Global Health Education in Pediatric Hospital Medicine Fellowships in the United States.

BACKGROUND AND OBJECTIVES: Pediatric fellows across all subspecialties are interested in global health (GH). Little is known about how GH is incorporated into Pediatric Hospital Medicine (PHM) fellowships. Our objective was to examine the current landscape of GH education in PHM fellowships. METHODS: In 2022, we conducted a cross-sectional electronic survey of PHM fellowship directors (FDs), current fellows, and recently graduated fellows (alumni) via e-mail and listservs. Surveys asked about GH education (curriculum, electives, and research) in PHM fellowships, barriers to GH training, and fellow interest in GH. RESULTS: Response rates were 56% (34/61) among PHM FDs, 57% (102/178) among fellows, and 29% (59/206) among alumni. Most fellows (73%) and alumni (59%) were interested in GH electives. Although 53% of FDs reported offering GH electives, a minority of fellows (21%) and alumni (19%) reported being offered GH electives (P <.001). Few FDs reported offering a GH curriculum (9%), although most fellows (63%) and alumni (50%) expressed interest. Of the 16 FDs without GH electives, 81% planned to offer them. Cited barriers included a lack of GH curricula, insufficient funding, competing educational demands, and a lack of international partnerships. More FDs (82%) than fellows (64%) and alumni (45%) agreed that GH education improves overall fellow education (P = .01). Similarly, more FDs (75%) than fellows (56%) and alumni (38%) agreed that offering GH education improves recruitment (P = .002). CONCLUSIONS: There is an unmet demand for GH education in PHM fellowships, and fellows may not be aware of GH opportunities.

A Qualitative Exploration of Pediatric Resident Perceptions of Autonomy in the Era of Pediatric Hospital Medicine Fellowship.

OBJECTIVE: Some pediatric residents report experiencing less autonomy when working clinically with pediatric hospital medicine (PHM) fellows than with attendings alone. We sought to explore pediatric senior resident (SR) experiences working clinically with PHM fellows, with a focus on characterizing fellow behaviors that could impact perceived resident autonomy. METHODS: In this qualitative study, we conducted virtual semistructured interviews with pediatric SRs. We recorded, deidentified, and transcribed interviews for codebook thematic analysis, making iterative adjustments to our codebook and themes until reaching thematic sufficiency. RESULTS: We conducted 17 interviews. A subanalysis identified key components of the resident mental model of autonomy, including independent clinical decision-making with 3 core qualifiers: 1) plan follow-through, 2) availability of a safety net, and 3) ownership. Our primary analysis identified 4 key themes (with a total of 7 contributory subthemes) describing resident experiences of autonomy, scaffolded based on an organizing framework adapted from Bronfenbrenner's ecological model including 1) microsystem factors (based on direct resident-fellow or resident-leadership team interactions), 2) mesosystem factors (based on fellow-attending interactions), 3) exosystem factors (based on fellow-intrinsic characteristics), and 4) macrosystem factors (cultural values, norms, and policies governing academic pediatrics). CONCLUSIONS: Many factors impact perceived resident autonomy on PHM fellow-inclusive teams. Although some are related to direct resident-fellow interactions, many others are more complex and may reflect resident interactions with the leadership team, attending-fellow dynamics, and the influence of cultural context. Based on our analysis, we propose several best-practice recommendations directed at fellows, attendings, the fellow-attending dyad, and Graduate Medical Education programs overall.

Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs.

The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.

Characteristics of adult hospital medicine fellowships in the United States: A cross-sectional survey study.

BACKGROUND: Hospitalists who seek academic careers are interested in developing skills in research, education, and quality improvement (QI). Since these are not major foci of residency programs, hospitalists may pursue a hospital medicine fellowship to acquire these skill sets. OBJECTIVE: We sought to characterize the current state of hospital medicine fellowships in the United States, including demographics, clinical requirements, curricular focus, financial structure, and scholarly outputs. DESIGNS, SETTINGS, AND PARTICIPANTS: This was a cross-sectional study of 32 hospital medicine fellowship programs across the United States in 2020-2021. An electronic survey was emailed to program leaders. RESULTS: Out of 32 eligible programs contacted, 19 (59.4%) programs responded, representing 22 fellowship tracks. Most (63.2%) programs have been in existence for 5 years or less. Fourteen (63.6%) of the tracks had multiple focus areas, while 8 (36.4%) had a single focus. Of the 14 fellowship tracks with multiple focus areas, 6 (42.8%) reported research, QI and medical education as curricular elements. All 14 reported research as one of the curricular elements. The majority (68.4%) of programs offered opportunities to obtain a master's degree, though the field of degree varied widely. A median of 50% (IQR 0) of fellows' time was spent in clinical activities. Considerable heterogeneity exists among adult hospital medicine fellowship programs. The majority focus on research, QI, and/or medical education. Hospital medicine fellowships offer opportunities for intesive faculty development and unique career pathways.

Med-Peds Residents' Career Plans and the Impact of Pediatric Hospital Medicine Fellowship: A Nationwide Survey.

BACKGROUND: The establishment of pediatric hospital medicine (PHM) as a fellowship-trained subspecialty represents a major change in the practice landscape, particularly for combined internal medicine-pediatrics (med-peds) residents. The most recent literature on med-peds residents' career choices predates PHM fellowship and its impact has not been well studied. We aimed characterize med-peds residents' career plans and the factors influencing their choices. METHODS: We distributed an electronic survey to the 1,505 resident members of the National Med-Peds Resident Association. In addition to sociodemographic data, participants reported their career plans, how well their residency prepared them for various aspects of practice, and their perceptions of PHM fellowship and its effect on their career choices. RESULTS: Among the 228 participants, the most planned careers were combined hospital medicine (36.8%, 84/228), combined subspecialty practice (32.5%, 74/228), and primary care (31.1%, 71/228). Residents felt well prepared for patient care and significantly more prepared for inpatient practice than for primary care. Participants rated the potential disadvantages of PHM fellowship as major deterrents and did not view the possible advantages as strong incentives. Among those who had considered a hospital medicine careers, 91.2% (186/203) were less likely to pursue PHM after its certification as a subspecialty. CONCLUSION: Med-peds residents have a wide range of career interests but fellowship has made them less likely to pursue PHM careers. These findings emphasize the importance of addressing the needs of med-peds trained providers as PHM certification pathways and fellowship curricula develop to avoid adverse effects on the workforce.

Post-discharge early assessment with remote video link (PEARL) initiative for patients discharged from hospital medicine services.

OBJECTIVES: The COVID-19 pandemic impacted the availability and accessibility of outpatient care following hospital discharge. Hospitalists (physicians) and hospital medicine advanced practice providers (HM-APPs) coordinate discharge care of hospitalized patients; however, it is unknown if they can deliver post-discharge virtual care and overcome barriers to outpatient care. The objective was to develop and provide post-discharge virtual care for patients discharged from hospital medicine services. METHODS: We developed the Post-discharge Early Assessment with Remote video Link (PEARL) initiative for HM-APPs to conduct a post-discharge video visit (to review recommendations) and telephone follow-up (to evaluate adherence) with patients 2-6 days following hospital discharge. Participants included patients discharged from hospital medicine services at an institution's hospitals in Rochester (May 2020-August 2020) and Austin (November 2020-February 2021) in Minnesota, US. HM-APPs also interviewed patients about their experience with the video visit and completed a survey on their experience with PEARL. RESULTS: Of 386 eligible patients, 61.4% were enrolled (n = 237/386) including 48.1% women (n = 114/237). In patients with complete video visit and telephone follow-up (n = 141/237), most were prescribed new medications (83.7%) and took them as prescribed (93.2%). Among five classes of chronic medications, patient-reported adherence ranged from 59.2% (narcotics) to 91.5% (anti-hypertensives). Patient-reported self-management of 12 discharge recommendations ranged from 40% (smoking cessation) to 100% (checking rashes). Patients reported benefit from the video visit (agree: 77.3%) with an equivocal preference for video visits over clinic visits. Among HM-APPs who responded to the survey (88.2%; n = 15/17), 73.3% reported benefit from visual contact with patients but were uncertain if video visits would reduce emergency department visits. CONCLUSION: In this novel initiative, HM-APPs used video visits to provide care beyond their hospital role, reinforce discharge recommendations for patients, and reduce barriers to outpatient care. The effect of this initiative is under evaluation in a randomized controlled trial.

Estimating the costs of physician turnover in hospital medicine.

BACKGROUND AND OBJECTIVE: Costs of physician turnover are lacking for specialties organized around a site of care. We sought to estimate the cost of physician turnover in adult hospital medicine (HM). DESIGN, SETTING, PARTICIPANTS: A retrospective cohort study within a large integrated health system between July 2017 and June 2020. To understand likely variation across the country, we also simulated costs using national wage data and a range of assumptions. MAIN OUTCOME AND MEASURES: Direct costs of turnover borne by our department and institution and indirect costs from reduced hospital billing. In our simulation, we measured costs per hired hospitalist. RESULTS: Between July 2017 and June 2020, 34 hospitalists left the practice, 97 hospitalists were hired, and a total of 234 hospitalists provided adult care at six hospitals. Direct costs of turnover totaled $6166 per incoming physician. Additional clinical coverage required at times of transition was the largest expense, followed by physician time recruiting and interviewing prospective candidates. The salary difference between outgoing and incoming hospitalists was cost-saving, while reduced billing would add to indirect costs per hire. In our simulation using national wage data, programs hiring one hospitalist would spend a mean of $56,943 (95% CI: $27,228-$86,659), programs hiring five hospitalists would spend a mean of $33,333 per hospitalist (95% CI: $9375-$57,292), and programs hiring 10 hospitalists would spend a mean of $30,382 per hospitalist (95% CI: $6877-$53,887). CONCLUSIONS: The financial cost of turnover in HM appears to be substantially lower than earlier estimates of the cost of turnover from non-hospitalist specialties.

A Novel Hospital Medicine Training Track for Internal Medicine Residents: Description and Program Evaluation of the First 15 Years.

Background: The growth of hospital medicine has resulted in a parallel growth of hospital medicine training within internal medicine residency programs (IMRPs), but the experience and outcomes of these training offerings have not yet been described. Objective: To describe the first dedicated hospitalist track and the program evaluation data. Methods: The University of Colorado Hospitalist Training Track (HTT) is a 3-year track within the IMRP with robust inpatient clinical training, specialized didactics, experiential improvement work, and career mentorship. We collected data on graduates' current practices and board certification pass rates. To further evaluate the track, we electronically sent a cross-sectional survey to 124 graduates from 2005 to 2019 to identify current practice settings, graduate roles, and assessment of the training track. Results: Among 124 graduates, 97 (78.2%) practice hospital medicine, and the board certification pass rate was slightly higher than the overall IMRP pass rate for those graduating classes. Sixty-two (50%) graduates responded to the survey. Among respondents, 50 (80.6%) currently practice hospital medicine and 34 (54.8%) practice in an academic setting. The majority (50, 80.6%) hold leadership roles and are involved in a variety of scholarship, educational, and operational projects. Dedicated clinical training, didactics, and mentorship were valued by respondents. Conclusions: This represents the first description and program evaluation of a HTT for IM residents. A dedicated HTT produces graduates who choose hospital medicine careers at high rates and participate in a wide variety of leadership and nonclinical roles.

Scholarly productivity and growth of academic hospital medicine full professors.

BACKGROUND: Scholarship remains the principal currency for faculty promotion in academic medicine. Reference points for scholarly growth and productivity at academic medical centers (AMCs) are lacking. METHODS: We identified hospital medicine full professors (HMFPs) at AMCs ranked in research by US News & World Report. Scopus was used to identify each HMFP's publications, citations, and Hirsch-index (H-index). Publications; citations; and first, middle, and senior author papers were measured in 3-year intervals postresidency. Scholarly productivity was analyzed by quintile based on publications, AMC research ranking, years postresidency, and grant funding. RESULTS: Data were extracted for 128 HMFPs from 54 AMCs. HMFPs were a mean of 20.5 (SD: 5.4) years postresidency. The median H-index was 7.0 (interquartile range [IQR]: 2.0-16.0); the median number of publications was 15.0 (IQR: 4.0-51.0). Top quintile HMFPs had a median of 175.5 (IQR: 101.5-248.0) publications, whereas fifth quintile HMFPs had a median of 0.0 (IQR: 0.0-1.0) (p < .001). HMFPs on faculty at the top 20 AMCs had a median of 35.5 (IQR: 11.0-108.0) publications, whereas HMFPs in AMCs ranked 81-122 had a median of 3.0 (IQR: 1.0-9.0) (p < .001). Grant-funded HMFPs had a median of 177.0 (IQR: 71.0-278.0) publications, while nongrant-funded HMFPs had a median of 11.0 (IQR: 3.0-25.0) (p < .001). At 3, 6, and 9 years postresidency, HMFPs had a median of 0.0 (IQR: 0.0-1.0), 1.5 (IQR: 0.0-5.0), and 3.5 (IQR: 0.0-11.0) publications. Fellowship training, additional degrees, and top 25 residency programs correlated with the top half of scholarly productivity. CONCLUSIONS: Scholarly productivity among HMFPs varies considerably. At 3, 6, and 9 years postresidency, it is minimal to modest. Grant funding and AMC research rank may establish separate frames of reference for scholarly growth.

Defining Supervision Preferences and Roles Within a New Subspecialty: Pediatric Hospital Medicine.

OBJECTIVE: To describe supervision preferences among pediatric hospitalists, Pediatric Hospital Medicine (PHM) fellows, and senior residents (SRs), and to better define the ideal role of a PHM fellow. METHODS: We conducted a cross-sectional survey study at 6 institutions nationwide. We developed 3 complementary surveys, one for each population (hospitalists, fellows, SRs). We calculated univariate descriptive and bivariate statistics for categorical variables using Chi-square tests with the Rao-Scott correction to account for clustering by institution. RESULTS: Survey respondents included 106 of 200 hospitalists (53%), all 20 fellows (100%), and 149 of 380 SRs (39%). Most hospitalists and all fellows preferred the supervising hospitalist to have 3+ years of experience or be fellowship-trained. Nearly all fellows preferred the attending round in-person providing progressive independence; while hospitalists and SRs desired greater attending presence on rounds. Hospitalists and fellows wanted more frequent communication when the attending does not round with the team, and more hospitalists desired at least 2 points of contact regardless of attending presence on rounds. Fifty-five percent of SRs reported experiencing much less/less autonomy when on with a fellow than when supervised by a hospitalist only. Regarding the fellow's role, most participants agreed SRs should lead rounds and contact the fellow first with questions. The majority agreed teaching should be a shared responsibility but lacked consensus about how to provide feedback. CONCLUSIONS: Study results reveal preferences about supervising fellows in this new subspecialty. Hospitalists, fellows, and SRs may have differing opinions regarding workflow, communication, and teaching, impacting team leadership and autonomy.

An Economic Evaluation of a Proactive Consultation-Liaison Psychiatry Pilot as Compared to Usual Psychiatric Consultation on Demand for Hospital Medicine.

BACKGROUND: A growing literature demonstrates the value of the proactive consultation-liaison psychiatry model for health care systems through reductions in hospital length of stay. Few studies include financial outcomes. OBJECTIVE: We evaluated the return on investment of a 1-year proactive consultation-liaison psychiatry pilot in a hospital medicine unit. METHODS: We used a pre-post method with an active comparison of three hospital medicine units with regular psychiatric consultation on demand. We staffed the pilot unit with one full-time psychiatrist who focused on early case finding, close communication with unit staff, frequent follow-up visits, and proactive discharge planning. We assessed the 1-year change in mean length of stay for all patients receiving psychiatric consultation, from which we estimated the direct contribution margin from bed-backfills and the program's return on investment. RESULTS: On the pilot unit, the percent of discharges that received psychiatric consultation increased from 7.34% to 13.79%, and the length of stay for patients who consulted declined by a mean of 1.82 days (P < 0.05), as compared to an increase of 0.15 days (P > 0.05) on the usual-care units. The pilot unit reduction in length of stay saved 451.71 days in total, allowing for 73.81 bed-backfills, a direct contribution margin of $419,343 (95% confidence interval, $50,754 to $787,933), a net direct contribution margin of $298,245 (-$70,344 to $666,835), and an return on investment of 132% (-31% to 295%). CONCLUSION: This study strengthens existing evidence for the relative cost-effectiveness of proactive consultation-liaison psychiatry for hospital medicine compared with usual psychiatric consultation on demand.

Gender Distribution of Scholarship and Measures of National Recognition in Hospital Medicine.

OBJECTIVE: Our specific aim was to assess the gender distribution of aspects of scholarly productivity and professional standing for pediatric hospital medicine over a 5-year period. We also evaluated for correlation between the makeup of editorial boards, conference planning committees, and chosen content. METHODS: We reviewed scholarly publications, presentations, editorial boards, planning committees, awardees, and society leadership in pediatric hospital medicine from 2015 to 2019 and determined gender using published methods to assess for differences between observed proportions of women authors and presenters and the proportion of women in the field. RESULTS: The field of pediatric hospital medicine at large is 69% women (95% confidence internal [CI] 68%-71%), and an estimated 57% of senior members are women (95% CI 54%-60%). We evaluated 570 original science manuscripts and found 67% (95% CI 63%-71%) women first authors and 49% (95% CI 44%-53%) women senior authors. We evaluated 1093 presentations at national conferences and found 69% (95% CI 65%-72%) women presenters of submitted content and 44% (95% CI 37%-51%) women presenters of invited content. Senior authorship and invited speaking engagements demonstrated disproportionately low representation of women when compared with senior members of the field (senior authorship, P = .002; invited presenters, P < .001). Strong positive correlation between gender composition of conference planning committees and selected content was also noted (r = 0.94). CONCLUSION: Our study demonstrated representative gender distribution for some aspects of scholarly productivity in pediatric hospital medicine; however, a lack of gender parity exists in senior roles.

Preparing for a Career in Pediatric Hospital Medicine: A Needs Assessment and Recommendations for Individualized Curricula.

OBJECTIVES: The individualized curriculum within residency programs allows residents to tailor their elective time toward future career goals and interests. Our objective was to identify experiences and activities that would foster resident interest and enhance preparation for a career in pediatric hospital medicine (PHM). METHODS: Electronic surveys were distributed to pediatric hospitalists, PHM fellowship directors, and graduating PHM fellows. These stakeholders were asked to identify key experiences for residents to explore before entering fellowship or practice. Descriptive statistics and thematic analysis were performed on survey responses. RESULTS: Forty-six percent of PHM fellows (16 of 35), 42% of pediatric hospitalists (149 of 356), and 58% of fellowship program directors (35 of 60) completed the survey. All 3 groups identified complex care as the most important clinical experience to gain in residency. Other highly valued clinical experiences included pain management, surgical comanagement, and palliative care. Lumbar puncture, electrocardiograph interpretation, and airway management were identified as essential procedural skills. Nonclinical experiences that were deemed important included quality improvement, development of teaching skills, and research methodology. All groups agreed that these recommendations should be supplemented with effective mentorship. CONCLUSIONS: Identification of key clinical experiences, nonclinical activities, and mentorship for residents interested in PHM may assist with tailoring the individualized curriculum to personal career goals. Incorporating these suggested experiences can improve preparedness of residents entering PHM.

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value.

OBJECTIVES: The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children. METHODS: A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research. The study team surveyed national pediatric hospitalist LISTSERVs for suggestions, condensed similar responses, and performed a literature search of articles published in the previous 10 years. Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations. RESULTS: Two hundred seven respondents suggested 397 preliminary recommendations, yielding 74 unique recommendations that underwent evidence review and rating. The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis. CONCLUSIONS: We propose that pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.

Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service.

BACKGROUND: Differential opioid prescribing patterns have been reported in non-White patient populations. However, these disparities have not been well described among hospitalized medical inpatients. OBJECTIVE: To describe differences in opioid prescribing patterns among inpatients discharged from the general medicine service based on race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: For this retrospective study, we performed a multivariable logistic regression for patient race/ethnicity and whether patients received an opioid prescription at discharge and a negative binomial regression for days of opioids prescribed at discharge. The study included all 10,953 inpatients discharged from the general medicine service from June 2012 to November 2018 at University of California San Francisco Medical Center who received opioids during the last 24 hours of their hospitalization. MAIN OUTCOMES AND MEASURES: We examined two primary outcomes: whether a patient received an opioid prescription at discharge, and, for patients prescribed opioids, the number of days dispensed. RESULTS: Compared with White patients, Black patients were less likely to receive an opioid prescription at discharge (predicted population rate of 47.6% vs 50.7%; average marginal effect [AME], -3.1%; 95% CI, -5.5% to -0.8%). Asian patients were more likely to receive an opioid prescription on discharge (predicted population rate, 55.6% vs 50.7%; AME, +4.9; 95% CI, 1.5%-8.3%). We also found that Black patients received a shorter duration of opioid days compared with White patients (predicted days of opioids on discharge, 15.7 days vs 17.8 days; AME, -2.1 days; 95% CI, -3.3 to -0.9). CONCLUSION: Black patients were less likely to receive opioids and received shorter courses at discharge compared with White patients, adjusting for covariates. Asian patients were the most likely to receive an opioid prescription.

Research and Career Outcomes for Pediatric Hospital Medicine Fellowship Graduates.

OBJECTIVES: Pediatric hospital medicine (PHM) fellowships have rapidly developed to meet established needs. The purpose of this research was to describe the research and career outcomes of PHM fellowship graduates. We hypothesized that graduates would report significant research and academic productivity. METHODS: This was an institutional review board-approved, cross-sectional survey of PHM fellowship graduates in 2018. The 88-item survey was modified from an existing survey, developed by experts to address study objectives and pilot tested, and it included quantitative and qualitative items to assess characteristics of fellowship training and research and career outcomes. RESULTS: A total of 63% of PHM fellowship graduates (143 of 228) completed the survey (graduation dates, 2000-2018). In total, 89% graduated from dedicated PHM fellowship programs, with 59% completing a 2-year fellowship and 78% now practicing primarily at a university or children's hospital. Fellows conducted research in clinical research (53%), quality improvement (41%), health services (24%), and medical education (19%). A total of 77% of graduates continued to do research after graduation, with 63% publishing and 25% obtaining grant funding. Graduates of 2- and 3-year fellowships and those with a master's degree were significantly more productive. Graduates now hold important roles in academic and health systems leadership. Graduates are highly satisfied with their decision to do PHM fellowship and identified 5 themes regarding how fellowship impacted their career outcomes. CONCLUSIONS: In this study, we document robust research activity and leadership positions among PHM fellowship graduates and can serve as a benchmark for metrics that PHM educational leaders can use to assess outcomes and improve training regarding research and career development.