Five years ago, a medical resident interested in pursuing a career as a hospitalist had few opportunities to receive specialized training. Five years from now, residents likely will have numerous hospitalist training tracks and electives from which to choose. This is partly thanks to a small group of pioneers who have seen the value of specialized hospitalist training for residents. These individuals have carefully considered what skills, information, and experience residents need to practice as confident and competent hospitalists, and they have developed programs and courses that meet these needs.
Sharpening Residents’ Focus
“Actually, we don’t call them ‘tracks,’ ” says Andrew Rudmann, MD, assistant professor of medicine and chief of the Hospital Medicine Division at the University of Rochester Medical Center. “We don’t want students to think that they’re stuck in an area once they choose it.”
Nonetheless, he notes, students increasingly are choosing careers as hospitalists, and they are expressing an interest in gaining skills and knowledge to help them become hospitalists.
Dr. Rudmann adds that his students “are sorting out their career plans earlier,” so it is important to offer specialized focus area programs. He has divided these into three areas: general medicine inpatient (hospitalist), general medicine outpatient (primary care), and subspecialty (other specialties).
The focus area programs are still in the developmental stage, Dr. Rudmann stresses. “We are in the process of developing the curricula for these programs, all of which will be elective experiences,” he says. Determining course options will be a challenge because there are a limited number of hours available for these electives. Nonetheless, Dr. Rudmann has identified several activities essential to producing effective hospitalists. These include:
- Rotation at a community hospital. “This program will focus on communication issues with primary care physicians,” explains Dr. Rudmann. “The students also will spend time in primary care offices to focus on the transition of patients from hospital to community care.”
- Quality improvement (QI) project. Residents will work one-on-one with hospitalists and develop a QI project from their work that they will present at the end of the rotation. As hospitalists, says Dr. Rudmann, these individuals frequently will be involved in QI initiatives and committees, and it is important that residents be prepared for these activities.
- Billing, coding, documentation mentorship. Each student will have a mentor, who will be required to instruct residents (either one-on-one or in small groups) about these issues. While billing, coding, and documentation are not glamorous, they are important components of a hospitalist practice, so Dr. Rudmann wants to ensure that residents are comfortable handling these activities.
Hospitalist students also will have the opportunity to spend time shadowing healthcare professionals in other areas such as the detox unit and bronchoscopy suite.
“It’s useful for a resident to spend time learning what these people do and what happens in these areas,” says Dr. Rudmann. “Our current healthcare system tends to be fragmented, and this experience will help physicians ensure smooth transitions for patients from one site to the next.”
Dr. Rudmann says he will suggest that residents interested in being hospitalists spend time in the ED observation unit. Additionally, these residents will be exposed to patient safety and medico-legal issues through active participation in morbidity/mortality conferences.
Residents also will have the opportunity to take a research elective course. However, Dr. Rudmann notes that students will need a real interest or passion for research to participate in this option, as it will consume one-half of their elective hours.
Day in the Life
Providing exposure to many of the day-to-day aspects of hospitalist practice is a key component of the hospitalist elective program at Emory University in Georgia.