Core competencies in hospital medicine: Development and methodology

Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills and self-confidence. This study aimed to (1) assess the effect of SBML on IM residents' simulated thoracentesis skills and (2) compare thoracentesis referral patterns, selfconfidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians. A random sample of 112 IM residents at an academic medical center completed thoracentesis SBML from December 2012 to May 2015. We surveyed physicians caring for hospitalized patients with thoracenteses during the same time period and compared referral patterns, self-confidence, and reasons for referral. SBML-trained resident thoracentesis skills improved from a median of 57.6% (interquartile range [IQR] 43.3-76.9) at pretest to 96.2% (IQR 96.2-100.0) at post-test (P < 0.001). Surveys demonstrated that traditionally trained residents were more likely to refer to IR and cited lower confidence as reasons. SBML-trained residents were more likely to perform bedside thoracenteses. Hospitalist physicians were most likely to refer to pulmonary medicine and cited lack of time to perform the procedure as the main reason. SBMLtrained residents were most confident about their thoracentesis skills, despite hospitalist physicians having more experience. This study identifies confidence and time as reasons physicians refer thoracenteses rather than perform them at the bedside. Thoracentesis SBML boosts skills and promotes bedside procedures that are safe and less expensive than referrals. Internal medicine (IM) residents and hospitalist physicians commonly conduct bedside thoracenteses for both diagnostic and therapeutic purposes. 1 The American Board of Internal Medicine only requires that certification candidates understand the indications, complications, and management of thoracenteses. 2 A disconnect between clinical practice patterns and board requirements may increase patient risk because poorly trained physicians are more likely to cause complications. 3 National practice patterns show that many thoracenteses are referred to interventional radiology (IR). 4 However, research links performance of bedside procedures to reduced hospital length of stay and lower costs, without increasing risk of complications. 1,5,6 Simulation-based education offers a controlled environment where trainees improve procedural knowledge and skills without patient harm. 7 Simulationbased mastery learning (SBML) is a rigorous form of competency-based education that improves clinical skills and reduces iatrogenic complications and healthcare costs. 5,6,8 SBML also is an effective method to boost thoracentesis skills among IM residents. 9 However, there are no data to show that thoracentesi...

Section: Discussionmentioning

confidence: 92%

The effect of simulation‐based mastery learning on thoracentesis referral patterns

Cohen

Williams

Scher

et al. 2016

“…The Society of Hospital Medicine (SHM) has established core competencies for hospitalists who manage patients with ACS, defining the scope of interactions between the hospitalist, patient, and other clinicians such as specialists and primary care providers (PCP) 4, 5. Several competencies focus on ACS and transitions in care, requiring the hospitalist to demonstrate the skills and attitudes outlined in Table 1.…”

Section: Core Hospitalist Competencies For Acs Relative To Transitionmentioning

confidence: 99%

Transitioning the patient with acute coronary syndrome from inpatient to primary care

Villanueva¹

2010

Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. Journal of Hospital Medicine 2010;5:S8-S14.

“…The complexities associated with practicing in this field were clarified in 2006 when the Society of Hospital Medicine identified 51 core competencies in hospital medicine. 3,6 Some hospitalist programs are willing to provide their PAs with onthe-job training, but many programs do not have the educational expertise or the resources to make this happen. Structured and focused postgraduate training in hospital medicine seems like a reasonable solution to prepare newly graduating PAs that are interested in pursuing hospitalist careers, but such opportunities are very limited.…”

mentioning

confidence: 99%

Learning needs of physician assistants working in hospital medicine

Torok

Lackner

Landis

et al. 2011

BACKGROUND: Hospital Medicine is growing rapidly, and the number of physician assistants (PAs) in this field is expected to grow. However, there is no available data related to the learning needs of PA hospitalists. OBJECTIVE: To conduct a needs assessment for PA hospitalists who may be embarking on a hospitalist career. DESIGN: Cross‐sectional survey based on the Core Competencies in Hospital Medicine. SETTING/PARTICIPANTS: A sample of hospitalist PAs working in the United States. MEASUREMENTS: Amount of experience with core diagnoses and procedures, preferences for additional training that would have prepared them to function as hospitalist PAs. RESULTS: Sixty‐nine PAs responded (response rate, 67%). Among the core clinical conditions, respondents had the most experience in managing diabetes and urinary tract infections and were least experienced with health care–associated pneumonias and sepsis syndrome. Over 90% rarely performed core competency procedures other than electrocardiogram and chest X‐ray interpretations. The top 3 content areas that PA hospitalists believed would have helped to better prepare them to care for inpatients were palliative care (percent of PAs who agreed or strongly agreed: 85%), nutrition for hospitalized patients (84%), and consultations (64%). Almost all (91%) indicated that they would have been interested in formal postgraduate hospital medicine training even if it meant having a lower stipend during the first year on the job. CONCLUSIONS: This is the first national data on self‐perceived learning needs of PA hospitalists. The results may prove helpful for both PAs entering hospitalist careers and for the physician groups looking to hire them. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine