A Framework, Not a Text
“We have a great team,” says Dr. Amin of the Task Force editorial board. “I think our goals were clear. We wanted to develop a set of competencies that would be unique and offer 1) an opportunity to define the space that we, as hospitalists, lead in system-based practice; and 2) a framework that would cross over the span of time, so that others could use that framework to develop future curricula.
“Once you write a book, the context is fixed. We thought this [framework for curriculum development] was a creative way of facilitating future projects and ideas,” he continues. “It becomes more of a bible for competencies in hospital medicine.”
Budnitz says the idea was to develop an enduring, flexible blueprint. “We set out to develop a guide that would serve as a blueprint for curricular development in hospital medicine,” she explains. “We wanted to standardize the expectations for learning outcomes but still allow curriculum developers to add their expertise of content and context. Each chapter of the guide is written as a set of learning objectives. We crafted these objectives to clearly indicate a proficiency level.
“For example,” says Budnitz, “it is a different expectation that someone can list the drugs that they might order for a particular condition, versus analyzing the benefits and limitations of different therapeutic approaches. And in both scenarios we have left it up to the content and curriculum developers to determine the precise list of therapeutic agents that are included in curricula and the educational approach that will most likely yield the intended learning outcome.”
Dr. Dressler elaborates on his colleagues’ characterizations of the document: “We weren’t planning on this being an overarching, comprehensive text on hospital medicine. We were not trying to develop or even provide content.”
Instead, he says, the aim was to provide medical educators with a relatively generic framework that would retain flexibility for change. “For instance,” he explains, “if a new drug comes out that is useful for [treating] heart failure, the expectation is that hospitalists should be able to explain and utilize the new and useful medications, but that we were not going to list every drug in the Core Competencies compendium.”
“The one idea that we kept coming back to is that we wanted to design a set of competencies,” said Dr. Pistoria. “We didn’t want to publish a textbook; we didn’t want to come up with a curriculum per se. We wanted to come up with a framework that someone could use to develop their own hospitalist program in their own institution.”
The Core Competencies Task Force developed an initial organizational structure for the guide and a list of chapter topics. The resulting chapter list was turned into a survey and sent to the SHM Board of Directors, Core Competencies Task Force, and Education Committee. The survey was also sent to a sample of members within each SHM region or chapter via its chapter or region director. A review of core competencies generated by other medical specialties and allied health professional societies followed.
Then, the task force put out a call for nominations of chapter contributors. Budnitz judges that there were between 150-200 responses for potential contributors. Reviewing all the nominations was no small task. In some cases the editorial board deemed it necessary to recruit non-hospitalist content experts to generate some chapters, such as those dealing with medical-legal issues. In those instances, the “outside expert” was often paired with a hospitalist to ensure that the hospitalist perspective was included.