“We wanted to provide residents with an opportunity to get some clinical exposure that they don’t necessarily get during general residency training and give them a better sense of what hospital medicine is—aside from taking care of patients in the hospital,” says Dan Dressler, MD, MSc, director of hospitalist medicine at the Emory University School of Medicine (Atlanta).
Emory’s hospitalist electives also give residents an opportunity to “pick the brains” of hospitalists. “They get to ask about things like schedules, committee involvement, research activities, and so on,” explains Dr. Dressler. “Residents really like this opportunity. They can feel isolated in the academic setting, and this really broadens their horizons.”
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Building a Hospitalist Track from the Ground Up
In developing Emory’s hospitalist elective program, Dr. Dressler sought guidance from colleagues at the University of California at San Francisco and the Mayo Clinic (Rochester, Minn.) who already had established specialized hospitalist education opportunities.
Still, developing a good program is not as easy as copying someone else’s efforts. In fact, Dr. Rudmann says that most of the ideas for Rochester’s program came from “a thorough self-examination process.”
“You don’t have to look far,” he explains. “Just look at your own program and talk to your own residents.”
One of the challenges of developing a hospitalist track is the limited time available for elective programs. Dr. Dressler suggests starting by “assessing what you already are doing in your general residency program. You don’t want to duplicate efforts. Determine what is being done well at your program already and what could be done additionally—either based on what others are doing or what should be considered core competencies in hospital medicine. Then implement the missing pieces.”
Even after all of these planning and self-examination efforts, Dr. Dressler cautions, “you probably won’t have enough time to do everything you want to do.” At this point, he suggests concentrating on those issues or skills for which “you have someone who is able and willing to teach and teach well.” For example, he suggested, “if you want to include training on QI but don’t have anyone who can teach this well, you might want to keep this as a goal for down the road.”
Problem-Solving as a Goal
Sometimes, hospitalist training programs can help solve a specific problem. For example, Jason Gundersen, MD, director of the Family Medicine Hospitalist Service at the University of Massachusetts Medical Center, saw that “facilities often don’t want to hire family physicians as hospitalists because they lack hospital experience. [So I] wanted to give family practice residents extra training and experience in hospital medicine.”
The result was a hospitalist fellowship program, the goal of which “is to help improve employment opportunities. It enables graduates to go to employers with specific hospital medicine training,” says Dr. Gundersen. “This gives family physicians more experiences and abilities so they can navigate an uncertain market more successfully. There is a growing interest in hospitalist opportunities on the part of family physicians, and we need to prepare them to fill these roles.”
Despite the growing popularity of hospitalist training tracks and the enthusiasm many express about them, there are people who do not believe these programs are important or necessary. John Ford, MD, MPH, assistant professor of medicine at University of California at Los Angeles’ (UCLA) David Geffen School of Medicine, agrees.
“The first thing you have to understand is that internal medicine residency programs involve a tremendous amount of inpatient care anyway,” says Dr. Ford. “And a lot of what residents do is take care of hospital patients, so this training is adequate for a career choice as a hospitalist.”