Pediatric Hospital Medicine Fellowship Research Articles

Characteristics of Pediatric Hospital Medicine Fellowship Program Directors.

Rapid growth in pediatric hospital medicine (PHM) fellowships has occurred, yielding many new program directors (PDs). Characteristics of PDs have potential implications on the field. To describe characteristics (demographic, educational) and scholarly interests of PHM fellowship PDs. We developed and distributed a 15-question, cross-sectional national survey to the PHM PDs listserv. Questions were pilot tested. The survey was open for 4 weeks with weekly reminders. Responses were summarized using descriptive statistics. Fifty-six current fellowship leaders (40 PDs, 16 associate PDs [APDs]) responded, including at least 1 from 43 of 59 active PHM fellowship programs (73%). Most respondents identified as female (71%) and ≤50 years old (80%). Four (7%, n = 2 PD, 2 APD) leaders identified as underrepresented in medicine. About half (n = 31, 55.4%) completed a fellowship themselves (APDs > PDs; 87.5% vs 42.5%), and 53.5% (n = 30) had advanced nonmedical degrees (eg, Master of Science, Doctor of Philosophy; APDs > PDs; 62% vs 45%). Most leaders (59%, n = 33) chose multiple domains when asked to select a "primary domain of personal scholarship." Education was the most frequently selected (n = 37), followed by quality improvement (n = 29) and then clinical research (n = 19). This survey confirms a high percentage of women as PHM fellowship leaders and highlights the need to increase diversity. Less than half of senior PDs completed a fellowship in any specialty. Leaders report interest in multiple domains of scholarship; few focus solely on clinical research.

The transition to Pediatric Hospital Medicine fellowship: A national survey-based needs assessment.

Each year, the number of fellows entering Pediatric Hospital Medicine (PHM) fellowship is increasing. Residency curricula do not always prepare trainees for all aspects of PHM as a specialty and gaps often exist in the transition to fellowship. To explore the preparedness of PHM fellows for clinical, teaching, and scholarship tasks at the start of fellowship and to identify opportunities for residency and fellowship program development. Quantitative survey. Current and recently graduated PHM fellows (matriculation years 2019-2022). We conducted a national cross-sectional survey from July 2022 to February 2023. We designed survey questions based on PHM fellowship core competencies. We asked participants to rate preparedness for tasks on a 5-point Likert scale (1 = very unprepared, 5 = very prepared). We analyzed numerical data using descriptive and comparative statistics and free-response data using inductive content analysis. We received 223 responses to our survey (response rate 74%). Of the respondents, 25% reported no PHM-specific orientation at their program (n = 55). Respondents reported lower median preparedness for research (3, interquartile range [IQR] [2,4]) and teaching tasks (4, IQR [4,4]) compared to clinical tasks (4, IQR [4,5]) at the start of fellowship (p < 0.01, p < 0.01). Content analysis revealed most fellows wished they had received more training around scholarship at the start of fellowship. Many PHM fellows enter fellowship feeling inadequately prepared, particularly in scholarship and teaching. Our findings suggest that residency and fellowship programs need to develop more robust curricula to better prepare trainees for successful PHM fellowship. This national survey-based needs assessment should serve as a guide for further program development.

Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs.

The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.

A Qualitative Exploration of Pediatric Resident Perceptions of Autonomy in the Era of Pediatric Hospital Medicine Fellowship

ObjectiveSome pediatric residents report experiencing less autonomy when working clinically with pediatric hospital medicine (PHM) fellows than with attendings alone. We sought to explore pediatric senior resident (SR) experiences working clinically with PHM fellows, with a focus on characterizing fellow behaviors that could impact perceived resident autonomy. MethodsIn this qualitative study, we conducted virtual semistructured interviews with pediatric SRs. We recorded, deidentified, and transcribed interviews for codebook thematic analysis, making iterative adjustments to our codebook and themes until reaching thematic sufficiency. ResultsWe conducted 17 interviews. A subanalysis identified key components of the resident mental model of autonomy, including independent clinical decision-making with 3 core qualifiers: 1) plan follow-through, 2) availability of a safety net, and 3) ownership. Our primary analysis identified 4 key themes (with a total of 7 contributory subthemes) describing resident experiences of autonomy, scaffolded based on an organizing framework adapted from Bronfenbrenner’s ecological model including 1) microsystem factors (based on direct resident-fellow or resident-leadership team interactions), 2) mesosystem factors (based on fellow-attending interactions), 3) exosystem factors (based on fellow-intrinsic characteristics), and 4) macrosystem factors (cultural values, norms, and policies governing academic pediatrics). ConclusionsMany factors impact perceived resident autonomy on PHM fellow-inclusive teams. Although some are related to direct resident-fellow interactions, many others are more complex and may reflect resident interactions with the leadership team, attending-fellow dynamics, and the influence of cultural context. Based on our analysis, we propose several best-practice recommendations directed at fellows, attendings, the fellow-attending dyad, and Graduate Medical Education programs overall.

"What next?": Navigating if pediatric hospital medicine fellowship is right for you.

"What next?": Navigating if pediatric hospital medicine fellowship is right for you.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Faculty Support for Advocacy Is Key to Training the Next Generation of Pediatrician-Advocates.

We are pleased to see a focus on advocacy in the hospital setting described by Winthrop et al in the October 2021 Hospital Pediatrics perspectives article, “Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.” We agree that pediatric residency training would benefit from advocacy teaching in this setting. Such training can be modeled after the advocacy curricular resources developed for pediatric hospital medicine. These resources include: (1) competency-based goals and objectives for the advocacy rotation that map to pediatric subspecialty entrustable professional activities, developed by the curriculum committee of the Pediatric Hospital Medicine Fellowship Program Directors Council; and (2) specific knowledge, skills, and attitudes in advocacy as defined by the 2020 Pediatric Hospital Medicine Core Competencies.1However, faculty development in advocacy is necessary but not sufficient to allow for advocacy training and curricular development in the inpatient setting. Inpatient faculty must also be given the time, resources, and support to perform and teach advocacy. This can only happen if advocacy scholarship is congruent to traditional scholarship, including both research and medical education. We propose the following additional faculty needs to establish integration of advocacy in the hospital practice setting: Adoption of advocacy portfolios: Clinician-researchers generate scholarship to benefit patients and populations in the form of peer-reviewed grants and publications. Clinician-educators have gained support for scholarly activities and faculty promotion in medical education through the development and application of educator portfolios. Recognition of advocacy as a scholarly pursuit can only be achieved through the dissemination and widespread adoption of advocacy portfolios (APs).2 APs supplement the curriculum vitae to highlight how advocacy can be held to the same rigorous scholarly standards as traditional scholarship. Recognition of advocacy and APs in the academic promotion process will allow those interested in pursuing an advocacy scholarship to be successful in obtaining the time and resources necessary for practice. A national group of pediatrician-advocates has developed the first standardized AP template along with the American Academy of Pediatrics Community Pediatrics Training Initiative.3Advocacy recognition within the Pediatric Hospital Medicine Board certification process: The American Board of Pediatrics (ABP) has proposed a pediatric subspecialty entrustable professional activity focused on population health. Additionally, “advocacy and leadership” is a content domain for Pediatric Hospital Medicine Board certification. Despite this, the ABP has not recognized advocacy as a form of scholarship and “work product” allowable for pediatric subspecialty fellowship completion and subsequent board certification, even it if meets the Glassick criteria for scholarship.4 Lastly, allowing physicians to submit advocacy projects for maintenance of certification credit would greatly assist in recognizing the role of physician advocacy in improving population health.Advocacy will gain congruence in academics through a simultaneous bottom-up and top-down approach: faculty use of APs as developmental and promotional tools, along with recognition and support from medical school leadership and the ABP. Only if these criteria are met will faculty be recognized for scholarly advocacy activities, thereby supporting the time, resources, and funding necessary for teaching such practice to the next generation.

Med-Peds Residents’ Career Plans and the Impact of Pediatric Hospital Medicine Fellowship: A Nationwide Survey

Background The establishment of pediatric hospital medicine (PHM) as a fellowship-trained subspecialty represents a major change in the practice landscape, particularly for combined internal medicine-pediatrics (med-peds) residents. The most recent literature on med-peds residents’ career choices predates PHM fellowship and its impact has not been well studied. We aimed characterize med-peds residents’ career plans and the factors influencing their choices. Methods We distributed an electronic survey to the 1,505 resident members of the National Med-Peds Resident Association. In addition to sociodemographic data, participants reported their career plans, how well their residency prepared them for various aspects of practice, and their perceptions of PHM fellowship and its effect on their career choices. Results Among the 228 participants, the most planned careers were combined hospital medicine (36.8%, 84/228), combined subspecialty practice (32.5%, 74/228), and primary care (31.1%, 71/228). Residents felt well prepared for patient care and significantly more prepared for inpatient practice than for primary care. Participants rated the potential disadvantages of PHM fellowship as major deterrents and did not view the possible advantages as strong incentives. Among those who had considered a hospital medicine careers, 91.2% (186/203) were less likely to pursue PHM after its certification as a subspecialty. Conclusion Med-peds residents have a wide range of career interests but fellowship has made them less likely to pursue PHM careers. These findings emphasize the importance of addressing the needs of med-peds trained providers as PHM certification pathways and fellowship curricula develop to avoid adverse effects on the workforce.

Pediatric Hospital Medicine Resident Elective: A Novel Resident Curriculum for an Evolving Field.

BackgroundAlthough 8-10% of pediatric residents pursue a career in Pediatric Hospital Medicine (PHM), many report an incomplete understanding of PHM careers and would benefit from a PHM elective.MethodologyWe followed Kern’s six-step curriculum development framework. A general needs assessment via literature review revealed a lack of published PHM elective curricula. A targeted needs assessment was conducted by surveying national PHM fellowship program directors, national PHM fellows, local junior PHM attendings, and local pediatric residents. Content analysis from these surveys was used to develop a PHM resident elective curriculum. The curriculum was implemented and evaluated through an experience log and written reflections.ResultsNeeds assessment surveys were completed by fellowship directors (22/61, 36%), fellows (36/103, 35%), attendings (10/26, 38%), and residents (15/98, 15%). Common themes included the importance of academic experiences, mentorship, non-teaching and non-inpatient clinical experiences, community hospital experience, and the desire to address knowledge gaps. Significant variability in survey responses suggested the importance of an individualized curriculum. Goals, objectives, and aligned educational strategies were developed to provide a breadth of clinical experiences, mentorship, and PHM-focused academic activities, with an emphasis on individualization. Implementation of the curriculum began in July 2021 and four residents enrolled in 2021-2022. The curricular evaluation demonstrated the achievement of objectives and improved resident awareness of PHM opportunities, clinical skill development, ancillary shadowing, and academic opportunities.ConclusionsA PHM resident elective was developed using Kern’s six-step approach with input from national fellows and fellowship program directors to address educational gaps and increase exposure to PHM careers. The next steps include the evaluation of the impact of the PHM elective on career choice and preparedness of residents.

Pediatric Hospital Medicine Needs More Randomized Controlled Trials.

Pediatric Hospital Medicine Needs More Randomized Controlled Trials.

Mind the Gap: Women in Pediatric Hospital Medicine.

Mind the Gap: Women in Pediatric Hospital Medicine.

Preparing for a Career in Pediatric Hospital Medicine: A Needs Assessment and Recommendations for Individualized Curricula.

The individualized curriculum within residency programs allows residents to tailor their elective time toward future career goals and interests. Our objective was to identify experiences and activities that would foster resident interest and enhance preparation for a career in pediatric hospital medicine (PHM). Electronic surveys were distributed to pediatric hospitalists, PHM fellowship directors, and graduating PHM fellows. These stakeholders were asked to identify key experiences for residents to explore before entering fellowship or practice. Descriptive statistics and thematic analysis were performed on survey responses. Forty-six percent of PHM fellows (16 of 35), 42% of pediatric hospitalists (149 of 356), and 58% of fellowship program directors (35 of 60) completed the survey. All 3 groups identified complex care as the most important clinical experience to gain in residency. Other highly valued clinical experiences included pain management, surgical comanagement, and palliative care. Lumbar puncture, electrocardiograph interpretation, and airway management were identified as essential procedural skills. Nonclinical experiences that were deemed important included quality improvement, development of teaching skills, and research methodology. All groups agreed that these recommendations should be supplemented with effective mentorship. Identification of key clinical experiences, nonclinical activities, and mentorship for residents interested in PHM may assist with tailoring the individualized curriculum to personal career goals. Incorporating these suggested experiences can improve preparedness of residents entering PHM.

How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine?

How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine?

Research and Career Outcomes for Pediatric Hospital Medicine Fellowship Graduates.

Pediatric hospital medicine (PHM) fellowships have rapidly developed to meet established needs. The purpose of this research was to describe the research and career outcomes of PHM fellowship graduates. We hypothesized that graduates would report significant research and academic productivity. This was an institutional review board-approved, cross-sectional survey of PHM fellowship graduates in 2018. The 88-item survey was modified from an existing survey, developed by experts to address study objectives and pilot tested, and it included quantitative and qualitative items to assess characteristics of fellowship training and research and career outcomes. A total of 63% of PHM fellowship graduates (143 of 228) completed the survey (graduation dates, 2000-2018). In total, 89% graduated from dedicated PHM fellowship programs, with 59% completing a 2-year fellowship and 78% now practicing primarily at a university or children's hospital. Fellows conducted research in clinical research (53%), quality improvement (41%), health services (24%), and medical education (19%). A total of 77% of graduates continued to do research after graduation, with 63% publishing and 25% obtaining grant funding. Graduates of 2- and 3-year fellowships and those with a master's degree were significantly more productive. Graduates now hold important roles in academic and health systems leadership. Graduates are highly satisfied with their decision to do PHM fellowship and identified 5 themes regarding how fellowship impacted their career outcomes. In this study, we document robust research activity and leadership positions among PHM fellowship graduates and can serve as a benchmark for metrics that PHM educational leaders can use to assess outcomes and improve training regarding research and career development.

Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.

Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.

Identifying and Supporting the Needs of Internal Medicine and Pediatrics Residents Interested in Pediatric Hospital Medicine Fellowship.

Pediatric hospital medicine (PHM) became a subspecialty of the American Board of Pediatrics (ABP) in 2016. Starting in 2019, residency graduates are required to complete fellowship training to qualify for PHM board eligibility. These requirements pose unique challenges to internal medicine-pediatrics (med-peds) residents interested in practicing combined adult hospital medicine (HM) and PHM. To describe the needs of med-peds residents interested in PHM fellowship training and how the current PHM training environment can meet these needs. We conducted two cross-sectional electronic survey studies: one of med-peds residents and one of PHM fellowship program directors (FDs). Surveys were distributed to resident and FD listservs. Questions were designed using an iterative consensus process among authors. Responses were analyzed with descriptive statistics. Four hundred sixty-six residents responded to the resident survey. Ninety-six percent (n = 446) had considered a career in HM. Almost all (n = 456, 97.9%) respondents indicated a preference for a fellowship with both adult HM and PHM clinical training. Subspecialty designation decreased desire to pursue a career including PHM for 90.1% of respondents. Twenty-eight (58.3%) FDs responded to the FD survey. Fifteen (53.6%) programs reported being able to accommodate adult HM and PHM clinical time. The majority of resident respondents reported a desire for a PHM fellowship with clinical time in both PHM and adult HM. Approximately 30% of current US PHM fellowship programs can accommodate adult HM practice for med-peds fellows, and many other programs would be willing to explore such opportunities.

Increasing Diversity in Pediatric Hospital Medicine: An Enduring Priority for a Young Subspecialty.

As children in America represent an increasingly racially and ethnically diverse population,1 the field of pediatrics faces the challenge of optimizing their care. One response to promote quality outcomes is to increase diversity in the health care workforce. In patient care, studies have revealed that diverse medical teams give more accurate diagnoses, have higher patient satisfaction, and foster greater patient adherence.2 Overall, a more diverse workforce can enhance cultural humility, improve access to care for underserved populations, and promote cultural competency in research.3 In alignment with the importance of diversity in driving improved outcomes, there is an increased national focus on improving diversity among health care providers. In this issue of Hospital Pediatrics , the American Academy of Pediatrics Section on Hospital Medicine (SOHM) Diversity and Inclusion (D&I) Task Force, led by Dixon et al,4 describes the recent state of diversity within Pediatric Hospital Medicine (PHM) fellowships. A survey was sent to PHM fellowship program directors in 2018 to assess sex, race and ethnicity, sexual identity and orientation, disability status, and socioeconomic disadvantage among PHM fellows, program directors, and faculty. A key finding in this study was the lack of racial and ethnic diversity in PHM fellowships, with no Black and only 2 Hispanic or Latino leaders out of 57 program directors from 35 programs in 2018 (4%). This was reflective of the lack of racial and ethnic diversity among PHM faculty with only 50 Black, American Indian, or Hispanic and/or Latino individuals out of 734 faculty (7%). Most concerning was the lack of diversity in the pipeline, with only 6 total fellows from Black, American Indian, or Hispanic and Latino backgrounds (10%). Meanwhile, it is estimated that 40% of US children were from these underrepresented backgrounds in 2018.5 Although in their study, Dixon et al were …

Diversity, Inclusion and Cultural Competency in Pediatric Hospital Medicine Fellowship Programs.

The objectives with this study were to describe the current state of Pediatric Hospital Medicine (PHM) fellowship programs with regards to (1) diversity of fellows and programs' leadership, (2) current diversity and inclusion (D&I) programs and measures of their success, and (3) the state of cultural competency training. In 2018, fellowship directors of the 35 active PHM fellowship programs were invited to participate in a survey of diversity, inclusion, and cultural competency at PHM fellowship programs. Participants were invited via in-person invitations at the annual PHM fellowship directors meeting and through e-mail invitations from July to September to complete an online survey. There was an 89% response rate of the survey. Most fellows, faculty, and program directors in PHM were female (74%, 70%, and 70%, respectively) and white (53%, 67%, and 60%, respectively). There were no African American, American Indian or Alaskan Native, or Native Hawaiian or other Pacific Islander program directors. Forty-five percent of programs reported that neither the fellowship program nor their hospital had a strategic plan that addresses D&I. Approximately 61% of programs had cultural competency training for fellows. This is the first survey to report on the state of D&I in PHM fellowship programs. There is lack of racial and ethnic diversity in programs fellows, faculty, and directors. Although most programs have cultural competency training, strategic planning to promote D&I is not widely implemented among PHM fellowship programs.

Development of Goals and Objectives for Pediatric Hospital Medicine Fellowship Curricula.

Pediatric hospital medicine (PHM) has experienced incredible growth in the last 20 years, including the creation of >50 PHM fellowships since the first program in 2003. In 2013, a National Pediatric Hospital Medicine Leaders Conference concluded that the best path forward for the field would be subspecialty certification with a 2-year accredited fellowship.1 This process culminated in formal recognition of PHM as a subspecialty by the American Board of Medical Specialties in 2016 and the first American Board of Pediatrics (ABP) certification examination in 2019.2,3 Also, in 2019, the Accreditation Council for Graduate Medical Education (ACGME) published requirements for PHM fellowships and began accrediting programs.4 Established PHM fellowships and programs in development now need to implement standardized curricular components to improve the consistency and educational quality of training and be compliant with ACGME accreditation requirements. During the initial period of PHM fellowship expansion, before American Board of Medical Specialties recognition of PHM as a subspecialty, PHM fellowship program directors (PDs) mobilized and formed a national PHM Fellowship Directors’ Council to oversee the evolution of PHM fellowships and provide a community for collaboration and development of shared resources. In 2014, the council created subcommittees to address areas of need within PHM fellowship programs. These included the curriculum subcommittee, which was composed of both new and established PDs as well as 2 community hospitalist representatives, all with specific interest and skills in curriculum development. Between 2014 and 2016, the council, led by the curriculum subcommittee, created a standardized 2-year fellowship curricular framework to reflect the …

PHM Fellowships: Advanced Training for an Evolving Field.

We read with interest “A Changing Landscape: Understanding Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.”1 The publication is timely, given the recent designation of Pediatric Hospital Medicine (PHM) as a subspecialty by the American Board of Medical Specialties and the American Board of Pediatrics (ABP), as well as initial accreditation of PHM fellowships by the Accreditation Council for Graduate Medical Education. Through this commentary, we seek to discuss the study findings and highlight the current landscape of PHM fellowship training as influenced by the PHM fellowship curricular framework, the ABP PHM subboard content, and the newly revised PHM Core Competencies. The authors sought to characterize categorical pediatric and combined pediatric residents’ perceptions of PHM fellowships, including barriers and facilitators to pursuing such training. In 2018, an anonymous online survey was sent to residency program directors and 23% agreed to distribute the survey. A total of 2657 residents were surveyed; 32.2% (855) responded. Study findings suggest that although many residents saw value in PHM fellowships, they also reported concerns. A majority of respondents cited potential for higher future earnings and opportunity to gain new skills in both clinical and scholarly domains as important factors encouraging them to pursue fellowship. Specifically, half of respondents stated that they would value training in each of the following areas: medical education, quality improvement, hospital administration, research, and clinical medicine. However, a majority reported that they were “somewhat” or “less likely” to pursue a position in PHM after PHM fellowship became required for board eligibility. Personal and financial factors, including family obligations, forfeited earnings while in fellowship, and existing educational debt, influenced the decision to pursue fellowship for some. The authors …