Keeping Academic Hospitalists Academic

I recently visited the Montefiore hospitalist program under the direction of Dr. Will Southern and met a great group of junior hospitalists in academia who are beginning to build their academic careers in medical education.  Later that afternoon, I joined SHM’s Physicians in Training Committee for a lively discussion on early career hospitalists.  While hospitalists are now an ever-present and growing fixture in academic teaching hospitals, they are often viewed as “clinical workhorses” and could get easily overlooked for positions in medical education.  It is clear that now is the right time to get hospitalists to the right place, specifically the nexus of current forces at play in medical education and hospital care that make hospitalists natural allies to medical school deans and residency program directors.  So for any early career hospitalists looking to “break in” to medical education, here are a few tips on getting to the “right place”.

1.  Cultivate skills in direct observation and supervision– The recent revamp of the entire residency evaluation process is referred to as the Next Accreditation System.  This massive overhaul includes an emphasis on directly observing residents’ clinical skills.  Who better to make such observations in the inpatient setting when residents are making rounds, managing discharges or conducting physical exams than hospitalists?   Starting an inpatient audit of histories and physicals or direct observations of such clinical skills will endear you to any program director and pretty soon you may even find yourself part of the “core faculty” of the residency program.

2.  Start teaching value – With the recognition of the skyrocketing costs of care and the waste and overtreatment that is costing the US health system roughly $700 billion dollars, training residents and students in high value care has become one of the most important things that medical educators are looking for faculty to teach.  One nice thing is that you don’t need to even develop your own curriculum.  With resources such as SHM’s Choosing Wisely List sponsored by the ABIM Foundation, the ACP’s High Value Care Curriculum, which just introduced online modules, and the Teaching Value online modules from Costs of Care, it is easy to build your curriculum using these off-the-shelf resources.  While training is one thing, role modeling is another.  So, the next time you are rounding with a resident, consider “celebrating restraint” by rewarding the resident for not ordering something.  Word will spread and you will become a hero to the housestaff overnight.

3.  Make yourself available for interprofessional learning – There is a new proposed LCME requirement that medical students must train in an interprofessional experience.  If your medical school is like ours, it may not have a nursing or pharmacy school and interprofessional learning opportunities are not obviously available.  Fortunately, in many academic medical centers, nonteaching hospitalists are a great example of working alongside allied health professionals in nursing, case management, and social work to name a few.  Exposing preclinical medical students to well-functioning interprofessional teams can not only help boost their exposure to these hard-to-find experiences, but also raise the visibility of hospitalists among the Dean’s office staff.

4.  Highlight your work in quality and safety  – Even though quality improvement and safety have been buzzwords in medical education for some time, they are getting renewed attention in residency training due to the emphasis by the ACGME on the Clinical Learning Environment Review– specifically how engaged are residents in quality and safety activities of the hospital.  Who is in a better position to get residents involved in hospital quality than hospitalists?

Hospitalists are probably already serving on such committees that are often dealing with everything from readmission reductions to optimizing health IT or parking.  In addition, not to be outdone, medical schools are getting in on the action.  In fact, the Association of American Medical Colleges have issued a series of “Entrustable Professional Activities” or things they expect graduating medical students to be able to do nationwide, and quality and safety play a huge role.  Given that medical students generally have had little exposure to these areas, it’s a great time to approach preclinical and clinical faculty to let them know about any quality/safety experience you have.  It is also a good time to obtain these skills and SHM and AAIM’s Quality and Safety Educators Academy is a great place to start for educators looking to get a foothold.

5.  Cultivate a technology niche– These days, technology is the big buzz word in medical education – whether it’s flipping the classroom with podcasts or launching an iPad program for your residents.  While many institutions are implementing electronic health records, few are teaching about informatics or information science leading to a new generation of physicians who believe progress notes actually are supposed to look like a wiki.  Moreover, social media has exploded in medical education with the use of Twitter and Facebook for a variety of purposes including spreading recent articles in the Journal of Hospital Medicine, or medical education “tweetchats” that bring together faculty from all over the world.  In addition to using technology effectively, safe and professional use of these technologies is also a needed curricula.  Fortunately, the AAMC has developed a toolkit complete with cases to help inspire discussion among trainees.  In addition, the ACP has developed an ethics paper to assist practicing physicians in considering their professional footprint when they post.

I look forward to hearing any other useful tips or experiences for early career hospitalists who are interested in getting involved in medical education.