Hospitalist Experience: Components & Grades

OBJECTIVES OF THE HOSPITALIST ELECTIVE

There is an increasing national demand for formally trained hospitalist physicians. But a hospitalist is more than a physician who spends a lot of time in the hospital. A review of the literature indicates that an expert hospitalist demonstrates the following competencies to a very high degree—teaching these competencies is the objective of this course:

· Understanding of how the process-of-care affects the management of acute care conditions

· Efficiency in management: timely ordering, transcription, and discharge planning

· Availability to patient, family, hospital staff, and community primary care physician

· Communication with the primary care physician during the hospital stay and on discharge

· Proficiency in evidence-based decision making, including extraction of relevant literature and application of diagnostic studies to estimate disease probabilities

HOSPITALIST ELECTIVE -- WEEKLY ROTATIONS
	DESCRIPTION		EVALUATION
Week A	Hospital Administration: assigned to meetings with CEO, COO, and VPs of a local hospital (opportunity to learn the pressures and incentives for hospital systems, and how administrators view medical services and physician care)		Because the objective of these week-long rotations is to provide the resident with insight into the activities and demands of the various sites, evaluations will not be requested by the rotation staff (this would introduce a barrier to collegial interaction). Residents, however, will rate each experience on the merit of the environment, opportunity to be involved, and interaction with individual staff. A journal will also be maintained and collected.
Week B	Intubation/Lines/Pain Management: operating room experience in intubation and catheterization, hospital injection pain control, and outpatient pain management
Week C	HOSPICE & HOME CARE: rotate through VistaCare and St Mary’s hospice, and post-cardiac WHC (opportunity to learn how and when to prepare your patients for the most appropriate discharge setting)
Week D	HOSPITALIST CLINICAL Rotation: rotate with a full-time community hospitalist to observe currents practices and attitudes
SUPPLEMENTAL ACTIVITIES
		DESCRIPTION		EVALUATION*
WORKSHOPS & LECTURES		Wednesday mornings will be organized workshops, and afternoons didactic presentations devoted to special issues in hospitalism.		Attend 75% of lectures for passing grade.
TUTORIALS: BAYESIAN DECISION MAKING VISUAL MEDICINE		Residents will complete interactive on-line tutorials about: (1) Bayesian Decision Making, (1) Boolean Searching,and (2) Visual Medicine. The Bayesian Tutorial will emphasize “in-your-head” estimations of disease likelihood before and after diagnostic studies are performed. The Boolean Tutorial focuses on rapid clinical retrieval of Medline information. The Visual Medicine Tutorial will feature photos taken of hospitalized patients, with a goal of “naming the diagnosis” and describing essential diagnostic or management considerations.		The Bayesian Tutorial will include an online pre-quiz as well as weekly online post-quizzes (clinical scenarios requiring the estimation of disease probability).
QUALITY IMPROVEMENT		A small QI project will be assigned each resident at the beginning of the month. Resident will spend 1-2 hours each week reviewing charts or other clinical records and will report their findings to the group towards the end of the course.		Quality improvement staff will rate each project as PASS versus HONORS (presenting the project at the final evening workshop is required for PASS; WMC potpourri for HONORS).
JOURNAL CLUB		Residents will be encouraged to attend the monthly hospitalist journal club throughout the year.
RESEARCH MONTH		Residents will be encouraged to elect a full month of hospitalist research, focusing on issues of quality improvement or medical decision-making.

*Summary of Course Grading:

To achieve a PASSING grade (the satisfactory range on the residency evaluation form), the resident will:

1. Attend 75% workshops and lectures

2. Participate in essentially all scheduled weekly rotation activities

Turn in lecture & course component evaluatons

3. Complete the on-line tutorials

4. Complete and present an assigned QI mini-project

Final assignment of an HONORS grade (the superior range on the residency evaluation form) will be determined by the Course Director and faculty, based on items above and overall performance of the resident.