Development and Implementation of a Hospitalist Faculty Development Program in a University- and Community-Based Multihospital System.

OBJECTIVES: Robust faculty development (FD) is an emerging area of focus within hospital medicine, a relatively new specialty with limited mentorship infrastructure to find and develop a professional niche. There are few descriptions in the literature of establishing and evaluating an FD program with strategies to evaluate success, invite collaboration, and achieve feasible, useful metrics. METHODS: We created our University Division of Hospital Medicine's FD Program to help community and academic hospitalist faculty fulfill professional goals in (and beyond) quality improvement, leadership, education, and clinical skills. We describe program development, initial implementation, and early evaluation results. We outline program roles and offerings such as professional development awards, lectures, and mentorship structures. RESULTS: Our program was successfully implemented, measured by engagement and participation via preliminary indicators suggesting programmatic effectiveness: faculty who applied for (and continued participation in) mentorship and faculty development awards and faculty who attended our lecture series. Since program implementation, faculty retention has increased, and percentages of faculty reporting they were likely to remain were stable, even during the coronavirus disease 2019 pandemic. Scholarly production increased and the number of division associate professors/professors grew from 2 in 2015 to 19 in 2024. CONCLUSIONS: Our experience can guide institutions seeking to support and encourage faculty professional development. Lessons learned include the importance of needs assessment and leadership commitment to meeting identified needs; how a steering committee can amplify the effectiveness and relevance of FD efforts; and the utility of multiple recognition strategies-quarterly newsletters, monthly clinical recognition, mentions on social media-to support and encourage faculty.

Gender Issues in Academic Hospital Medicine: a National Survey of Hospitalist Leaders.

BACKGROUND: Gender inequities are documented in academic medicine. Within General Internal Medicine (GIM), there are fewer female division directors and first and last authors on publications. With gender parity in US medical school graduates and with Academic Hospital (AH) medicine being a relatively newer discipline, one might postulate that AH would have less gender inequity. DESIGN: A national survey of AH programs was developed via literature review and expert recommendations. Domains included program and faculty information. Gender of the leader was determined via website or telephone call. PARTICIPANTS: Leaders of AH programs associated with the American Association of Medical Colleges (AAMC). Programs without a primary teaching hospital or hospitalist program and those not staffed by university-affiliated physicians were excluded. MAIN MEASURES: Description and characteristics of leaders and programs including a multivariable analysis of gender of hospitalist leaders and the portion of female faculty. KEY RESULTS: 59% response rate (80 of 135); there were no differences between responders/non-responders in NIH funding (p = 0.12), type of institution (p = 0.09), geographic region (p = 0.15), or year established (p = 0.86). Reported number of female and male faculty were approximately equal. 80% of hospitalist leaders were male; 37% of male hospitalist leaders were professors, no female leaders were professors. In univariate and multivariate analysis only the number of hospitals staffed was a significant predictor of having a female hospitalist leader. There were no significant predictors of having fewer female faculty. CONCLUSION: This study demonstrated gender inequality in academic hospital medicine regarding leadership and rank. Though there was equal gender distribution of faculty, among leaders most were men and all "full professors" were men. As diversity benefits the tripartite mission research on methods, initiatives and programs that achieve gender equity in leadership are needed.

Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services.

BACKGROUND: Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. OBJECTIVE: We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. DESIGN AND SETTING: The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. MEASUREMENTS: The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. RESULTS: One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. CONCLUSION: The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis.

Levamisole is a known immunomodulating agent frequently used as a cutting agent in cocaine consumed in the United States today. Numerous cases of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis connected with the use of levamisole-adulterated cocaine have previously been reported in the literature, classically characterized by a retiform purpuric rash. We report a case of a crack-cocaine user without cutaneous abnormalities who developed ANCA-associated glomerulonephritis that progressed to renal failure. This case demonstrates the difficulties in solidifying the diagnosis of levamisole-induced vasculitis in the absence of cutaneous findings and the need to pursue more testing to establish causality in ANCA-associated vasculitis that has potential for severe end-organ damage in patients who continue to use cocaine.

Reorganizing a hospital ward as an accountable care unit.

Traditional hospital wards are not specifically designed as effective clinical microsystems. The feasibility and sustainability of doing so are unclear, as are the possible outcomes. To reorganize a traditional hospital ward with the traits of an effective clinical microsystem, we designed it to have 4 specific features: (1) unit-based teams, (2) structured interdisciplinary bedside rounds, (3) unit-level performance reporting, and (4) unit-level nurse and physician coleadership. We called this type of unit an accountable care unit (ACU). In this narrative article, we describe our experience implementing each feature of the ACU. Our aim was to introduce a progressive approach to hospital care and training.

A rare case of squamous cell carcinoma of the bladder presenting as a metastatic right ventricular mass.

A 74-year-old woman presented with bilateral lower extremity swelling, worsening dyspnea on exertion, and mild hemoptysis. An echocardiogram at time of admission showed a mass in the right ventricle. The pathology of a sample obtained via transvenous biopsy was consistent with squamous cell carcinoma; no primary source could initially be identified. Severe thrombocytopenia, likely consumptive, precluded surgical intervention, so the patient underwent palliative radiation. Unfortunately, she developed fatal respiratory failure. Upon autopsy, the bladder was found to contain polyps of invasive squamous cell carcinoma, similar in morphology to the tumor mass in the heart. Her lungs contained multiple tumor emboli at different stages, which was likely the final cause of her death. Squamous cell carcinoma metastases to the endocardium are extremely rare and without defined treatment. Surgery can improve prognosis in those with primary tumors that are benign or without metastases. In those with symptomatic metastatic tumors, palliative debulking can done although generally will not improve prognosis. It is currently unknown whether radiation improves survival. In this case, irradiation did destroy a portion of the tumor as the final pathology showed extensive necrosis of the tumor; unfortunately, it did not change her symptoms and did not change the final outcome.