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Schord S, Fennell M, Painter A, Sevov C, Liao N. Preparation for PHM: Considerations for Pediatric Residency Programs. Hosp Pediatr 2024:e2024007845. [PMID: 39148477 DOI: 10.1542/hpeds.2024-007845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/08/2024] [Accepted: 05/18/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Shauna Schord
- Division of Hospital Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Meghan Fennell
- Division of Hospital Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Alana Painter
- Division of Hospital Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Claire Sevov
- Division of Hospital Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and
- Division of Hospital Medicine, Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nancy Liao
- Division of Hospital Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and
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Osburn TS, McCarthy PJ, Dawlett M, LaRussa L, DeLeon S, McKnight H. Hiring in the Pediatric Hospital Medicine Board Certification Era: PHM Leader Perspectives. Hosp Pediatr 2024; 14:e335-e340. [PMID: 39034836 DOI: 10.1542/hpeds.2023-007552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES The designation of pediatric hospital medicine (PHM) as a board-certified (BC) subspecialty has led to uncertainty about the importance of PHM board certification in hiring pediatric hospitalists and ambiguity in counseling trainees interested in PHM careers about the decision to pursue fellowship. We sought to determine the importance of PHM board eligibility or certification in hiring practices. METHODS We conducted an online, cross-sectional, survey-based study of individuals who self-identified as PHM division leadership utilizing the PHM Division Director Listserv and participant recruitment at a national meeting. RESULTS A total of 86 responses were received. A total of 64% (30/47) of university-setting hospitals, 77% (17/28) of community hospitals, and 100% (11/11) of combined settings reported that they will hire applicants who are not board-eligible (BE) or BC (P = .83). Of the hospitals who will be hiring non-BE hospitalists, 50% of university settings, 77% of community settings, and 55% of combined settings plan to give equal consideration to both BE and non-BE applicants (P = .21). A total of 57% (21/37) of programs with a PHM fellowship felt that fellowship training was an important or very important consideration in hiring, compared with 27% (13/49) of programs without a PHM fellowship (P = .04). CONCLUSIONS Programs with a PHM fellowship were significantly more likely to believe that fellowship training is an important consideration in hiring hospitalists. PHM board certification and fellowship training are perceived as more important by university-based programs, although all settings will consider hiring applicants who are not BC or BE.
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Affiliation(s)
- T Shea Osburn
- Division of Hospital Medicine, Department of Pediatrics, Valley Children's Hospital, Madera, California
| | - Patrick J McCarthy
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marie Dawlett
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Liborio LaRussa
- Department of Pediatrics, Lehigh Valley Reilly Children's Hospital, Allentown, Pennsylvania
| | - Stephanie DeLeon
- Division of Hospital Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Heather McKnight
- Division of Hospital Medicine, Department of Pediatrics, University of California-Davis, Davis, California
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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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Harrison WN, Mittal VS, O'Toole JK, Quinonez RA, Mink R, Leyenaar JK. Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678M. [PMID: 38300016 DOI: 10.1542/peds.2023-063678m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.
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Affiliation(s)
- Wade N Harrison
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vineeta S Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jennifer K O'Toole
- Division of Hospital Medicine, Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ricardo A Quinonez
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Mink
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center and the David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - JoAnna K Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Health, Lebanon, New Hampshire
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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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Treasure JD, Caldwell A, Brower LH. Developing fellowships in a rapidly growing field. J Hosp Med 2023; 18:367-368. [PMID: 36895174 DOI: 10.1002/jhm.13073] [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: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Jennifer D Treasure
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alicia Caldwell
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura H Brower
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Mann J, Elia M, Morton K. Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine. Hosp Pediatr 2022; 12:e446-e448. [PMID: 36398449 DOI: 10.1542/hpeds.2022-006769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jennifer Mann
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Moza R, Fish D, Peterson RJ. Workforce Characteristics of Med-Peds Hospitalists. Cureus 2022; 14:e24799. [PMID: 35676991 PMCID: PMC9169433 DOI: 10.7759/cureus.24799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This article aims to describe the workplace characteristics of internal medicine and pediatrics (med-peds) hospitalists practicing hospital medicine (as internal medicine hospitalists, pediatric hospitalists, or both) in the United States. Methods The investigators conducted a cross-sectional survey of med-peds hospitalists via distribution through online platforms supported by the Society of Hospital Medicine (SHM), the American Academy of Pediatrics (AAP), and Twitter™. This sample was then reviewed and evaluated for similarities and differences in workplace characteristics. Results One hundred and sixteen respondents completed the survey and provided data on 63 unique institutions employing med-peds hospitalists. Of these institutions, 46% (n=29) employed six or more med-ped hospitalists within their hospital system. Furthermore, 44% (n = 28) of the institutions utilized the med-peds skillset to meet patient care needs in their hospitals. Forty hospitalists from 24 unique institutions saw both adults and children on the same day. Only 5.6% (n=6) of respondents were fellowship-trained. Interestingly, 34.9% of institutions (n=22) were required to provide adult-based care (age >21 years) within the pediatric hospital due to the COVID-19 pandemic. Of note, 35.5% (n=38) of participants from 24 unique institutions stated a high likelihood of hiring additional med-peds hospitalists in the next one to two years. Conclusions Med-peds hospitalists have a unique role within the hospitalist workforce given the variety of practice patterns and clinical needs they can fill within a hospital system. This survey provides the first sampling of workplace characteristics for actively practicing med-peds hospitalists in the United States.
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McCarthy JJ, Swartz S, Liljestrom T, Menigo J, Cotter L, Toth H. Med-Peds Residents' Career Plans and the Impact of Pediatric Hospital Medicine Fellowship: A Nationwide Survey. Hosp Top 2022; 101:336-343. [PMID: 35414350 DOI: 10.1080/00185868.2022.2063775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The establishment of pediatric hospital medicine (PHM) as a fellowship-trained subspecialty represents a major change in the practice landscape, particularly for combined internal medicine-pediatrics (med-peds) residents. The most recent literature on med-peds residents' career choices predates PHM fellowship and its impact has not been well studied. We aimed characterize med-peds residents' career plans and the factors influencing their choices. METHODS We distributed an electronic survey to the 1,505 resident members of the National Med-Peds Resident Association. In addition to sociodemographic data, participants reported their career plans, how well their residency prepared them for various aspects of practice, and their perceptions of PHM fellowship and its effect on their career choices. RESULTS Among the 228 participants, the most planned careers were combined hospital medicine (36.8%, 84/228), combined subspecialty practice (32.5%, 74/228), and primary care (31.1%, 71/228). Residents felt well prepared for patient care and significantly more prepared for inpatient practice than for primary care. Participants rated the potential disadvantages of PHM fellowship as major deterrents and did not view the possible advantages as strong incentives. Among those who had considered a hospital medicine careers, 91.2% (186/203) were less likely to pursue PHM after its certification as a subspecialty. CONCLUSION Med-peds residents have a wide range of career interests but fellowship has made them less likely to pursue PHM careers. These findings emphasize the importance of addressing the needs of med-peds trained providers as PHM certification pathways and fellowship curricula develop to avoid adverse effects on the workforce.
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Affiliation(s)
- James J McCarthy
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sheila Swartz
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tracey Liljestrom
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Menigo
- Internal Medicine-Pediatrics Residency Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leah Cotter
- Internal Medicine-Pediatrics Residency Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather Toth
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Dudas RA, Krugman SD. How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine? Hosp Pediatr 2022; 12:e47-e49. [PMID: 34913061 DOI: 10.1542/hpeds.2021-006383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Robert A Dudas
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Scott D Krugman
- Herman & Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland
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Boggs E, Luttrell H, Basco W, Brittan M, Jerardi K, Kessenich J, Kondos V, O'Toole J, Solomon J, Tarchichi T, Jenkins A. Identifying and Supporting the Needs of Internal Medicine and Pediatrics Residents Interested in Pediatric Hospital Medicine Fellowship. J Hosp Med 2021; 16:jhm.3658. [PMID: 34424184 DOI: 10.12788/jhm.3658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pediatric hospital medicine (PHM) became a subspecialty of the American Board of Pediatrics (ABP) in 2016. Starting in 2019, residency graduates are required to complete fellowship training to qualify for PHM board eligibility. These requirements pose unique challenges to internal medicine-pediatrics (med-peds) residents interested in practicing combined adult hospital medicine (HM) and PHM. OBJECTIVE To describe the needs of med-peds residents interested in PHM fellowship training and how the current PHM training environment can meet these needs. METHODS We conducted two cross-sectional electronic survey studies: one of med-peds residents and one of PHM fellowship program directors (FDs). Surveys were distributed to resident and FD listservs. Questions were designed using an iterative consensus process among authors. Responses were analyzed with descriptive statistics. RESULTS Four hundred sixty-six residents responded to the resident survey. Ninety-six percent (n = 446) had considered a career in HM. Almost all (n = 456, 97.9%) respondents indicated a preference for a fellowship with both adult HM and PHM clinical training. Subspecialty designation decreased desire to pursue a career including PHM for 90.1% of respondents. Twenty-eight (58.3%) FDs responded to the FD survey. Fifteen (53.6%) programs reported being able to accommodate adult HM and PHM clinical time. CONCLUSION The majority of resident respondents reported a desire for a PHM fellowship with clinical time in both PHM and adult HM. Approximately 30% of current US PHM fellowship programs can accommodate adult HM practice for med-peds fellows, and many other programs would be willing to explore such opportunities.
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Affiliation(s)
- Elizabeth Boggs
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Harrison Luttrell
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - William Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Mark Brittan
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Karen Jerardi
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeri Kessenich
- Division of Hospital Medicine, Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
| | - Valien Kondos
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Division of Hospital Medicine, Department of Internal Medicine and Pediatrics, ChristianaCare Hospital, Newark, Delaware
| | - Jennifer O'Toole
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey Solomon
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Tony Tarchichi
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ashley Jenkins
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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