Core competencies in hospital medicine: Development and methodology

Abstract

BACKGROUND: The hospitalist model of inpatient care has been rapidly expanding over the last decade, with significant growth related to the quality and efficiency of care provision. This growth and development have stimulated a need to better define and characterize the field of hospital medicine. Training and developing curricula specific to hospital medicine are the next step in the evolution of the field. METHODS: The Core Competencies in Hospital Medicine: A Framework for Curriculum Development (the Core Competencies), by the Society of Hospital Medicine, introduces the expectations of hospitalists and provides an initial structural framework to guide medical educators in developing curricula that incorporate these competencies into the training and evaluation of students, clinicians‐in‐training, and practicing hospitalists. This article outlines the process that was undertaken to develop the Core Competencies, which included formation of a task force and editorial board, development of a topic list, the solicitation for and writing of chapters, and the execution of multiple reviews by the editorial board and both internal and external reviewers. RESULTS: This process culminated in the Core Competencies document, which is divided into three sections: Clinical Conditions, Procedures, and Healthcare Systems. The chapters in each section delineate the core knowledge, skills, and attitudes necessary for effective inpatient practice while also incorporating a systems organization and improvement approach to care coordination and optimization. CONCLUSIONS: These competencies should be a common reference and foundation for the creation of hospital medicine curricula and serve to standardize and improve inpatient training practices. Journal of Hospital Medicine 2006;1:48–56. © 2006 Society of Hospital Medicine.

Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners

“…The recent increases in handover frequency due to duty hours restrictions for resident physician trainees in the USA2 as well as Canada and France3 and increased awareness of potential patient harm due to communication problems in the patient handover4 have driven the need for new interventions to improve handover quality. Eighty-nine per cent of these interventions,5 including those endorsed by The Joint Commission (TJC),6 the US Accreditation Council for Graduate Medical Education (ACGME),7–10 and the Society of Hospital Medicine (SHM),11 focus on increasing compliance to a structured format for verbally communicating information,12 13 such as in the order of Situation Background Assessment Recommendation (SBAR) 14. As such, they are focused almost solely on the sender, or person giving the information who is completing their shift 12 13…”

Managed Care and Organizational Influences on Hospitalist Program Adoption

“…Similarly, medical errors are common in hospitals when hospitalists and other physicians or nurses do not communicate frequently or in a timely fashion (Gittell et al 2008). Researchers (Dressler et al 2006;Harrison and Curran 2009) have noted that there is often a break in the communication between primary care physicians and hospitalists that could reduce quality of care and potentially result in a hospital readmission. Therefore, with no substantial evidence suggesting hospitalist programs improve clinical quality, HMOs may be less likely to negotiate subsequent contracts with individual hospitalists or hospitalists groups.…”

New cost-effective pleural procedure training: manikin-based model to increase the confidence and competency in trainee medical officers

“…Pleural procedures are commonly performed and include thoracentesis, chest drain placement, tunnelled intrapleural catheter placement and pleuroscopy. Procedures such as thoracentesis have even been identified as a core competency for hospitalists 14. However, residency training in internal medicine may not provide hospitalists with the skills to safely perform such necessary procedures 15.…”