Residents Create a New Curriculum for Future Hospitalists

Hospital medicine, whose practitioners are known as hospitalists, is a popular career choice for Stanford residents in internal medicine and also has been the fastest growing specialty across the country over the past eight years. Given the attention that such statistics can command, is it at all surprising that leaders of the residency program took it seriously when two of their residents suggested that a new curriculum be devised for those pursuing a career in hospital medicine?

Why is hospital medicine so popular?

According to Neera Ahuja, MD (clinical associate professor, General Medical Disciplines), there are several reasons; “In part I think it’s because residents receive a good deal of exposure to hospital medicine during their training: through working with hospitalists in the clinical setting; with hospitalists being a part of many of the educational initiatives in the residency program (the Stanford 25, the pathways of distinction [PODs], the popular quality improvement elective led by Lisa Shieh, MD, PhD [clinical professor, General Medical Disciplines]); and as core faculty/mentors. So they know what they’re getting into. And secondly, there’s no additional training requirement.” When residents graduate from their residency program, they are qualified to be hospitalists. As both the Director of the Stanford Hospitalist Program and associate residency program director, Ahuja is in a position to know.

Two second-year residents, Andrea Smeraglio, MD, and Andre Kumar, MD, came up with a proposal: what if we had a curriculum that residents could opt-in to, so that those who were interested in becoming hospitalists could take certain electives during residency to better prepare themselves?

Seeking data to back up their idea and to determine the amount of interest it engendered, the residents surveyed their peers, and the results of the survey helped to build the curriculum. Here are some pivotal results:

Areas of a potential hospitalist program that the residents defined as important:

90.9% Mentorship
86.9% Opportunities to teach
85.7% Establishment of a hospitalist curriculum

Clinical rotations that were identified as important:

95.5% Medicine consult
90.8% Point-of-care ultrasound diagnostics
86.4% Exposure to community practice

Interest was clearly keen among many residents, but balance was critical. Making mandatory changes to the internal medicine residency program to benefit future hospitalists would not benefit everyone. Out of this concern for balance came SHAPE, Stanford Hospitalist Advanced Practice & Education, a certificate-awarding program aimed at those resident colleagues of Kumar and Smeraglio who anticipate becoming career hospitalists.

“This curriculum is not the easy way out,” says Ahuja. In addition to the usual rotations required of all residents, “there’s an extra ICU month, some perioperative medicine which residents don’t get a lot of exposure to, some neurology, and some consultative electives.”

SHAPE is a three-year program, and there are expected to be five residents participating per year. After starting July 1, 2015, there are currently between eight and 12 SHAPE participants, including some interns who want to start preparing themselves now.

SHAPE has three foci. The first is clinical excellence, which will be achieved in part through the new curriculum. The second is academic advancement, which will include some targeted lectures, including a medical teaching workshop led by Kelley Skeff, MD, PhD (professor, General Medical Disciplines), and a course on the use of bedside ultrasound as suggested in the survey. The third is mentorship, also a key finding from the survey, in which hospitalist faculty will provide guidance in areas such as research, quality improvement activities, CV building and, ultimately, job applications.

The SHAPE curriculum includes a research requirement: a project and a presentation at an academic meeting. The project is designed to begin in the first year. Ahuja explains: “We will first hear what each resident is interested in; for those who are unsure about a topic, the mentors will make some suggestions and give them some options and let them choose one that suits their interests. Their mentors will help them start the project, maybe in quality improvement or medical education, maybe something a little more clinical. My hope is that in three years they’ll do more than one project.”

The key to SHAPE in Ahuja’s mind is that it was resident-initiated. “This is a generation that is comfortable being vocal and empowering change,” she says. “The housestaff have a voice and we are very open to changes that can help the residency program.”

No one anticipates that SHAPE was born fully formed. As some elements fail to gain traction, they will be replaced with others of interest to the participants. It will evolve, says Ahuja, “according to the residents’ voice. I really commend Ann and Andre for being creative and proactive about it.”

“This is really an exciting time for hospitalists,” explains Smeraglio. “The career, the training, and the opportunities are exponentially expanding. We want Stanford to be on the cutting edge of that growth, and with SHAPE I believe we will be.”

Kumar adds: “We are hoping to train the best, and we have set the bar high.”

Poonam Hosamani, MD, Andre Kumar, MD, Andrea Smeraglio, MD, and Neera Ahuja, MD 

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