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.

Assessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: an internal survey.

BACKGROUND: In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. Rapid cardiopulmonary resuscitation and early defibrillation is extremely connected to patient outcome. In this study, we aimed to assess the effects of a basic life support and defibrillation course in improving knowledge in IHCA management. METHODS: We performed a prospective observational study recruiting healthcare personnel working at Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Study consisted in the administration of two questionnaires before and after BLS-D course. The course was structured as an informative meeting and it was held according to European Resuscitation Council guidelines. RESULTS: 78 participants completed pre- and post-course questionnaires. Only 31.9% of the participants had taken part in a BLS-D before our study. After the course, we found a significative increase in the percentage of participants that evaluated their skills adequate in IHCA management (17.9% vs 42.3%; p < 0.01) and in the correct use of defibrillator (38.8% vs 67.9% p < 0.001). However, 51.3% of respondents still consider their preparation not entirely appropriate after the course. Even more, we observed a significant increase in the number of corrected responses after the course, especially about sequence performed in case of absent vital sign, CPR maneuvers and use of defibrillator. CONCLUSIONS: The training course resulted in significant increase in the level of knowledge about the general management of IHCA in hospital staff. Therefore, a simple intervention such as an informative meetings improved significantly the knowledge about IHCA and, consequently, can lead to a reduction of morbidity and mortality.

Where are we now with inpatient consultative dermatology?: Assessing the value and evolution of this subspecialty over the past decade.

The importance of inpatient consultative dermatology is often underrecognized and undervalued. A significant need exists because the burden of skin disease in the hospital is great and expertise regarding the recognition and management of uncommon and severe skin disorders is limited outside the field. In response to this need, the concept of a dermatology hospitalist was defined and the Society for Dermatology Hospitalists was created in 2009. Over the past decade, the subspecialty has developed and fostered both research and education. Data now exist demonstrating the value of inpatient dermatology services not only to patients but also to payors and health care systems. Future needs include strategies to improve access to expertise and additional efforts to establish our field as an indispensable and enduring component of hospital-based care.

Dermatology hospital fellowships: present and future.

The question of what makes a successful dermatology hospitalist has risen to the forefront due to the rapidly increasing number of these providers. Inpatient dermatology fellowships have formed as a direct consequence. Though mostly in their infancy, these programs have primary or secondary goals to train providers in the dermatologic care of the hospitalized patient. This article presents a brief synopsis of the history of traditional hospitalist fellowships and extrapolates these findings to existing hospitalist dermatology fellowships. As more of these programs arise, these fellowships are poised to revolutionize dermatologic inpatient care from a systems perspective.

The efficient, effective community hospital inpatient dermatology consult.

Hospital dermatology is often thought to be too cumbersome for the private practicing dermatologist to handle, leaving patients in our communities without needed care and our medical colleagues in the dark when it comes to diagnosing and/or managing skin disease in the hospitalized patient. This notion that "someone else will figure it out" undervalues our expertise as a specialty and threatens the appropriate health outcomes we knowingly understand patients deserve. In this manuscript, we intend to break down the hospital consult conceptually so as to make clear how simple it can be to help our physician colleagues and make an important impact upon patients at their most vulnerable time.

Hospital Medicine and Fellowship Program in Rural North Dakota - A Multifaceted Success Story.

INTRODUCTION: Recruitment of hospitalists and primary care physicians for Critical Access Hospitals and tertiary care hospitals in North Dakota is difficult. To address this challenge, 2 programs were implemented in Bismarck, North Dakota. METHODS: St. Alexius Medical Center created a hospitalist fellowship training program in collaboration with the University of North Dakota School of Medicine and Health Sciences and physicians willing to work in Critical Access Hospitals were offered a joint appointment to teach hospitalist fellows and obtain a clinical academic appointment at the university. RESULTS: Since it was created in 2012, 84 physicians have applied for 13 fellowships. Of the 11 fellows who have completed the program, 64% (7/11) remained in North Dakota to practice. CONCLUSIONS: Physicians are more likely to work in a rural Critical Access Hospital if they spend time working at a tertiary care center and have clinical academic appointments. Where recruitment is challenging, hospitalist fellowship programs are helpful in meeting the health care workforce demand.

Hospitalist career decisions among internal medicine residents.

BACKGROUND: Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). OBJECTIVE: To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. DESIGN: Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. PARTICIPANTS: 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. MAIN MEASURES: Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. KEY RESULTS: Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. CONCLUSIONS: Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.

Comparing patient outcomes of academician-preceptors, hospitalist-preceptors, and hospitalists on internal medicine services in an academic medical center.

BACKGROUND: Patient outcomes with hospitalist care have been studied in many settings, yet little is known about how hospitalist care interacts with trainee care to affect patient outcomes in teaching hospitals. OBJECTIVES: The aim of this study was to compare patient outcomes between hospitalist-preceptors and hospitalists working alone (isolating the effect of housestaff involvement), and between hospitalist-preceptors and academician-preceptors (isolating the effect of attending type, given housestaff involvement). DESIGN: A four-year retrospective cohort study of patients (n = 13,313) admitted to all internal medicine services at an academic medical center from July 2008 to June 2012. MAIN MEASURES: Using generalized estimating equations, we measured readmission within 30 days, hospital length of stay, cost of the index hospitalization, and cumulative cost including readmissions within 30 days. KEY RESULTS: In the adjusted models, 30-day readmission odds were higher for academic-preceptors (OR, 1.14 [95% CI, 1.03 - 1.26]) and hospitalist-preceptors (OR, 1.10 [95% CI, 1.002 - 1.21]) than for hospitalists working alone. Compared with hospitalists working alone, academic-preceptors were associated with shorter length of stay (mean difference, 0.27 days [95% CI, 0.18 - 0.38]), lower index hospitalization costs (mean difference, $386 [95% CI, $192 - $576]), but similar cumulative inpatient costs within 30 days of discharge. Compared with hospitalists working alone, hospitalist-preceptors were associated with shorter length of stay (mean difference, 0.34 days [95% CI, 0.26 - 0.42]), lower index hospitalization cost (mean difference, $570 [95% CI, $378 - $760]), and a trend toward lower cumulative cost (mean difference, $1347 [95% CI, $254 - $2,816]). CONCLUSIONS: Preceptor-led medicine services were associated with more readmissions within 30 days, shorter lengths of stay, and lower index admission-associated costs. However, when considering cumulative hospitalization costs, patients discharged by academician-preceptors incurred the highest cost and hospitalist-preceptors incurred the lowest cost.

OBGYN Hospitalist Fellowships: An Update on Fellowship Training in the United States.

Due to improved outcomes in clinical care, patient safety, and education, demand for OBGYN hospitalists is increasing. As a result, an OBGYN hospitalist fellowship was developed to train future leaders in OBGYN hospital medicine. This article is a discussion regarding the landscape of OBGYN hospitalist fellowships across the country. Utilizing information from program-specific Web sites, as well as discussions with past and present fellowship directors, this article summarizes key differences and similarities across programs, as well as reviews important considerations for those hoping to start a fellowship at their own institution.

Obstetrics and Gynecology Hospitalists as Champions of Drills and Simulation.

Obstetrics and gynecology Hospitalists are not only skilled providers of emergency obstetric and gynecologic care but also safety officers who advocate for and maintain safety and quality in the hospital setting. In these areas and others, they play an essential role in championing and establishing simulation-based education in the hospital setting. The use of Simulations and Drills in maintaining quality and safety in patient care is nationally recognized by leading obstetric and gynecologic organizations.

A Survey Study of Motivators for Pediatric Hospitalists to Work in the Community.

BACKGROUND AND OBJECTIVE: The loss of pediatric beds in the community has contributed to decreased access to pediatric inpatient and emergency services. Community pediatric hospitalist programs could reduce the overhead of inpatient care, promoting the financial feasibility of caring for hospitalized children closer to home. This study aims to determine which career motivators are the most important for pediatric hospitalists to begin working in, remain in, and leave the community setting. METHODS: A survey was sent to a convenience sample of 269 community hospitalists from 31 different sites. Sites were invited if the program director was known to the authors. Responses were evaluated and χ-square or Fisher's exact test were used to compare the differences. RESULTS: One hundred twenty six community pediatric hospitalists completed the survey (response rate 49.1%). The 3 most important motivators for pediatric hospitalists to begin working in the community were work-life integration (80%), geographic location (75%), and flexible hours (71%). Pediatric hospitalists who planned to leave the community setting were more likely to cite mentoring and teaching opportunities (76% vs 32%, P = .0002), opportunities for research and quality improvement (29% vs 10%, P = .021), and paid time for nonclinical interests (52% vs 26%, P = .02) as very important. CONCLUSIONS: This study demonstrates key motivators for pediatric hospitalists to work in the community and elucidates motivators for transitioning to larger pediatric centers. This knowledge may be used to guide community pediatric hospital medicine recruitment and program development that could lead to improved retention.

Hiring in the Pediatric Hospital Medicine Board Certification Era: PHM Leader Perspectives.

OBJECTIVES: The designation of pediatric hospital medicine (PHM) as a board-certified (BC) subspecialty has led to uncertainty about the importance of PHM board certification in hiring pediatric hospitalists and ambiguity in counseling trainees interested in PHM careers about the decision to pursue fellowship. We sought to determine the importance of PHM board eligibility or certification in hiring practices. METHODS: We conducted an online, cross-sectional, survey-based study of individuals who self-identified as PHM division leadership utilizing the PHM Division Director Listserv and participant recruitment at a national meeting. RESULTS: A total of 86 responses were received. A total of 64% (30/47) of university-setting hospitals, 77% (17/28) of community hospitals, and 100% (11/11) of combined settings reported that they will hire applicants who are not board-eligible (BE) or BC (P = .83). Of the hospitals who will be hiring non-BE hospitalists, 50% of university settings, 77% of community settings, and 55% of combined settings plan to give equal consideration to both BE and non-BE applicants (P = .21). A total of 57% (21/37) of programs with a PHM fellowship felt that fellowship training was an important or very important consideration in hiring, compared with 27% (13/49) of programs without a PHM fellowship (P = .04). CONCLUSIONS: Programs with a PHM fellowship were significantly more likely to believe that fellowship training is an important consideration in hiring hospitalists. PHM board certification and fellowship training are perceived as more important by university-based programs, although all settings will consider hiring applicants who are not BC or BE.

Effect of online diabetes training for hospitalists on inpatient glycaemia.

AIM: An online diabetes course for medical residents led to lower patient blood glucose, but also increased hypoglycaemia despite improved trainee confidence and knowledge. Based on these findings, we determined whether an optimized educational intervention delivered to hospitalists (corresponding to an Acute Physician or Specialist in Acute Hospital Medicine in the UK) improved inpatient glycaemia without concomitant hypoglycaemia. METHODS: All 22 hospitalists at an academic medical centre were asked to participate in an online curriculum on the management of inpatient dysglycaemia in autumn 2009 and a refresher course in spring 2010. RESULTS: All hospitalists completed the initial intervention. Median event blood glucose decreased from 9.3 mmol/l (168 mg/dl) pre-intervention to 7.8 mmol/l (141 mg/dl) post-intervention and 8.5 mmol/l (153 mg/dl) post-refresher (P < 0.001 for both). Hospitalizations categorized as hyperglycaemia decreased from 83.3 to 55.6% (P = 0.014), with a trend towards euglycaemia (10-28.9%, P = 0.08) and no change in hypoglycaemia. Hyperglycaemic patient-days decreased from 72.0 to 57.3% (P = 0.004), with greater target glycaemia (27.3-39.4%, P = 0.016) and no change in hypoglycaemia. CONCLUSIONS: An optimized online educational intervention delivered to hospitalists yielded significant improvements in inpatient glycaemia without increased hypoglycaemia.

Assessing hospitalists' opinions regarding the role of environmental health within the practice of hospital medicine.

BACKGROUND: Environmental health represents the concept that a stable climate and clean environment are fundamental prerequisites for good human health. Despite growing awareness of the impact of climate change more broadly, knowledge of environmental health has not fully entered mainstream medicine in the United States. OBJECTIVE: To understand practicing hospitalists' perspectives regarding the current and future roles of environmental health within the practice of hospital medicine, as well as existing barriers and potential motivators to its further inclusion. METHODS: We conducted virtual focus groups of practicing hospitalists in partnership with the Hospital Medicine Reengineering Network from across the United States. Structured interviews elicited hospitalists' thoughts pertaining to environmental health. Transcripts then underwent descriptive coding to identify and group comments into themes. RESULTS: We conducted three focus groups with a total of 14 physician participants. Four themes emerged: the negative environmental impact of the healthcare system, a lack of prioritization of environmental health within hospital medicine, the potential for expanding environmental health in nonclinical roles including medical education, and the importance of systems-level support. CONCLUSION: Environmental health is felt to be of importance, and while there exist avenues to do better, there is limited understanding of hospitalists' most effective role in making change.

The laborist model of obstetric care: we need more evidence.

Literature suggesting improved patient outcomes and patient satisfaction with the hospitalist model of inpatient medical care coupled with the desire to improve provider satisfaction led to the introduction of the laborist in obstetrics. This represents a significant change in the way obstetrics has been experienced and practiced from both a patient and provider perspective. The laborist was designed as a plausible model of obstetric care delivery where hospitals employ physicians to provide continuous coverage of labor and delivery units without other competing clinical duties. Anecdotal use of the laborist model in the provision of obstetric care is growing rapidly, despite the lack of research regarding its impact on maternal outcomes, neonatal outcomes, patient and provider satisfaction, and graduate medical education. We provide an overview of both the positive and negative attributes of this model of obstetric care delivery, discuss the current state of research addressing these attributes, and propose a research strategy to improve understanding of the impact of this model of care delivery.

Neurohospitalists: an emerging subspecialty.

Akin to the rapid growth in hospitalist medicine seen in the prior decade, there has been a recent explosion in the need for neurohospitalists. Factors driving this demand include nationally mandated quality and safety measures, the increasing complexity and age of the hospitalized patient, and diminished training in diagnosis and management of neurological illnesses for internal medicine residents. The role of the neurohospitalist is varied and may include not only providing neurological care to hospitalized patients but also serving as a leader in an institution's push to meet quality and safety measures. Close collaboration with intensivists, vascular neurologists, and outpatient neurologists is both a challenge and essential for successful delivery of care both during hospitalization and after discharge. Future challenges facing neurohospitalists include defining its relationship to other fields, instituting a pathway for certification, and conducting research to guide the development of evidence-based practice and quality measures.

Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education.

The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p<.01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p<.01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p<.01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.

Chemical terrorism for the intensivist.

The use of chemical agents for terrorist attacks or military warfare is a major concern at the present time. Chemical agents can cause significant morbidity, are relatively inexpensive, and are easy to store and use. Weaponization of chemical agents is only limited by the physicochemical properties of some agents. Recent incidents involving toxic industrial chemicals and chemical terrorist attacks indicate that critical care services are frequently utilized. For obvious reasons, the critical care literature on chemical terrorism is scarce. This article reviews the clinical aspects of diagnosing and treating victims of chemical terrorism while emphasizing the critical care management. The intensivist needs to be familiar with the chemical agents that could be used in a terrorist attack. The military classification divides agents into lung agents, blood agents, vesicants, and nerve agents. Supportive critical care is the cornerstone of treatment for most casualties, and dramatic recovery can occur in many cases. Specific antidotes are available for some agents, but even without the antidote, aggressive intensive care support can lead to favorable outcome in many cases. Critical care and emergency services can be overwhelmed by a terrorist attack as many exposed but not ill will seek care.