Hospitalist training update

Residency Program Insider, January 16, 2007

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Hospitalist training update

As the fastest growing field in medicine, the demand for up-and-coming hospitalists-physicians whose primary focus is the care of patients in the hospital setting-is great. The Society of Hospital Medicine cites that there are five to eight positions for every hospitalist today. As a result of this demand, formal training in the field of hospital medicine will be needed to advance the field and help define the emerging role of hospitalists, particularly in academic teaching hospitals, where hospitalists increasingly work hand-in-hand with residents. Yet while a handful of programs are offering hospital medicine fellowships, hospitalist training programs are few and far between.

While hospitalists typically train in an internal medicine or family practice program, hospitalists-in-training require a slightly different training curriculum. There are many programs doing a hospitalist elective, and there are some research-oriented fellowships, but there are not many programs training residents to be clinical hospitalists. Two years ago, there was significant interest in doing a hospitalist fellowship or additional training after residency. Now medical students are expressing interest in hospital medicine because of its flexibility in hours, acute care setting, and high reimbursement rates.

Hospitalists tend to need more training in areas that are underemphasized in other residencies, such as palliative care and orthopedics. Our hospitalist training program involves emphasis on the following non-clinical training areas:

1. Palliative and geriatric care: Hospitalists constantly deal with transitions of care that involve geriatric patients. At the University of Colorado Health Sciences Center, our hospitalist program residents go on a palliative care retreat once a year to Vail, CO, where they receive interactive and didactic training in and around palliative care.

2. Quality improvement and systems improvement: It is important for hospitalists to understand the hospital system of care in a way that other internal medicine residents may not. Hospitalists function as shepherds of the hospital. Hospitalist residents understand and study the myriad of problems within a hospital system. Residents are given a block of time, mentored by faculty, in which they will work on quality solutions involving the peer review process and root cause analysis. Residents also work closely with legal teams and risk management while working on QI initiatives.

3. Focus on leadership skills: Because hospital medicine is a young field (and attracting new graduates at a rapid pace), many hospitalist leaders are in their mid-30s. This can result in a group of men and women in charge of national hospital medicine groups or in influential hospital leadership positions with no formal skills or training in leadership. Our program devotes about 10-12 didactic hours a year on leadership skills like conflict resolution and negotiation, strategic planning, and business influence.

All the best,

Jeffery Glasheen, MD
Director of hospital medicine
Associate program director
Division of internal medicine
University of Colorado Health Sciences Center

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