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Miller BG, Mike TB, Fromme HB. We're All in This Together: The Future of PHM Workforce. Hosp Pediatr 2024; 14:e362-e364. [PMID: 39034844 DOI: 10.1542/hpeds.2024-007857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Benjamin G Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas B Mike
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - H Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Elster MJ, Cohen A, Herchline D, Chieco D, Hoefert J, Denniston S. The transition to Pediatric Hospital Medicine fellowship: A national survey-based needs assessment. J Hosp Med 2024; 19:159-164. [PMID: 38263765 DOI: 10.1002/jhm.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Each year, the number of fellows entering Pediatric Hospital Medicine (PHM) fellowship is increasing. Residency curricula do not always prepare trainees for all aspects of PHM as a specialty and gaps often exist in the transition to fellowship. OBJECTIVE To explore the preparedness of PHM fellows for clinical, teaching, and scholarship tasks at the start of fellowship and to identify opportunities for residency and fellowship program development. DESIGN Quantitative survey. SETTING AND PARTICIPANTS Current and recently graduated PHM fellows (matriculation years 2019-2022). METHODS We conducted a national cross-sectional survey from July 2022 to February 2023. We designed survey questions based on PHM fellowship core competencies. MAIN OUTCOME AND MEASURES We asked participants to rate preparedness for tasks on a 5-point Likert scale (1 = very unprepared, 5 = very prepared). We analyzed numerical data using descriptive and comparative statistics and free-response data using inductive content analysis. RESULTS We received 223 responses to our survey (response rate 74%). Of the respondents, 25% reported no PHM-specific orientation at their program (n = 55). Respondents reported lower median preparedness for research (3, interquartile range [IQR] [2,4]) and teaching tasks (4, IQR [4,4]) compared to clinical tasks (4, IQR [4,5]) at the start of fellowship (p < 0.01, p < 0.01). Content analysis revealed most fellows wished they had received more training around scholarship at the start of fellowship. CONCLUSIONS Many PHM fellows enter fellowship feeling inadequately prepared, particularly in scholarship and teaching. Our findings suggest that residency and fellowship programs need to develop more robust curricula to better prepare trainees for successful PHM fellowship. This national survey-based needs assessment should serve as a guide for further program development.
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Affiliation(s)
- Martha J Elster
- Division of Pediatric Hospital Medicine, The University of California, San Francisco, San Francisco, California, USA
| | - Adam Cohen
- Division of Pediatric Hospital Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Daniel Herchline
- Division of Hospital Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Deanna Chieco
- Division of Pediatric Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Hoefert
- Division of Pediatric Hospital Medicine, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Sarah Denniston
- Division of Pediatric Hospital Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Mike TB, Marek R, Jackson K, Lee S, Fromme HB. Pediatric Hospital Medicine: Cultivating a Sustainable Field. Hosp Pediatr 2024; 14:e120-e122. [PMID: 38282521 DOI: 10.1542/hpeds.2023-007490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Thomas B Mike
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Rachel Marek
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Kelsey Jackson
- Division of Hospital Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Susan Lee
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - H Barrett Fromme
- Department of Pediatrics, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Goldstein L, Lau J, Ford H, Balmer D, Tenney-Soeiro R. A Qualitative Exploration of Pediatric Resident Perceptions of Autonomy in the Era of Pediatric Hospital Medicine Fellowship. Acad Pediatr 2024; 24:162-172. [PMID: 37567441 DOI: 10.1016/j.acap.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Some pediatric residents report experiencing less autonomy when working clinically with pediatric hospital medicine (PHM) fellows than with attendings alone. We sought to explore pediatric senior resident (SR) experiences working clinically with PHM fellows, with a focus on characterizing fellow behaviors that could impact perceived resident autonomy. METHODS In this qualitative study, we conducted virtual semistructured interviews with pediatric SRs. We recorded, deidentified, and transcribed interviews for codebook thematic analysis, making iterative adjustments to our codebook and themes until reaching thematic sufficiency. RESULTS We conducted 17 interviews. A subanalysis identified key components of the resident mental model of autonomy, including independent clinical decision-making with 3 core qualifiers: 1) plan follow-through, 2) availability of a safety net, and 3) ownership. Our primary analysis identified 4 key themes (with a total of 7 contributory subthemes) describing resident experiences of autonomy, scaffolded based on an organizing framework adapted from Bronfenbrenner's ecological model including 1) microsystem factors (based on direct resident-fellow or resident-leadership team interactions), 2) mesosystem factors (based on fellow-attending interactions), 3) exosystem factors (based on fellow-intrinsic characteristics), and 4) macrosystem factors (cultural values, norms, and policies governing academic pediatrics). CONCLUSIONS Many factors impact perceived resident autonomy on PHM fellow-inclusive teams. Although some are related to direct resident-fellow interactions, many others are more complex and may reflect resident interactions with the leadership team, attending-fellow dynamics, and the influence of cultural context. Based on our analysis, we propose several best-practice recommendations directed at fellows, attendings, the fellow-attending dyad, and Graduate Medical Education programs overall.
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Affiliation(s)
- Laura Goldstein
- Department of Pediatrics, Children's Hospital of Philadelphia, Pa.
| | - Julianna Lau
- Department of Pediatrics, Children's Hospital of Philadelphia, Pa
| | - Hannah Ford
- Department of Pediatrics, Children's Hospital of Philadelphia, Pa
| | - Dorene Balmer
- Department of Pediatrics, Children's Hospital of Philadelphia, Pa
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Casillas CA, Brower L. "What next?": Navigating if pediatric hospital medicine fellowship is right for you. J Hosp Med 2023; 18:941-943. [PMID: 37415429 DOI: 10.1002/jhm.13160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Carlos A Casillas
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Brower
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Gottenborg E, Limes J, Pingree E, Bryant A. Charting the course of Hospital Medicine tracks: Exploring the past, present and future. J Hosp Med 2023; 18:944-947. [PMID: 37424060 DOI: 10.1002/jhm.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/03/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Emily Gottenborg
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julia Limes
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elizabeth Pingree
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Bryant
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
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Patel SJ, Lynn J, Varghese S, Sanders RD, Zwemer E, Seelbach EB, Patra KP, Mirchandani DR, Griego E, Beck J. Preparing for a Career in Pediatric Hospital Medicine: A Needs Assessment and Recommendations for Individualized Curricula. Hosp Pediatr 2022; 12:e30-e37. [PMID: 34913058 DOI: 10.1542/hpeds.2021-005830] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The individualized curriculum within residency programs allows residents to tailor their elective time toward future career goals and interests. Our objective was to identify experiences and activities that would foster resident interest and enhance preparation for a career in pediatric hospital medicine (PHM). METHODS Electronic surveys were distributed to pediatric hospitalists, PHM fellowship directors, and graduating PHM fellows. These stakeholders were asked to identify key experiences for residents to explore before entering fellowship or practice. Descriptive statistics and thematic analysis were performed on survey responses. RESULTS Forty-six percent of PHM fellows (16 of 35), 42% of pediatric hospitalists (149 of 356), and 58% of fellowship program directors (35 of 60) completed the survey. All 3 groups identified complex care as the most important clinical experience to gain in residency. Other highly valued clinical experiences included pain management, surgical comanagement, and palliative care. Lumbar puncture, electrocardiograph interpretation, and airway management were identified as essential procedural skills. Nonclinical experiences that were deemed important included quality improvement, development of teaching skills, and research methodology. All groups agreed that these recommendations should be supplemented with effective mentorship. CONCLUSIONS Identification of key clinical experiences, nonclinical activities, and mentorship for residents interested in PHM may assist with tailoring the individualized curriculum to personal career goals. Incorporating these suggested experiences can improve preparedness of residents entering PHM.
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Affiliation(s)
- Shivani J Patel
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Justin Lynn
- Department of Pediatrics, Medical Center, University of Rochester, Rochester, New York
| | - Sarah Varghese
- Department of Pediatrics, Emory University/Children's Hospital of Atlanta, Atlanta, Georgia
| | - Rebecca Dean Sanders
- Department of Pediatrics, Emory University/Children's Hospital of Atlanta, Atlanta, Georgia
| | - Eric Zwemer
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - E Berry Seelbach
- Department of Pediatrics, University of Kentucky, Lexington, Kentucky
| | - Kamakshya P Patra
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Dipti R Mirchandani
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra University, Hempstead, New York
| | - Elena Griego
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Jimmy Beck
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
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Chandrasekar H, White YN, Ribeiro C, Landrigan CP, Marcus CH. A Changing Landscape: Exploring Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships. Hosp Pediatr 2021; 11:109-115. [PMID: 33397817 DOI: 10.1542/hpeds.2020-0034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed. METHODS A survey to explore residents' perspectives on PHM fellowships, with questions regarding demographics, likelihood of pursuing PHM after fellowship introduction, and influencing factors was distributed to pediatric and combined pediatric residents via program directors. RESULTS The survey was distributed to an estimated 2657 residents. A total of 855 (32.2%) residents completed the survey; 89% of respondents had at least considered a career in PHM, and 79.4% reported that the introduction of the PHM fellowship requirement for subspecialty certification made them less likely to pursue PHM. Intent to practice in a community setting or only temporarily practice PHM, Combined Internal Medicine and Pediatric trainee status, and high student loan burden were associated with decreased likelihood of pursuing PHM (P < .05). Most respondents reported that forfeited earnings during fellowship, family and student loan obligations, and perceived sufficiency of residency training discouraged them from pursuing PHM fellowship. Half of respondents valued additional training in medical education, quality improvement, hospital administration, research, and clinical medicine. CONCLUSIONS Many survey respondents expressed interest in the opportunity to acquire new skills through PHM fellowship. However, the majority of respondents reported being less likely to pursue PHM after the introduction of fellowship requirement for board certification, citing financial and personal opportunity costs. Understanding factors that residents value and those that discourage residents from pursuing PHM fellowship training may help guide future iterations of fellowship design.
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Affiliation(s)
- Hamsika Chandrasekar
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California;
| | - Yasmine N White
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Christopher P Landrigan
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and.,Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Carolyn H Marcus
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and.,Harvard Medical School, Harvard University, Boston, Massachusetts
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