Session: “Teaching and Supervising a PHM Fellow: The Transition from Learner to Instructor."
Analysis: The session was led by Sarah Denniston, MD, FAAP, of Children’s Hospital of San Antonio/Baylor College of Medicine, and a collaboration of presenters ranging from fellowship directors to new pediatric hospitalist fellows. It was a very interactive discussion that prompted shared stories and encouraged changes in the way hospital medicine views a fellow. Presenters reviewed current evidence-based approaches to effective teaching, while supervision of senior residents and fellow-level trainees rounded out the discussion.
As the number of pediatric hospital medicine fellowships increases, so does the variability in each program. This session focused on the unique challenges PHM fellowships face, a balance of supervision and autonomy, specifically:
- Limited faculty development
- Resident exposure to fundamental PHM core competencies
- No national standards
- Resident transition directly into PHM attending role
Looking at survey responses from fellowship programs, Dr. Denniston described multiple program variables in defining the role of the PHM fellow, specifically if they were billable providers, what type of supervision they have, and what training is provided to the faculty who work with the PHM fellows.
Supervision was the hottest topic. Many of the fellows in the audience were able to share their thoughts and encourage session attendees to discuss with their home institutions the idea of autonomy. The billing provides a challenge, but ways to provide increased autonomy as a fellow progresses in the fellowship were addressed. From independent rounding to “running the list” as a daily check in, this can be accomplished even if the fellow is not able to provide billing. If at least two hospitalist teams are within the structure of the daily rounding, the discussion encouraged independent rounding and check in with a senior hospitalist.
Other hot topics were faculty development and senior hospitalist leadership. Many programs have a large enough staff pool to allow for more senior hospitalists to be the “supervisor” for the fellow, reporting that from a fellow standpoint they valued the mentorship and guidance elicited from the experience of a senior hospitalist. The junior or newer hospitalists also agreed that it is a challenge to feel adequate in providing the education and mentorship to a fellow.
Overall, faculty development is a necessary engagement process in creating a strong PHM fellowship, and both attendees and presenterd cited the need for clear expectations—not only for the faculty but the fellows as well.
Rounding out the session was a short didactic on principles of learning and understanding the generational differences in learners. It is important for all educators to recognize different teaching methods as ways to promote autonomy and enhance not only fellow experience, but senior resident as well.
Setting expectations was a theme, encouraging personal and program responsibility to education.
- PHM fellows need autonomy as they progress towards the role of an independent attending.
- PHM fellowship programs need to establish very clear faculty and fellow expectations, noting the need for senior hospitalist experience.
- Educators need to be aware of generational differences in learning and utilize different learning styles.
Dr. Pestak is a pediatric hospitalist and associate program director for the pediatric residency program at Cleveland Clinic Children’s.