PEDIATRIC SPECIAL SECTION:
Pediatric Fellowship Offered
Children’s Hospitalists of San Diego offers program
The Pediatric Hospitalist program at Children’s Hospital and Health Center of San Diego (CHHC) began in 1978. The current hospitalists are employed by Children’s Specialists of San Diego (CSSD), a 180-member pediatric-only specialty medical group. Inpatient care is provided for 75% of all general pediatric patients at the 233-bed tertiary care CHHC. Program consultation is offered at nearby Palomar Medical Center, a 23-bed unit within a larger 319-bed community hospital with a trauma center.
The hospitalists are the primary teaching faculty for the house staff and medical students who come from the University of California San Diego (UCSD), Balboa Naval Hospital, Pendleton Naval Medical Center, and Scripps Family Medicine. All hospitalists are board-certified pediatricians and have additional degrees or postresidency training, such as chief residency or fellowship experience.
Hospitalists fulfill many leadership roles in the hospital and community when not on service. A detailed list is available in a previous issue of The Hospitalist (Nov/Dec 2004;8(6):59-60). Current research includes an Agency for Healthcare Research and Quality (AHRQ) safety grant on medication errors, a bronchiolitis clinical trial, juvenile justice research on hepatitis B, a Hispanic cultural competency grant from the California Endowment, spiratory syncytial virus immunoprophylaxis outcomes in a managed population, and primary care perceptions of pediatric dentistry. Thus the hospitalist program has a long history of strong commitment to children and the core aspects of pediatric hospital medicine.
The CSSD Pediatric Hospitalist Fellowship Program goal is to train highly motivated pediatricians for careers in academic and clinical hospital medicine. Over a two-year period instruction is provided in clinical, advocacy, administrative, teaching, and research aspects of pediatric hospital medicine. Clinical education emphasizes inpatient acute care, including intensive care and emergency transport at the busy main campus at CHHC. Outpatient clinical care offers experiences in adolescent juvenile hall medicine, hospice, and child protection. The diverse clinical exposure, teaching from local and national leaders, and volume of patients ensure graduates of this program are well prepared for any clinical hospitalist position.
The staff gains administrative experience via both hospital and medical group quality improvement activities. This work is directed by the medical director for CSSD and the physician advisor for quality management for CHHC, both of whom are CSSD pediatric hospitalists. Skills in process improvement, continuous quality improvement, risk management, organizational management and leadership are honed during the fellowship. Opportunity exists to take courses through the American College of Physician Executives if the trainee desires a future in administrative hospitalist medicine.
Academics and teaching are a core value of the pediatric hospitalist service. The fellow participates in the monthly division journal club and internal case review. Daily teaching while on the clinical service includes bedside rounds, management rounds, and attending rounds. Pediatric hospitalists are the primary inpatient teaching staff and as such have a significant responsibility for daily house staff education. The fellow participates in noon conferences and other educational venues under the guidance of the director of inpatient teaching (also a pediatric hospitalist).
Advocacy skills are learned through experiences in the juvenile hall system, Center for Child Protection, the American Academy of Pediatrics (AAP), and at the local and state level for children’s services funding. Under the leadership of the medical directors for the Center for Child Protection and the A.B. and Jessie Polinsky Center for Abused Children, the fellow participates in case review and observes expert child abuse testimony in court. Discussions with legislators in Sacramento focus upon protection of the California Children’s Services system, which supports critically ill state-funded children. The fellow learns AAP local and national structure, participating in conferences and chapter events.