Hospitalist Training Program
OverviewThe hospitalist training program (HTP), which commenced in July 2004 and is the oldest operating comprehensive hospitalist training program in the country, strives to take a novel approach to preparing residents for a future as a hospitalist or primarily hospital-based specialist. The program is built on data, including a study completed by University of Colorado researchers, showing that internal medicine trained hospitalists are generally under prepared in several key areas. At the conclusion of the program graduates are better prepared to function clinically as a hospitalist but are also ready to act as leaders and change agents in improving the healthcare system.
Rotations
Hospitalist Preceptorship:
During this month the resident has one-on-one interaction with a hospitalist faculty member rotating in a hospitalist model of care. While on service they staff new admissions and consultations daily, work with a multi-disciplinary team and learn first-hand about hospital systems of care and quality improvement. A daily didactic curriculum focuses on problem based learning and understanding the hospital system and the hospitalists' interaction within it. Topics includes in-depth instruction in billing (residents are responsible for assisting the attending in billing) and coding (learning the meaning of DRG, RVU, CMI and more), understanding the rationale for and use of hospital protocols as well as clinical topics such as hospital preventive medicine and preventing and managing antimicrobial resistance.
Consultative and Perioperative Medicine: Data supports that upwards of one-third of a hospitalists' job consists of consultative, perioperative and neurological work. This rotation stresses the co-management model of care whereby patients are seen collaboratively with our orthopedic and neurologic colleagues. Additional consultative work is provided to other non-medical services. Daily didactics stress key issues such as the pre-operative cardiac and pulmonary evaluation, perioperative diabetes and steroid management, the prevention of post-operative venous thromboembolism and the management of post-operative fever. The neurology component stresses the medical management of the acute stroke patient and is complemented by several didactics surrounding hypertensive and glycemic control as well as general neuroanatomy and physical exam.
Inpatient Geriatrics: Recognizing that 20% of the population will be over the age of 65 years old in the near future, we have developed an inpatient geriatrics rotation aimed at enhancing the care of elderly at a very vulnerable time in their lives. A formal curriculum in hospital-based geriatrics has been developed and is taught throughout the course of the month. Additionally, residents round with a multi-disciplinary team which includes geriatricians, physical therapists, pharmacists and nurses all focused on improving the care we give to our elderly population. Several visits to a skilled nursing facility or hospice to follow up their patients afford the residents a first-hand opportunity to better understand the importance of transitions of care. Additionally, residents spend a week working with the inpatient palliative care team. This experience includes several didactics surrounding end-of-life decision making, the hospice benefit, and pain and symptom management.
Quality and Systems Improvements: All HTP residents have the opportunity to spend a block of time working on a mentored QI or systems improvement project. A formal curriculum overviews the key tenets of patient safety and QI work and teaches residents how to develop, implement and measure a QI project. The goal is to encourage physicians, and employ them with the needed skills, to function as change agents in their future roles as hospital leaders.