Hospital Medicine represents the fastest growing career choice of graduating residents from Internal Medicine training programs. Glasheen, et al have noted deficiencies in current Internal Medicine training for the growing role of hospitalists as they extend beyond traditional direct patient care. Non‐clinical training needs include health‐care economics, patient safety/quality improvement, continuums of care, leadership, and communication.
Our goal was to create a PGY2 Internal Medicine Hospitalist rotation with a curriculum focused on meeting the training needs identified for a hospitalist career. The rotation would also provide increased inpatient experience with initial workup, assessment, management, and transitioning care of admitted patients.
The Resident Inpatient Training Experience (RITE) rotation is a required 1 month PGY2 rotation at Baylor College of Medicine. Two PGY2 residents are assigned to each of the two hospital settings — Michael E. DeBakey VA Hospital and Ben Taub General Hospital. An experienced hospitalist serves as the attending physician and works one‐on‐one with the residents without any students or interns. The RITE team admits an average of 16‐18 patients from 7am to 5pm four days each week. The curriculum is provided to each resident in a workbook format divided into three modules: Basic Principles in Patient Safety and Quality Improvement, Advanced Quality Improvement and Cost Conscious Care, and Billing/Coding. Using principles from the flipped classroom model, the residents are expected to independently read the workbook and complete basic exercises. Each Monday morning, hospitalist faculty lead a facilitated exercise on applying the principles of the weekly module. Residents are asked to answer a pre‐rotation and post‐rotation survey.
The pre‐rotation survey (n=20, response rate 87%) showed that residents identified deficits in their training in hospital reimbursement (85%), hospital metrics (80%), physician billing/coding (75%), quality improvement (35%), and patient safety (25%).
The post‐rotation survey (n=16, response rate 84%) showed 81.25% strongly agreed and 18.75% agreed that the rotation was important for training and education. The same number responded that the rotation would help their skills in leading a traditional ward team supervising interns and students. The residents’ self‐assessment of knowledge in the following categories increased: discharge planning/transitions of care (3.55 to 3.94), patient safety (3.6 to 3.86), quality improvement (3.45 to 3.56), cost conscious care (2.95 to 3.56), hospital reimbursement (2.5 to 2.94), physician billing/coding (2.2 to 2.88) [Likert scale 1=very poor to 5=excellent]. The interest to pursue a career in hospital medicine increased for 56.25% of the residents on the RITE rotation.
The addition of a required hospitalist rotation during Internal Medicine residency helps to increase knowledge of many training needs identified for future hospitalists. The residents viewed the RITE rotation as important for their training and increased their confidence in leading a ward service. The rotation also led to more residents interested in pursuing hospital medicine as a career. Hospitalists should lead efforts to develop a hospitalist rotation as part of the Internal Medicine residency.
To cite this abstract:Shah C, Hubenthal E, Bates J, Lin D, Campbell S, Hamill R. Impact of a Hospital Medicine Rotation During Internal Medicine Residency. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 190. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-a-hospital-medicine-rotation-during-internal-medicine-residency/. Accessed March 28, 2020.