In February we experienced a landmark in the development of the field of hospital medicine with the publication of the premiere issue of the Journal of Hospital Medicine (JHM). The debut of JHM demonstrates that hospital medicine is maturing as a field and—even more importantly—that it is developing as a new field with specific issues relevant to its practice.
It is difficult to overestimate the critical role that our journal will play in the growth of our field. The content for the inaugural issue of JHM reflects the depth and breadth of hospital medicine—community acquired pneumonia, palliative care, gastrointestinal bleeding, geriatrics, and a patient’s perspective on hospital care. The many authors who submitted their manuscripts took a leap of faith that our journal would be a respected and widely read vehicle for disseminating their hard work. This leap is even greater given that JHM is not yet listed in PubMed. Nonetheless these authors believe that JHM will thrive, be well read, and influence practice and patient care.
I agree because I know the talent of hospitalists and the potential of our field. The first issue of JHM also included a supplement devoted to the core competencies in hospital medicine. These core competencies represent another milestone in the growth of our field. With the core competencies we have outlined the specific knowledge, skills, and attitudes that define who we are and what we do.
Bringing a journal from concept to reality takes a Herculean effort by many people. I especially want to thank Mark Williams, MD, editor of JHM, for his leadership and grand vision for JHM that reflects our society and field so well. I also want to thank the associate editors and editorial board for giving their time, energy, and expertise to our journal.
I want to share my gratitude and appreciation for Larry Wellikson, MD, the CEO of SHM, who took an idea and mandate presented by the SHM Board of Directors and “operationalized” it in the most effective way. Finally, I want to thank Vickie Thaw, associate publisher at John Wiley & Sons, and her publishing team who have been such great partners in this endeavor.
Growth in Research at the SHM
Papers published in JHM represent only the tip of the iceberg of research in hospital medicine. This year we had 176 abstracts submitted for presentation at our annual meeting in May. These abstracts in research, innovations, and vignettes reflect the enthusiasm, interest, and dedication of many hospitalists. I am always impressed as I read the abstracts and wander through the poster session at the amount of work and creativity represented.
What is even more impressive about these abstracts is that they reflect the breadth of hospital medicine—adult medicine and pediatrics; academic and community hospitals; clinical work and administration; internal medicine, family practice, and pediatrics; disease-specific treatments; and system approaches to care. This year for the first time we will publish the abstracts in a supplement to both The Hospitalist and JHM. All hospitalists who have an abstract accepted for the meeting will be able to cite their work. The supplement marks another advance for our society and field.
I hope that many of you who have submitted abstracts will consider turning them into manuscripts and submitting to JHM. Abstracts whet the appetite to know more, and papers provide the details to improve care.
The Importance of Pursuing Research at SHM
These efforts are critical to our field and represent one visible way that SHM pursues research. SHM must pursue research because it helps define our field. We must ensure that the questions asked are relevant to hospital medicine and that the interventions tested and solutions advocated reflect the real world.
While we welcome anyone to pursue research in hospital medicine and how to improve the care of hospitalized patients, we must ensure that hospitalists play a key role in conducting this research. Research conducted by non-hospitalists may advocate for unrealistic interventions or result in research that is not representative of our field. As the organization that represents hospitalists, SHM can also ensure that research asks the right questions and finds practical solutions with real-world applicability.
For example, SHM should promote:
- Research about best practices, innovations in care delivery, and implementation of known beneficial treatments;
- New approaches to system issues, including error reduction, inpatient-outpatient communication, information systems and transitions; and
- Clinical trials of common inpatient conditions, such as pneumonia and acute decompensated heart failure.
By playing a central role in research, SHM can also advocate for community-based initiatives that ensure research occurs where the majority of patients are cared for.
If we fail to lead in research someone else will, and others will be able to define best practices in hospital medicine. We should not let others define hospital medicine. We took a critical step in defining our field by developing and publishing the core competencies in hospital medicine. Research will be another important way for us to delineate our field. Finally, if SHM does not pursue research we risk losing our academic credentials as a society and a field. Ultimately it will be difficult to succeed as a field and specialty if we do not succeed in academic centers because that is where students and residents—the hospitalists of tomorrow—choose their careers. Hospitalists are great teachers and role models for students and residents. However, in order to ensure that the role models and teachers flourish, we need to pursue research so hospital medicine remains a legitimate part of the academic mission.
SHM Research Initiatives
Although JHM may be the most visible sign of research at SHM, it is not the only one. Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a tool kit to support discharge planning for elders.
I am especially proud that each of these projects involves community and academic hospitalist programs. The SHM Research Committee, chaired by Andy Auerbach, MD, has played a key role in defining a vision for research at the SHM, and I thank Dr. Auerbach and the committee for their efforts and guidance. I am also delighted that SHM recently hired Kathleen Kerr as a senior advisor for research. Kerr’s extensive experience with hospitalists, quality improvement, and research at the University of California, San Francisco, makes her the ideal person to help spearhead this important initiative at SHM. Taken together we have a strong foundation for our research initiative and ensuring that SHM plays a key role in helping to define and shepherd research in hospital medicine.
The Future of Research at SHM
As difficult as it is to publish the first issue of a new journal, the real challenge will be to publish the second issue and beyond. Sustaining the quality and breadth reflected in the first issue will take the combined efforts of the entire editorial staff at JHM, all hospitalists, and all others interested in improving the care of hospitalized patients.
The good news is that, as reflected in our abstract submissions, there is a deep pool of good work in hospital medicine to write about and publish. The other good news is that our field is one in which many of the best innovations and much of the important research comes from community settings and not just academic centers. In fact our strength in research comes from the fact that we can draw from both academic and community programs to create new, “generalizable” knowledge. An even greater strength is when these programs collaborate to take advantage of the best that each has to offer to research.
I encourage each of us to think about the work we are doing and to think about what innovative, creative, or successful program should be shared and implore each of us to submit our work to JHM. Help make JHM the best source for innovation and best practices in hospital medicine. Help shape JHM into the best possible journal it can be—the one you open right away and read through because it is so relevant to your practice.
As our field grows we will look back on this moment as a critical landmark in the development of our field. Hold on to your first issue: It may be a valuable collector’s item when volume 50 is being published and JHM is one of the world’s leading journals. What practices will we look back on and laugh at? What practices will have survived years of scrutiny? What will our field look like? Only time will tell. Read JHM to find out. TH
SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.