Wednesday, July 1, 2015

Engaging residents in pediatric hospital medicine – a novel elective

Marta King, MD, MEd
Primary Children's Medical Center

Educators have proposed several methods to address the gap between residency training and the practice of hospital medicine. An elective within residency allows those considering careers in hospital medicine to sample curricular components of the field. The purpose of this project was to design a learner-centered pediatric hospital medicine resident elective. We used American College of Graduate Medical Education core competencies, pediatric hospital core competencies, and expert consensus to design clinical, administrative, research, teaching, practice-based learning, and systems-based practice elective activities. University of Utah pediatric hospitalists, as well as pediatric, combined program, and family medicine residents and graduates were asked to rate the proposed elective using an anonymous web-based survey. 23 hospitalists, 61 residents, and 30 program graduates completed the survey (n=101). 41% spent or were planning to spend ≥25% of their time practicing in an inpatient setting. 84% rated the proposed elective as valuable or very valuable. Those focused on inpatient work ranked the rotation as significantly more valuable than those who were not (93% vs. 67%, p=0.003). Activities receiving highest interest were: 1) general inpatient care and consults, 2) conscious sedation and airway management, 3) rapid response and palliative care teams; 4) patient teaching sessions with asthma and diabetes educators. Activities receiving lowest interest were: 1) shadowing ancillary hospital staff (interpretation, education, child life), 2) care of specific patients (tracheostomy/ventilator dependent and sedation observation), 3) hospital medicine list-serve; 4) administrative meetings. Significant differences were seen between activities practicing hospitals and residents interested in hospital-based careers rated as valuable. Participants endorsed the hospital medicine elective with freedom to choose activities most suited to individual resident regardless of current or future career plans. As a variety of activities were deemed valuable, a learner-centered approach with a menu of activities to choose from may be most beneficial. Future studies will focus on elective implementation and evaluation.