Strategies for Content Inclusion
Dr. Amin points out that the task force “went as broad and as wide as we could to get feedback on the content for the Core Competencies.” However, it was simply not possible—nor was it the editorial board’s intent—to compile an exhaustive list of all the hundreds of diagnoses that hospitalists may see on a regular basis. The editorial board identified common diagnoses from the top 15-20 DRGs from the Medicare database. The task was then to communicate the most important aspects of what hospitalists do, in the domains of knowledge, skills, and attitudes.
To manage the sheer bulk of solicited CVs and potential chapter authors, the editorial board used a divide-and-conquer strategy. Even so, says Dr. Pistoria, this process took a fair amount of time. When chapters began arriving and the task force was reduced to the core editorial board, “the homework started kicking up, with a lot of home editing time, telephone and e-mail editing, and some face-to-face meetings to ensure that chapters were standardized and had the same format.”
Once the editorial board began its work, it was relatively easy to decide that majority rule would be the best process for resolving differences of opinion, “but honestly,” says Dr. McKean, “only a handful of issues were generated. If we didn’t develop a consensus or if we were not all in agreement, then we sometimes looked for feedback from experts outside of the task force and the editorial board.”
Keeping with the ethos of inclusion, most board members consulted with other experts at their institution about key elements to include in the document.
Regarding the “majority rules” process, “Everyone had the chance during the editorial process to voice their opinions,” says Dr. Pistoria. “If they had concerns and were able to persuade enough people, the appropriate change would be made. I think, in the end, that everyone in the core editorial group felt that their opinions were heard, and I think that lends itself to the pride that we all feel in the final product.”
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.
—Alpesh Amin, MD, MBA, FACP
A Work in Progress
Budnitz contributed critical guidance when the board generated writing guidelines for chapter authors. Each received a template for their chapter: a document instructing them how to write a competency, and a letter indicating the intent for their particular chapter. The template went through several iterations, she says, as early chapters were returned and the board began their editing.
For example, each clinical condition is discussed through the domains of knowledge, skills, and attitudes. It was the board’s job to ensure that concepts consistently appeared in the same domain across chapters with a similar degree of specificity and in the same order. “Partway through the process, we refined our template and made it more specific,” reports Budnitz. “We were able to give the second round of contributors a little more guidance as a result.
“We originally thought the document would be ready in early 2005,” she explains. “I think we were under the misimpression that the chapters would come back, that we’d read through them in a month or two, and it would be done. It turns out that just the sheer logistics of editing four or five versions of 70 chapters was quite a process.”