A Novel Resident-Centered Elective for Aspiring Hospitalists
Background/Purpose: In recent years, an increasing number of Internal Medicine (IM) residency programs have begun to offer elective experiences to address the growing interest in Hospital Medicine (HM) as a specialty among trainees. These elective rotations typically include non-clinical activities such as teaching, research, and quality improvement (QI) alongside the traditional rounding role1. At our large academic institution, we offer a two-week elective to IM residents who are interested in HM. Our traditional elective model was launched in 2017, and consisted of a templated schedule comprised of one week of rounding under the supervision of a hospitalist and one week of additional clinical and non-clinical activities including general medicine consults, procedure and admitting shifts, QI, and leadership shadowing. However, participating residents expressed significant variability in individual educational goals and preferences, which prompted us to restructure the curriculum. We found it important to consider residents’ goals while also addressing curricular components relevant to HM that the IM residency program might otherwise be lacking. Presently, a paucity of guidance exists on how to address the disparate goals and preferences of aspiring hospitalists. Objectives: To restructure our Academic HM rotation by tailoring to residents’ unique preferences while simultaneously addressing educational gaps in the IM residency training. Methods: Program leadership first helped identify educational gaps in the residency curriculum which included perioperative medicine and dedicated education on inpatient billing/coding. We innovated to fill these gaps and personalize the elective based on interests. We created a new, resident-centered template that allows flexibility for trainees to pre-select one week of either near-autonomous traditional rounding supervised by an academic hospitalist in the academic or community setting, or one week of perioperative medical/surgical co-management paired with a perioperative medicine hospitalist. Perioperative consultative medicine and inpatient billing/coding experiences were standardized for all elective residents planning careers in HM. Finally, we created a Hospitalists as Leaders pathway for trainees interested in a more immersive administrative shadowing experience or QI activities. We launched our newly restructured curriculum in July 2020. From July 2020-June 2022 we collected qualitative post-rotation feedback from participating residents through an optional survey. Common themes were extracted from the data. Our study was classified as exempt from review by the Duke University Institutional Review Board. In 2023 we initiated a pilot study of the longer-term effects of our elective by inviting graduates who are currently practicing hospital medicine to share additional reflections. Results/Outcomes/Improvements or Evaluation: Residents who completed our HM elective valued the breadth of experiences, personalization, exposure to activities outside of traditional rounding, and direct interaction with faculty. Limited data from graduates who completed the elective suggest that their experiences were helpful with applying for jobs and becoming involved in QI projects in their practices. Rotation directors felt that constructing individualized schedules was time-consuming and identified a need for a component of standardization. Significance/Implications/Relevance: HM elective rotation directors should consider the educational preferences of residents who plan to enter the field of HM when designing the optimal elective structure, while balancing the feasibility of creating personalized schedules.
- 2025