What's the CATCH? A Participatory Learning Model for Case Review Rounds to Support a Culture of Safety and Quality Improvement in Pediatric Hospital Medicine.

OBJECTIVE: To evaluate the effectiveness of a new model, Case Analysis and Translation to Care in Hospital (CATCH), for the review of pediatric inpatient cases when an adverse event or "close call" had occurred. STUDY DESIGN: The curricular intervention consisted of an introductory podcast/workshop, mentorship of presenters, and monthly CATCH rounds over 16 months. The study was conducted with 22 pediatricians at a single tertiary care center. Intervention assessment occurred using participant surveys at multiple intervals: pre/post the intervention, presenter experience (post), physicians involved and mentors experience (post), and after each CATCH session. Paired t-tests and thematic analysis were used to analyze data. Time required to support the CATCH process was used to assess feasibility. RESULTS: Our overall experience and data revealed a strong preference for the CATCH model, high levels of engagement and satisfaction with CATCH sessions, and positive presenter as well as physicians-involved and mentor experiences. Participants reported that the CATCH model is feasible, engages physicians, promotes a safe learning environment, facilitates awareness of tools for case analysis, and provides opportunities to create "CATCH of the Day" recommendations to support translation of learning to clinical practice. CONCLUSIONS: The CATCH model has significant potential to strengthen clinical case rounds in pediatric hospital medicine. Future research is needed to assess the effectiveness of the model at additional sites and across medical specialities.

Getting it RITE: Impact of a Dedicated Hospital Medicine Curriculum for Residents.

OBJECTIVE: The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience. METHODS: This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident Inpatient Training Experience service for 1 month and completed a pre- and postrotation confidential online survey. Primary outcomes included confidence in managing hospitalized patients, knowledge regarding hospital medicine topics, and interest in pursuing hospital medicine as a career. RESULTS: Thirty-three PGY-2 residents completed both the pre- and postrotation survey (72% response rate). After completing the rotation, the residents' confidence level (measured on a 5-point Likert scale, with 1 = strongly disagree and 5 = strongly agree) rose significantly in managing hospitalized patients, from 3.82 to 4.33 (P = 0.003) and in leading a ward team, from 3.76 to 4.21 (P = 0.020). Knowledge level (measured on a 5-point Likert scale with 1 = very poor and 5 = excellent) improved significantly in transitions of care, from 3.45 to 3.79 (P = 0.023); cost-conscious care, from 3.00 to 3.42 (P = 0.016); physician billing/coding, from 2.55 to 3.03 (P = 0.007); hospital metrics, from 2.39 to 2.94 (P = 0.002); and hospital reimbursement, from 2.48 to 3.09 (P = 0.001). Interest in pursuing hospital medicine as a career also increased. CONCLUSIONS: Resident independence in managing patients and training in hospital medicine topics has not kept up with evolving need. Dedicated hospital medicine rotation and curriculum are effective ways to alleviate the deficiencies in resident education.

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.

Hospital Dermatology, Introduction.

Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.

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.

Optimizing education on the inpatient dermatology consultative service.

A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge and an opportunity for dermatology consultation teams. There is an emergence of new information about how dermatology can best be taught in the hospital, much of which relies on principles of workplace learning as well as the science of how learning and teaching best happen in work settings. These best practices are summarized in this narrative review with integrated discussion of concepts from outpatient dermatology education and lessons learned from other inpatient teaching models. In addition, consultative dermatology curricula should utilize a blended curriculum model comprised of patient care and active learning and self-study modalities. Specific educational methods will discuss 2 strategies: (1) direct patient-care activities (ie, bedside teaching rounds) and (2) nonpatient care activities (ie, case presentations, didactic sessions, online modules, and reading lists).

Teledermatology in the inpatient setting.

Teledermatology (TD) is a health care delivery modality that uses telecommunication technology to provide dermatologic care. It has grown to be a reliable and diagnostically accurate means of producing quality care while increasing access and reducing wait times in the outpatient setting. In the inpatient setting, TD may be an effective method to improve access to dermatologic care by remotely triaging, assisting, or providing dermatologic consultative services. For inpatient dermatology, there is the potential for TD to increase access to care in the community setting where dermatologists have full outpatient schedules. Using inpatient TD to triage conditions may be especially helpful in determining if a patient needs to be emergently/urgently seen, or if outpatient care could be appropriate. To best establish TD in the inpatient setting, certain practice guidelines should be considered to ensure the highest quality patient care. These features include Health Insurance Portability and Accountability Act (HIPAA)-consistent protocols to ensure high-quality video sessions and clinical photographs are acquired, stored, and transmitted using secure software and networks, establishing relationships with primary care teams to ensure trust in consulting advice and ensuring consistent communication regarding recommendations, and appropriate patient follow-up.

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.

Cross-comparison of MRCGP & MRCP(UK) in a database linkage study of 2,284 candidates taking both examinations: assessment of validity and differential performance by ethnicity.

BACKGROUND: MRCGP and MRCP(UK) are the main entry qualifications for UK doctors entering general [family] practice or hospital [internal] medicine. The performance of MRCP(UK) candidates who subsequently take MRCGP allows validation of each assessment. In the UK, underperformance of ethnic minority doctors taking MRCGP has had a high political profile, with a Judicial Review in the High Court in April 2014 for alleged racial discrimination. Although the legal challenge was dismissed, substantial performance differences between white and BME (Black and Minority Ethnic) doctors undoubtedly exist. Understanding ethnic differences can be helped by comparing the performance of doctors who take both MRCGP and MRCP(UK). METHODS: We identified 2,284 candidates who had taken one or more parts of both assessments, MRCP(UK) typically being taken 3.7 years before MRCGP. We analyzed performance on knowledge-based MCQs (MRCP(UK) Parts 1 and 2 and MRCGP Applied Knowledge Test (AKT)) and clinical examinations (MRCGP Clinical Skills Assessment (CSA) and MRCP(UK) Practical Assessment of Clinical Skills (PACES)). RESULTS: Correlations between MRCGP and MRCP(UK) were high, disattenuated correlations for MRCGP AKT with MRCP(UK) Parts 1 and 2 being 0.748 and 0.698, and for CSA and PACES being 0.636. BME candidates performed less well on all five assessments (P < .001). Correlations disaggregated by ethnicity were complex, MRCGP AKT showing similar correlations with Part1/Part2/PACES in White and BME candidates, but CSA showing stronger correlations with Part1/Part2/PACES in BME candidates than in White candidates. CSA changed its scoring method during the study; multiple regression showed the newer CSA was better predicted by PACES than the previous CSA. CONCLUSIONS: High correlations between MRCGP and MRCP(UK) support the validity of each, suggesting they assess knowledge cognate to both assessments. Detailed analyses by candidate ethnicity show that although White candidates out-perform BME candidates, the differences are largely mirrored across the two examinations. Whilst the reason for the differential performance is unclear, the similarity of the effects in independent knowledge and clinical examinations suggests the differences are unlikely to result from specific features of either assessment and most likely represent true differences in ability.

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.

Pediatric Hospital Medicine Fellows' Perspectives on Autonomy Through Time.

OBJECTIVE: Promoting autonomy is at the core of fellowship education. Pediatric hospital medicine (PHM) fellowship programs are relatively new, and many supervising physicians are not trained on how to promote fellow autonomy. Moreover, no studies have explored fellows' perception of autonomy throughout training. To fill this gap, we explored PHM fellows' perceptions of autonomy throughout training. METHODS: PHM fellows starting fellowship in July 2021 were recruited to participate in a longitudinal qualitative study. Using self-determination theory as a sensitizing framework, the authors conducted semistructured interviews with 14 fellows throughout fellowship. Incoming data were iteratively analyzed, and codes were created from patterns in the data. Coded data were clustered into themes. RESULTS: Four themes developed: (1) at the beginning of fellowship, fellows valued direct observation and close supervision from their attending. (2) Initially, fellows felt pressured to make the identical clinical decision as their attending, but over the course of training, they realized their autonomous decisions could coexist with different decisions from their attending physicians. (3) At first, fellows desired attending presence to support and guide their decision making. Over time, fellows desired a coach who could provide valuable formative feedback. (4) Because of the hierarchical nature of medicine, conversations between fellows and attending physicians about autonomy were challenging to initiate. CONCLUSIONS: Fellows' perceptions of autonomy change throughout fellowship, which should be taken into consideration as provisions of autonomy evolve through training. Our findings can inform PHM fellowship curricula and professional development around the promotion of autonomy in fellowship.

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.

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.

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.

Development, implementation, and evaluation of a simulation-based educational curriculum for pediatric hospitalists.

BACKGROUND AND OBJECTIVES: Minimal published simulation-based educational training exists for practicing pediatric hospitalists. Our aim was to determine specific pediatric hospital medicine (PHM) knowledge, skill, and competency needs aligned with our scope of practice and evaluate the impact of a simulation-based training curriculum. DESIGN AND METHODS: Baseline and post-training surveys were administered to 48 physicians providing self-ratings on a 5-point scale from Novice to Expert on published PHM competencies. Results were used to develop a targeted simulation curriculum. Participants were considered competent in a domain if their mean score was 3 or greater. We categorized participant responses to individual questions into nine domain scores on survey self-assessments. Score analysis was performed using the signed-rank test and McNemar's test. Post-training evaluations solicited curriculum acceptance and perceived clinical value. RESULTS: The baseline response rate was 98% and the post-training response rate was 85%. Areas with the lowest competency on baseline self-assessment included advanced airway management (38%), vascular access and emergency medications (38%), code cart skills (19%), team communication (51%), and medically complex care (49%). Post-training scores improved significantly for five of nine domains, with the largest gains in the "not competent" at baseline group. Percent competent (% with mean score >3) increased significantly in three domains (advanced airway management, code cart skills, and complex care). Participants rated educational sessions favorably (98%) and most (95%) reported using knowledge/skills learned for patient care. CONCLUSION: Baseline self-assessment results were instrumental in curriculum design. Post-training analysis revealed gains in multiple domains and identified opportunities for future interventions. Most hospitalists reported participation positively impacted patient care with high learner satisfaction.

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.

A Changing Landscape: Exploring Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.

BACKGROUND: Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed. METHODS: A survey to explore residents' perspectives on PHM fellowships, with questions regarding demographics, likelihood of pursuing PHM after fellowship introduction, and influencing factors was distributed to pediatric and combined pediatric residents via program directors. RESULTS: The survey was distributed to an estimated 2657 residents. A total of 855 (32.2%) residents completed the survey; 89% of respondents had at least considered a career in PHM, and 79.4% reported that the introduction of the PHM fellowship requirement for subspecialty certification made them less likely to pursue PHM. Intent to practice in a community setting or only temporarily practice PHM, Combined Internal Medicine and Pediatric trainee status, and high student loan burden were associated with decreased likelihood of pursuing PHM (P < .05). Most respondents reported that forfeited earnings during fellowship, family and student loan obligations, and perceived sufficiency of residency training discouraged them from pursuing PHM fellowship. Half of respondents valued additional training in medical education, quality improvement, hospital administration, research, and clinical medicine. CONCLUSIONS: Many survey respondents expressed interest in the opportunity to acquire new skills through PHM fellowship. However, the majority of respondents reported being less likely to pursue PHM after the introduction of fellowship requirement for board certification, citing financial and personal opportunity costs. Understanding factors that residents value and those that discourage residents from pursuing PHM fellowship training may help guide future iterations of fellowship design.

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.