatively influenced by high clinical service intensity measured in terms of annual work RVUs, patient encounters, and duty days.
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Affiliation(s)
- Robert L Robinson
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Velez-Ruiz N, Khan J, Greene JG. Defining the role of the academic neurohospitalist in residency education. Neurohospitalist 2014; 4:127-32. [PMID: 24982716 DOI: 10.1177/1941874414530722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to better understand the potential impact of the burgeoning neurohospitalist model of inpatient care on education of neurology residents and to better define possible roles for "neurohospitalists" in residency education. METHOD We designed a brief qualitative open-ended survey directed toward academic leaders in neurology and distributed it by e-mail to every academic neurology department in the United States and Canada. RESULTS Of 83 respondents, 36 (43%) had an active neurohospitalist program and only 10% felt certain they would not have 1 within the next 5 years. All respondents expected to have residents continue to be involved with inpatient care. The main perceived advantage for resident education associated with neurohospitalists was inpatient care expertise, and the main expected disadvantage was decreased exposure to subspecialty attendings. The majority anticipated positive impact on all Accreditation Council for Graduate Medical Education core competencies predominantly based on neurohospitalists' expertise in the inpatient setting. CONCLUSION The majority of academic neurology departments are expected to have a neurohospitalist program within the next 5 years. There are several perceived advantages and disadvantages to such a program for education of neurology residents. In general, the impact of these programs is expected to improve resident education. Regardless of expectations, neurohospitalists will likely play a prominent role in the education of the next generation of neurologists.
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Affiliation(s)
- Naymee Velez-Ruiz
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jaffar Khan
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - James G Greene
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
Pediatric hospital medicine (PHM) is moving toward becoming an American Board of Pediatrics (ABP) subspecialty, roughly a decade after its formal inception in 2003. Education has played a central role as the field has evolved. Hospitalists are needed to educate trainees, medical students, residents, fellows, and nurse practitioner and physician assistant students in inpatient pediatric practice. Continuous professional development is needed for hospitalists currently in practice to augment clinical skills, such as providing sedation and placing peripherally inserted central catheter lines, and nonclinical skills in areas such as quality improvement methodology, hospital administration, and health service research. To address the educational needs of the current and future state of PHM, additional training is now needed beyond residency training. Fellowship training will be essential to continue to advance the field of PHM as well as to petition the ABP for specialty accreditation. Training in using adult educational theory, curriculum, and assessment design are critical for pediatric hospitalists choosing to advance their careers as clinician-educators. Several venues are available for gaining advanced knowledge and skill as an educator. PHM clinician-educators are advancing the field of pediatric education as well as their own academic careers by virtue of the scholarly approach they have taken to designing and implementing curricula for unique PHM teaching situations. PHM educators are changing the educational paradigm to address challenges to traditional education strategies posed by duty hour restrictions and the increasing drive to shorten the duration of the hospitalization. By embracing learning with technology, such as simulation and e-learning with mobile devices, PHM educators can address these challenges as well as respond to learning preferences of millennial learners. The future for PHM education is bright.
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Ratelle JT, Dupras DM, Alguire P, Masters P, Weissman A, West CP. Hospitalist career decisions among internal medicine residents. J Gen Intern Med 2014; 29:1026-30. [PMID: 24573714 PMCID: PMC4061354 DOI: 10.1007/s11606-014-2811-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/12/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). OBJECTIVE To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. DESIGN Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. PARTICIPANTS 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. MAIN MEASURES Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. KEY RESULTS Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. CONCLUSIONS Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.
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Overby PJ, Beal JC, Yozawitz EG, Moshé SL. Introduction of a Pediatric Neurology Hospitalist Service With Continuous Electroencephalography Monitoring at a Children's Hospital. Neurohospitalist 2014; 4:74-9. [PMID: 24707335 DOI: 10.1177/1941874413519803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hospitalists, specializing in inpatient medicine, are increasingly being utilized in the hospital setting to improve efficiency, decrease costs and length of stay, and potentially improve outcomes. With these goals in mind and with the purpose of addressing the specific needs of patients on the inpatient pediatric neurology service, we established a pediatric neurohospitalist service in 2009. The primary purpose of this article is to describe the structure and the rationale for a pediatric neurohospitalist service with continuous electroencephalography at a pediatric teaching hospital and to discuss the categories of disease seen by the inpatient neurology service.
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Affiliation(s)
- Philip J Overby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jules C Beal
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Elissa G Yozawitz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA ; Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA ; Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
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Oyeyemi AY, Oyeyemi AL, Adegoke BO, Rufai AA. Physiotherapy clinical teachers’ perceptions on important attributes in teaching – A Nigerian perspective. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2012.747565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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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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Lucena JF, Alegre F, Rodil R, Landecho MF, García-Mouriz A, Marqués M, Aquerreta I, García N, Quiroga J. Results of a retrospective observational study of intermediate care staffed by hospitalists: impact on mortality, co-management, and teaching. J Hosp Med 2012; 7:411-5. [PMID: 22271454 DOI: 10.1002/jhm.1905] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 11/10/2011] [Accepted: 11/27/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospitalized patients are complex and institutions have to face the high cost of critical care and the limited resources of the ward. Intermediate care appears as an attractive strategy to provide rational care according to patient needs. It is an interesting scenario to expand co-management and teaching. STUDY DESIGN Retrospective observational study. SETTING Intermediate care unit (ImCU) of a single academic hospital. PATIENTS AND METHODS 456 patients admitted from April 2006 to April 2010 were included in the study. Demographics, admission physiologic parameters and in-hospital mortality were recorded. We used the Simplified Acute Physiology Score II (SAPS II) as prognostic score system. Co-management with medical and surgical teams, and the number of training residents were evaluated. RESULTS In-hospital mortality was 20.6%, whereas the expected mortality was 23.2% based on SAPS II score. The correlation between SAPS II predicted and observed death rates was accurate and statistically significant (Rho = 1.0, p < 0.001). Co-management was performed with several medical and surgical teams, with an increase in perioperative comanagement of 22.7% (p = 0.014). The number of training residents in ImCU increased from 4.3% to 30.4% (p = 0.002) CONCLUSIONS An ImCU led by hospitalists showed encouraging results regarding patient survival and SAPS II is an useful tool for prognostic evaluation in this population. Intermediate care serves as an expansion of role for hospitalists; and clinicians, trainees and patients may benefit from co-management and teaching opportunities at this unique level of care.
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Affiliation(s)
- Juan Felipe Lucena
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clínica Universidad de Navarra, Pamplona, Spain.
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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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Trowbridge RL, Almeder L, Jacquet M, Fairfield KM. The effect of overnight in-house attending coverage on perceptions of care and education on a general medical service. J Grad Med Educ 2010; 2:53-6. [PMID: 21975884 PMCID: PMC2931224 DOI: 10.4300/jgme-d-09-00056.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/10/2009] [Accepted: 01/14/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND An increased emphasis on patient safety has led to calls for closer supervision of medical trainees. It is unclear what effect an increased degree of faculty presence will have on educational and clinical outcomes. The aim of this study was to evaluate resident and attending attitudes and preferences regarding overnight attending supervision. METHODS This study was a cross-sectional electronic survey of physicians. Participants were resident and faculty physicians recently on inpatient service rotations after implementation of an overnight attending coverage system. RESULTS Of 58 total respondents, most faculty (91%) and resident (92%) physicians reported they were satisfied with the overall quality of care delivered and believed the quality of care delivered overnight improved with an in-house attending system (90% and 85%, respectively). Most resident physicians (82%) believed the educational experience improved with the system of increased attending availability. Nearly all faculty (95%) and resident (97%) physicians preferred the in-house attending system to the traditional system of attendings being available by pager. The implementation of such coverage resulted in increased cost to the hospital for compensating covering hospitalist physicians. CONCLUSION In-house attending coverage was acceptable to both residents and faculty, with perceived improvements in quality and educational experience.
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Affiliation(s)
- Robert L. Trowbridge
- Corresponding author: Robert Trowbridge, MD, Department of Medicine/Pavilion 2227, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, 207.662.4618,
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Freed GL, Dunham KM, Lamarand KE. Hospitalists' involvement in pediatrics training: perspectives from pediatric residency program and clerkship directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1617-1621. [PMID: 19858826 DOI: 10.1097/acm.0b013e3181bb1f0d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To explore the use and perceived impact of pediatric hospitalists as teaching attendings among pediatric residency and clerkship programs. METHOD Between November 2007 and February 2008, the authors conducted a mail-based survey of all pediatric residency program directors (170) and pediatric clerkship directors (131) in the United States as identified by the Association of Pediatric Program Directors and Council on Medical Student Education in Pediatrics. The surveys focused on the responsibilities of pediatric hospitalists in training programs and their perceived impact on the roles of pediatric residents and medical students. RESULTS The response rate for residency directors was 86% (146/170) and 87% (114/131) for clerkship directors. One hundred thirteen (77%) residency programs and 91 (80%) clerkship programs used hospitalists as teaching attendings. Among these programs, 65% (73) of residency program directors and 64% (58) of clerkship directors reported that pediatric hospitalists are responsible for all general inpatient services. The majority of residency (76%, 84) and clerkship directors (71%, 64) reported that hospitalists are more accessible to trainees than traditional attendings. A minority of residency program directors (36%, 39) reported that use of hospitalists has decreased senior resident autonomy. CONCLUSIONS The role of hospitalists in resident and student education will likely continue to evolve over the next decade.Additional refinement of the roles and responsibilities of hospitalists will address lingering concerns in some programs about resident autonomy.
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Affiliation(s)
- Gary L Freed
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI 48109-0456, USA.
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Natarajan P, Ranji SR, Auerbach AD, Hauer KE. Effect of hospitalist attending physicians on trainee educational experiences: a systematic review. J Hosp Med 2009; 4:490-8. [PMID: 19824099 DOI: 10.1002/jhm.537] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Trainees receive much of their inpatient education from hospitalists. PURPOSE To characterize the effects of hospitalists on trainee education. DATA SOURCES MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term "hospitalist", and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION Original English language research studies meeting all of the following: involvement of hospitalists; comparison to nonhospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing hospitalists to nonhospitalists, trainees were more satisfied with hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonhospitalist general internists from specialists showed that trainees preferred hospitalists, but the other did not demonstrate a hospitalist advantage over general internists. CONCLUSIONS Trainees are more satisfied with inpatient education from hospitalists. Whether the increased satisfaction translates to improved learning is unclear.
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Affiliation(s)
- Pradeep Natarajan
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abstract
CONTEXT The ways hospitalists interact with and contribute to internal medicine residencies in the United States have been described locally, but have not been documented on a national level. OBJECTIVES To describe the penetration of hospitalists into medicine residency faculty nationally, and document their contributions to teaching activities. DESIGN, SETTING, AND PARTICIPANTS Survey of all 386 internal medicine residency directors in the United States in 2005 (272 respondents) and 2007 (236 respondents). MEASUREMENTS Number of teaching hospitals utilizing hospitalists, number of programs utilizing hospitalists to teach, hospitalist teaching duties, and number with hospitalist tracks. RESULTS In 2005, program directors recalled 54% of teaching hospitals employed hospitalists before and 73% after implementation of work-hour limitations. Of those employing hospitalists, 92% of programs in the Northeast and West used them to teach. Two years later, the Midwest (78%) and South (76%) continued to lag behind in the proportion of teaching hospitalists. Specific teaching activities of hospitalists included: attending on teaching service (92%), conducting rounds (81%), observation of clinical skills (67%), lectures (68%), and morning report (52%). Seven percent of program directors reported other duties of hospitalists, including: supervising procedures, reviewing night float patients, serving as associate program directors, and writing curricula. Eleven percent of training programs had hospitalist tracks. CONCLUSIONS As hospitalists have become prevalent and have become efficient clinicians in community and university hospitals, the majority of internal medicine residencies have enlisted them to provide rounds, lectures, and bedside teaching. A small number of residencies are beginning to develop tracks to facilitate this new career option for graduates.
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Affiliation(s)
- Brent W Beasley
- Internal Medicine, University of Missouri-Kansas City, Saint Luke's Hospital, Kansas City, Missouri 64111, USA.
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O'Leary MD KJ, Williams MD MV. The evolution and future of hospital medicine. ACTA ACUST UNITED AC 2008; 75:418-23. [DOI: 10.1002/msj.20078] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goldenberg J, Glasheen JJ. Hospitalist educators: future of inpatient internal medicine training. ACTA ACUST UNITED AC 2008; 75:430-5. [DOI: 10.1002/msj.20075] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Flanders SA, Saint S, McMahon LF, Howell JD. Where should hospitalists sit within the academic medical center? J Gen Intern Med 2008; 23:1269-72. [PMID: 18592320 PMCID: PMC2517972 DOI: 10.1007/s11606-008-0682-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 04/18/2008] [Accepted: 04/18/2008] [Indexed: 11/30/2022]
Abstract
One of the most significant changes in US hospitals over the past decade has been the emergence of hospitalists as key providers of inpatient care. The number of hospitalists in both community and teaching hospitals is growing rapidly, and as the field burgeons, many are questioning where hospitalists should reside within the academic medical center (AMC). Should they be a distinct division or department, or should they be incorporated into existing divisions? We describe hospital medicine's current trajectory and provide recommendations for hospital medicine's place in the AMC. Local social and economic factors are most likely to determine whether hospital medicine programs will become independent divisions at most AMCs. We believe that in many large AMCs, separate divisions of hospital medicine are less likely to form soon, and in our opinion should not form until they are able to fulfill the tripartite mission traditionally carried out by independent specialist divisions. At community hospitals and less research-oriented AMCs, hospital medicine programs may soon be ready to become separate divisions.
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Affiliation(s)
- Scott A Flanders
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Abstract
In the mid 1990s, a new model for hospital care began to take hold in the United States, in which a separate physician, who I dubbed a "hospitalist," assumed the responsibility for managing the inpatient stay in place of the primary care physician. A 2006 American Hospital Association survey indicated that there are more than 20,000 hospitalists in the United States, making this the fastest growing medical specialty in American medical history. In this article, I briefly trace the reasons for the field's remarkable growth, describe some of hospital medicine's key issues and concerns, and speculate about the future shape of the field.
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Affiliation(s)
- Robert M Wachter
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco 94143-0120, USA.
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O'Leary KJ, Chadha V, Fleming VM, Martin GJ, Baker DW. Medical subinternship: student experience on a resident uncovered hospitalist service. TEACHING AND LEARNING IN MEDICINE 2008; 20:18-21. [PMID: 18444180 DOI: 10.1080/10401330701797974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Studies demonstrating the value of hospitalists to medical student education have been performed in traditional resident covered ward service settings (RCWS). PURPOSE To compare medical subinterns' experiences on an RCWS to that on a resident uncovered hospitalist service (RUHS). METHODS We assessed students' overall experience and knowledge learned on the two services using a 5-point Likert scale. We also assessed learning environment characteristics, workload, and time spent at the hospital on each service. RESULTS The mean rating for knowledge learned was higher on the RCWS. Subinterns rated the two services equivalent on measures of educational value of patient problems, faculty assessment, supervision, and number and value of teaching sessions. The RCWS received higher ratings on variety of patient problems and frequency of intellectual discussion. CONCLUSIONS The RCWS provided a superior learning experience for subinterns. Academic medical centers should take these findings into consideration before placing medical students on an RUHS.
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Affiliation(s)
- Kevin J O'Leary
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Nicholson LJ, Warde CM, Boker JR. Faculty training in evidence-based medicine: improving evidence acquisition and critical appraisal. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2007; 27:28-33. [PMID: 17385730 DOI: 10.1002/chp.90] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Evidence-based medicine (EBM) integrates published clinical evidence with patient values and clinical expertise, the output of which is informed medical decision making. Key skills for evidence-based practice include acquisition and appraisal of clinical information. Faculty clinicians often lack expertise in these skills and are therefore unable to demonstrate this process for students and residents. METHODS We conducted a yearlong case-based EBM workshop for 28 clinician educators, with precourse and postcourse evaluations of EBM resource use and literature appraisal skills. RESULTS Of the original 28 participants, 26 completed the course. Self-assessed EBM resource use improved significantly. Self-reported EBM knowledge correlated with measured skill (r = 0.45), and both improved with the intervention (both p < .001). Higher EBM skills scores correlated with time logged on the course's EBM Web sites (r = 0.56; p < .05), workshop attendance rates (r = 0.55; p = .003), and fewer years since medical school graduation (r = -0.56; p < .005). DISCUSSION An interactive, longitudinal, EBM course derived from a needs assessment can improve 2 skills important for evidence-based practice: online literature retrieval and critical appraisal skills.
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Affiliation(s)
- Laura J Nicholson
- University of California, San Diego, School of Medicine, San Diego, CA 92130, USA.
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Geskey JM, Kees-Folts D. Third-year medical students' evaluation of hospitalist and nonhospitalist faculty during the inpatient portion of their pediatrics clerkships. J Hosp Med 2007; 2:17-22. [PMID: 17274044 DOI: 10.1002/jhm.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although the data on the impact of hospitalist programs on the inpatient education of medical students during their internal medicine clerkships are favorable, the data is limited on the inpatient educational experience of medical students during their pediatric clerkships. The purpose of this study was to compare the evaluations of hospitalist and nonhospitalist faculty of third-year medical students during their inpatient pediatrics rotations. METHODS We performed a retrospective study of the evaluations of third-year medical student of hospitalist and nonhospitalist faculty during their inpatient pediatrics rotations at Penn State Children's Hospital from July 1999 through September 2000. Using a 4-point scale, students gave an overall evaluation and also rated the hospitalist and nonhospitalist faculty on effectiveness as teachers, effectiveness as pediatricians, and effectiveness as student advocates. Using the same 4-point scale, students rated the following aspects of the rotation: ward rounds, sick newborn care, well newborn care, outpatient clinics, private physician's office, noon conferences, and morning report. RESULTS A total of 67 students rotated on the pediatric inpatient service during the study period; 35 students rotated with 2 hospitalists, and 32 students rotated with 8 nonhospitalists. All 67 students (100%) submitted an evaluation. The hospitalists received higher scores than nonhospitalists on effectiveness as teachers (3.87 vs. 2.91; P < 0.001), effectiveness as pediatricians (3.94 vs. 3.25; P < .001), effectiveness as student advocates (3.76 vs. 2.97; P < .001), and in the overall evaluation (3.93 vs. 3.06; P < .001). Ward rounds were rated as more beneficial when conducted by hospitalists then when conducted by nonhospitalists (3.15 vs. 2.58; P < .006). CONCLUSIONS Hospitalists were perceived by third-year medical students as providing more effective teaching and more satisfying overall rotations than were nonhospitalists during the inpatient portion of the students' pediatric clerkships. Further studies that examine inpatient systems, particularly as they relate to the acquisition of knowledge and the development of effective communication skills in medical learners, are needed.
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Affiliation(s)
- Joseph M Geskey
- Department of Pediatrics, Division of General Pediatrics, Penn State Children's Hospital, Penn State University College of Medicine, Hershey, Pennsylvania 17033-0850, USA.
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Skrabal MZ, Kahaleh AA, Nemire RE, Boxer H, Broshes Z, Harris M, Cardello E. Preceptors' perspectives on benefits of precepting student pharmacists to students, preceptors, and the profession. J Am Pharm Assoc (2003) 2006; 46:605-12. [PMID: 17036647 DOI: 10.1331/1544-3191.46.5.605.skrabal] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To educate pharmacists on the shortage of quality preceptors and the benefits received from precepting; present insights from successful preceptors and offer guidance to current and prospective preceptors; and encourage pharmacists to become preceptors and mentor aspiring pharmacy professionals. SETTING Advanced experiential settings for Nova Southeastern, Ohio Northern, and Creighton Universities. PRACTICE DESCRIPTIONS: Hospital, community, and outpatient clinic settings. PRACTICE INNOVATION Successful incorporation of student pharmacists and the experiential process into pharmacy practice. MAIN OUTCOME MEASURE Not applicable. RESULTS A variety of factors has produced an increased demand for qualified pharmacist preceptors, including workload issues, an increasing number of pharmacy schools, and an increased experiential load in the pharmacy school curricula. Characteristics of quality preceptors include demonstrating enthusiasm in their teaching, being open to questions, and providing constructive feedback. Sites and preceptors can benefit from teaching student pharmacists by receiving assistance in developing and maintaining clinical services, sensing the satisfaction of giving back to the profession, and material rewards provided by schools of pharmacy. In this article, three successful preceptors share their perspectives and insights about precepting, and a professional organization perspective is included to highlight the support for precepting student pharmacists. CONCLUSION Additional introductory and advanced quality pharmacy experiential practice sites are needed, and pharmacists are encouraged to contact nearby pharmacy schools to become preceptors.
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Affiliation(s)
- Maryann Z Skrabal
- Office of Experiential Education, Pharmacy Practice Department, School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
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Arora V, Fang MC, Kripalani S, Amin AN. Preparing for "diastole": advanced training opportunities for academic hospitalists. J Hosp Med 2006; 1:368-77. [PMID: 17219531 DOI: 10.1002/jhm.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Academic hospital medicine can be described as comprising periods of "systole," during which hospitalists provide clinical care, and periods of "diastole," the portion of a hospitalist's time spent in nonclinical activities. Far from being a period of relaxation, diastole is an active component of a hospitalist's work, the time devoted to the pursuit of career advancement. This period is a critical opportunity for career development in terms of medical research, education, quality improvement, or administration. An appropriate balance of systole and diastole may potentially prevent burnout and allow hospitalists opportunities to focus on academic advancement. Although an increasing number of residency graduates opt for a career in academic hospital medicine, few are prepared for the period of diastole. This article describes several career options in academic hospital medicine, specifically, opportunities in education, research, quality improvement, and administrative opportunities. By informing future hospitalists about the career opportunities within academic hospital medicine possible through managing their diastolic time, we hope that future generations of trainees will be better prepared to enter this field.
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Affiliation(s)
- Vineet Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Pressel DM. Hospitalists in medical education: coming to an academic medical center near you. J Natl Med Assoc 2006; 98:1501-4. [PMID: 17019919 PMCID: PMC2569720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Hospitalists are physicians whose medical practice focuses on general medical inpatient care. In the past decade, the number of practicing hospitalists has soared, and hospitalist programs have been established at both community hospitals and academic medical centers. As hospitalists increasingly assume a greater share of inpatient care responsibilities, they will contribute to the training of medical students and house staff. This paper reviews current data on the impact of hospitalists on medical education and the future of hospitalist training.
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Affiliation(s)
- David M Pressel
- Department of Pediatrics, A.I. DuPont Hospital for Children, Wilmington, DE 19899, USA.
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Freed GL, Uren RL. Hospitalists in children's hospitals: What we know now and what we need to know. J Pediatr 2006; 148:296-9. [PMID: 16615954 DOI: 10.1016/j.jpeds.2005.12.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 12/19/2005] [Accepted: 12/20/2005] [Indexed: 11/17/2022]
Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, 48109, USA.
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Ranji SR, Rosenman DJ, Amin AN, Kripalani S. Hospital medicine fellowships: works in progress. Am J Med 2006; 119:72.e1-7. [PMID: 16431196 DOI: 10.1016/j.amjmed.2005.07.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 07/29/2005] [Indexed: 10/25/2022]
Abstract
The field of hospital medicine continues to grow rapidly, and with this growth has come the realization that residency alone may not provide the full complement of skills required of a successful hospitalist. As a result, several institutions have started hospitalist fellowships, new programs with the specific goal of training clinicians to improve hospital care. These fellowships offer diverse approaches to preparation for a hospitalist career, with opportunities for advanced training in clinical care, teaching, research, and quality improvement. This article provides an overview of the programs, explores the choices for trainees in selecting a fellowship, and the challenges for institutions in developing a new fellowship. Although hospitalist fellowships are still in evolution, they will play an important role in the development of hospital medicine.
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Affiliation(s)
- Sumant R Ranji
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0131, USA.
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Dressler DD, Pistoria MJ, Budnitz TL, McKean SCW, Amin AN. Core competencies in hospital medicine: development and methodology. J Hosp Med 2006; 1:48-56. [PMID: 17219471 DOI: 10.1002/jhm.6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The hospitalist model of inpatient care has been rapidly expanding over the last decade, with significant growth related to the quality and efficiency of care provision. This growth and development have stimulated a need to better define and characterize the field of hospital medicine. Training and developing curricula specific to hospital medicine are the next step in the evolution of the field. METHODS The Core Competencies in Hospital Medicine: A Framework for Curriculum Development (the Core Competencies), by the Society of Hospital Medicine, introduces the expectations of hospitalists and provides an initial structural framework to guide medical educators in developing curricula that incorporate these competencies into the training and evaluation of students, clinicians-in-training, and practicing hospitalists. This article outlines the process that was undertaken to develop the Core Competencies, which included formation of a task force and editorial board, development of a topic list, the solicitation for and writing of chapters, and the execution of multiple reviews by the editorial board and both internal and external reviewers. RESULTS This process culminated in the Core Competencies document, which is divided into three sections: Clinical Conditions, Procedures, and Healthcare Systems. The chapters in each section delineate the core knowledge, skills, and attitudes necessary for effective inpatient practice while also incorporating a systems organization and improvement approach to care coordination and optimization. CONCLUSIONS These competencies should be a common reference and foundation for the creation of hospital medicine curricula and serve to standardize and improve inpatient training practices.
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Affiliation(s)
- Daniel D Dressler
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Dressler DD, Pistoria MJ, Budnitz TL, McKean SCW, Amin AN. Core competencies in hospital medicine: development and methodology. J Hosp Med 2006; 1 Suppl 1:48-56. [PMID: 17219569 DOI: 10.1002/jhm.85] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The hospitalist model of inpatient care has been rapidly expanding over the last decade, with significant growth related to the quality and efficiency of care provision. This growth and development have stimulated a need to better define and characterize the field of hospital medicine. Training and developing curricula specific to hospital medicine are the next step in the evolution of the field. METHODS The Core Competencies in Hospital Medicine: A Framework for Curriculum Development (the Core Competencies), by the Society of Hospital Medicine, introduces the expectations of hospitalists and provides an initial structural framework to guide medical educators in developing curricula that incorporate these competencies into the training and evaluation of students, clinicians-in-training, and practicing hospitalists. This article outlines the process that was undertaken to develop the Core Competencies, which included formation of a task force and editorial board, development of a topic list, the solicitation for and writing of chapters, and the execution of multiple reviews by the editorial board and both internal and external reviewers. RESULTS This process culminated in the Core Competencies document, which is divided into three sections: Clinical Conditions, Procedures, and Healthcare Systems. The chapters in each section delineate the core knowledge, skills, and attitudes necessary for effective inpatient practice while also incorporating a systems organization and improvement approach to care coordination and optimization. CONCLUSIONS These competencies should be a common reference and foundation for the creation of hospital medicine curricula and serve to standardize and improve inpatient training practices.
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Affiliation(s)
- Daniel D Dressler
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Holmboe ES, Bowen JL, Green M, Gregg J, DiFrancesco L, Reynolds E, Alguire P, Battinelli D, Lucey C, Duffy D. Reforming internal medicine residency training. A report from the Society of General Internal Medicine's task force for residency reform. J Gen Intern Med 2005; 20:1165-72. [PMID: 16423110 PMCID: PMC1490285 DOI: 10.1111/j.1525-1497.2005.0249.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 07/26/2005] [Accepted: 07/26/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Eric S Holmboe
- American Board of Internal Medicine, Philadelphia, PA 19106, USA.
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Abstract
The hospitalist "specialty" is sweeping the inpatient setting with numbers of physicians choosing this specialty expected to exceed 20,000 by 2010. Yet, little is known about the involvement of nursing in the design, implementation, and evaluation of a hospitalist initiative. The author suggests the chief nursing officer's pivotal role in proactively encouraging the design and implementation of a hospitalist-nurse manager patient-centered care delivery model. The chief nursing officer can create an environment to foster research designed to identify outcomes from this partnership of hospitalist and clinical (nurse) manager.
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Affiliation(s)
- Lynda Olender
- Bronx VA Medical Center, Bronx, New York 10468, USA.
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