Baking Hospitalist Training into Residency

(from the August 2018 ACP Hospitalist)

Although half of large internal medicine residency programs offer hospitalist-focused rotations, there are no standards for their structure.

By Mollie Durkin

In the past, internal medicine residency programs didn't always worry about offering specific training in hospital medicine. When Christopher Sankey, MD, FACP, was interested in high-acuity general medicine at the end of his residency 15 years ago, he figured he'd be an intensivist.

“The only experience that I had baked into my residency training program that showed me high-acuity general medicine was in the ICU,” he said.

Dr. Sankey matched into a critical care fellowship, but his now-wife still had to complete her residency training, so he gave up his fellowship spot and got a hospitalist job. Three months in, he was sold on hospital medicine.

“If I had had access to a hospital medicine-specific experience as a resident, I think it would've been a lot clearer, and I wouldn't have had to luck into it in the way that I did,” said Dr. Sankey, now associate program director for Yale's internal medicine residency and an academic hospitalist at Yale-New Haven Hospital.

As of this past academic year, he's also the founder of a hospitalist training elective, which 12 Yale residents have completed. Residents choose from a menu of opportunities to customize hospitalist training to their own needs and desires, such as meeting individually with internal medicine-trained administrators or observing rapid response calls and procedures.

These days, more residents have access to such training. In a May 2015 survey of 82 large internal medicine residency program, 50% of program leaders reported offering hospitalist-focused rotations. Of the programs without hospitalist rotations, about 22% reported plans to implement them, according to results published in March 2018 by the Journal of Hospital Medicine.

But the article also pointed out a chief challenge (and opportunity) inherent in creating the experience: There's no standard for what it should look like. The academic hospitalist leaders who launched early programs had to identify what they considered the most important components of training, and they can now share their insights with those following in their footsteps.

Meeting unmet needs

Despite the potential for variation, most of the elective rotations identified in the survey study were one month in duration and included second- and/or third-year residents. The average length of existence of the rotations was about five years, with a range of one to 15 years. That early-adopting outlier is the University of Colorado in Denver.

The residency program there offers both a two-year hospitalist training track, which holds about 10 residents per year, and a one-month hospital medicine elective that has two residents per month, said Patrick Kneeland, MD, executive medical director for patient and provider experience at UCHealth and director for quality, safety, and efficiency in the University of Colorado's hospital medicine division.

Read the full article in ACP Hospitalist.

ACP Hospitalist provides news and information about hospital medicine, covering the latest trends and issues in the field.

Back to the October 2018 issue of ACP IMpact