Implementation of a Hospital Medicine Rotation and Curriculum for Internal Medicine Residents

Abstract

Introduction: Hospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency. Methods: The RITE rotation was initially implemented in the 2013-2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of care. Prior to RITE, residents received an email orientation to the service. To evaluate the rotation and curriculum, residents completed a pre-and postrotation online survey. Forty-six upper PGY 2 residents each rotated on the service for 1 month. An experienced hospitalist attended on the service and facilitated a weekly discussion on each module. This publication includes an updated version of the email orientation, the four modules, and the surveys. Results: There was a 72% response rate for completion of the pre-and postrotation survey. Confidence in managing hospitalized patients and knowledge of module content taught during the rotation improved. Discussion: We found that implementation of a hospital medicine rotation and curriculum improved resident independence and knowledge of the module topics and was a successful way to alleviate current deficiencies in resident education.

Missing Voices: What Early Career Hospitalists View as Essential in Hospital Medicine–Focused Education

“…Early and longitudinal mentorship opportunities could allow HMFE to act as a scaffolding for residents to build relationships with HM faculty and bridge the mentorship gap between residency and practice. 19,20 Building on existing survey data from residency leaders, 11 published outcomes from HMFE curricula, [6][7][8][9]21 and synthesizing our findings from ECHs, we developed an organizing framework for HMFE in residency (Fig) . We highlight the importance of elevating existing key elements for HMFE programming and cultivating emerging elements, including point-of-care ultrasound, health equity, and the business of HM. Given their need for structured mentorship, HMFE participating residents pursuing an academic HM career may benefit from pairing with a designated HMFE core faculty mentor to provide longitudinal mentorship and career advice.…”

“…Building on existing survey data from residency leaders, 11 published outcomes from HMFE curricula, 6–9,21 and synthesizing our findings from ECHs, we developed an organizing framework for HMFE in residency (Fig). We highlight the importance of elevating existing key elements for HMFE programming and cultivating emerging elements, including point-of-care ultrasound, health equity, and the business of HM.…”

“…Recognizing this gap, some residency programs have developed HM-focused education (HMFE) curricula as electives, rotations, and/or longitudinal tracks. [6][7][8][9] Existing programming has been described using surveys of residency and HMFE faculty leaders, but lacks the valuable insights and reflections of trainees or early career hospitalists (ECHs). 10,11 The perspectives of ECHs with recent exposure to HMFE are important for informing curricular design, yet their voices are currently missing in the conversation.…”

“…Recognizing this gap, some residency programs have developed HM-focused education (HMFE) curricula as electives, rotations, and/or longitudinal tracks 6–9 . Existing programming has been described using surveys of residency and HMFE faculty leaders, but lacks the valuable insights and reflections of trainees or early career hospitalists (ECHs) 10,11 .…”

Providing Structured Real-Time Feedback on Postdischarge Outcomes Using Electronic Health Record Data

“…7 Most of these educational interventions are didactic or case based, rather than incorporating individualized, external sources of data for recent patients. [8][9][10][11] Residents report that the majority of learning on how to orchestrate transitions of care is done by peer-to-peer instruction 5 or informally on rounds, 12 and they often disagree with other healthcare professionals about what role they should play at patient discharge. 13 Both trainees and program directors desire information about patient outcomes.…”