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

Abstract

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.

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

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

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

Charting the course of Hospital Medicine tracks: Exploring the past, present and future

“…A robust Hospital Medicine track provides adequate exposure to these clinical conditions and procedures to achieve competency for independent practice upon graduation. Current models include a 2‐ or 4‐week experience in each clinical domain 17 . Finally, a critical component of the practice of Hospital Medicine is the management of transitions of care to the outpatient setting, given the complexity of the healthcare system, the high proportion of vulnerable populations in the inpatient setting, and significant Medicare reimbursement tied to readmissions 12,18 .…”

“…Hospitalists have been at the forefront of the quality and safety movement, and as a result, have been well‐positioned to assume hospital leadership roles, particularly as value‐based care model evolves. Based on one program's experience, most graduates of the hospitalist track held leadership positions within 5 years of residency graduation 17 . Therefore, a hospitalist track should also focus on leadership competencies including leading teams, change management, and conflict resolution 17 …”

“…Comprehensive programmatic outcomes of Hospital Medicine tracks, typically longitudinal 2‐year programs, are limited. However, outcomes from the Hospitalist Training Track at the University of Colorado, the only 3‐year longitudinal training program in the country, suggest that those who participate in the track are likely to remain in Hospital Medicine and to participate in nonclinical endeavors that align with health system initiatives and strategic goals 17 . In their 15‐year experience, nearly 80% of graduates remained in the field, 68% were involved in quality and safety, 42% in clinical operations, 17 and four in five achieved leadership positions within 5 years after completion of residency training 17 .…”