Hospitalist

Overview

The 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, built on data showing that internal medicine trained hospitalists are generally under prepared in several key areas, addresses important educational and mentorship needs by utilizing the robust, 34-member hospitalist faculty at the University of Colorado Hospital, Denver VA Medical Center and Denver Health Medical Center.  At the conclusion of the program graduates are not only better prepared to function clinically as a hospitalist but are also ready to act as leaders and change agents in improving the healthcare system. 

The HTP is available to 6 residents in both the second and third year. Applications are accepted toward the end of the intern year for entry into the two-year program and the onset of the R2 year.  All rotations are available as electives for those who are not in the program. 

Rotations

Hospitalist residents rotate closely with hospitalist faculty and are exposed to an innovative curriculum during their hospitalist rotations. Current rotations include a hospitalist preceptorship rotation which exposes residents to the key curricular and structural components required to be an outstanding hospitalist.  The consultative and perioperative medicine rotation offer amble opportunity to learn the tenets of co-management of surgical patients, medical consultation and acute stroke management.  While rotating on the inpatient geriatric service, hospitalist residents will learn how to most successfully care for frail elderly patients, including the importance of care transitions.  Finally, all residents have the opportunity to perform a process or quality improvement project during the program.   Many residents have turned this activity into scholarly activity, given them a head start on an academic career.

Hospitalist Preceptorship

Residents currently spend one month during their second and third year on the preceptorship rotation. 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 learning and understanding the hospital system and the hospitalists' interaction with 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

Residents currently spend one month during their second and third year on the consultative and perioperative rotation. 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. Other acute neurologic disease states are covered as well.

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 that commenced in July 2007. All HTP residents rotate on this hospitalist-run service in both the 2nd and 3rd year. 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 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. All projects are faculty mentored.

Other opportunities

Hospital-based Research

Residents are allowed to use 1-2 months during their residency toward completing a research project.  Several hospitalist residents have chosen to work with our hospitalist faculty on hospital-based clinical research and quality improvement research projects. 

Palliative Care Medicine Retreat

This annual 2-day event takes place at a mountain hut just outside of Vail. It is proctored by nationally renowned palliative care experts as well as hospitalists who practice palliative care. The focus of the meeting changes annually but it is always a great opportunity to unite hospitalist faculty and residents for two days of great learning and a lot of fun. The retreat starts on a Saturday afternoon with participants hiking or biking into the hut and is followed by several hours of an interactive workshop. The evening time is reserved for a barbecue and socializing followed by a morning of palliative care didactics and another hike/bike out. Attendees have found this to be an extremely enjoyable way to learn palliative care and to get to know their resident colleagues and faculty at the same time.

Longitudinal Curriculum

The promise of the hospital medicine movement is that hospitalists will provide higher quality care.  However, this cannot be done simply by becoming better clinicians.  Therefore we have developed a comprehensive curriculum focused on providing future hospitalists with the knowledge and skills to become successful change agents in the realm of patient safety and quality improvement.  Delivered in two hour monthly sessions, early sessions utilize peer review and root cause analysis to teach the concepts of patient safety.  Later sessions focus on how to take an identified patient safety problem and turn it into a successful quality improvement project.  The final sessions focus on basic business and leadership skills such that the successful hospitalist can translate what she learned about patient safety and quality improvement into actionable process improvements.  The sessions are highly interactive, informative and fun. Residents have the opportunity to apply the skills learned during these sessions during their formal, mentored QI project time.  In the end, residents graduate well prepared to immediately improve the healthcare systems they enter as hospitalists.

Career Development Curriculum

A career development curriculum meets quarterly with the goal of preparing future hospitalists for the rigors of attaining and succeeding in their future profession.  Topics include:  developing an effective curriculum vitae, techniques for successful job interviewing, how to approach contract negotiations and differentiating academic and community hospitalist jobs. 

Systems-based Morbidity and Mortality Conference

A quarterly systems-based M & M conference will begin in July 2006 and will augment the internal medicine department’s M & M conference.  This innovative conference will shift the focus from the disease to the system to understand what role the healthcare environment played in the resultant medical error.  This resident-run (faculty mentored) conference should generate many opportunities for system and quality improvement projects. 

Examples of components of the HTP curriculum

rev 8/7/07