The field of hospital medicine has continued to evolve in recent years. In fact, the term “hospitalist” wasn’t even invented until 1996! This term usually refers to a physician with a specialization in internal medicine who cares for patients that are in the hospital as opposed to those who may visit outpatient clinics or receive care elsewhere.

As of the year 2012, there were more than 30,000 hospitalists practicing across the United States, and 3,000 of these were trained specifically in pediatrics or in internal medicine and pediatrics (a specialty often called ‘med-ped’). Becoming a hospitalist is similar to other physician specialties in that it involves both a standard medical education as well as residency training. During the residency portion of their education, students may participate in activities such as doing rounds in the hospital, participating in journal club, teaching younger residents, or learning about the best ways to deliver cost-effective care. Pediatric hospitalists are thus fully trained pediatricians who specialize in providing hospital-based care to patients and their families. The residency program for these pediatric hospitalists offers unique opportunities to provide innovative care.

One way that pediatric hospitalists have helped to “lead the field” with their innovative approaches is through something called family-centered bedside rounds (FCBR). This approach allows families to decide if they want to be part of attending-physician rounds, and the participation of family appears to improve communication, which in turn offers new learning opportunities for residents and medical students alike. Some of the skills which are deemed necessary for successful medical practice and which must be learned during residency training include patient-centered care, problem solving, encouraging autonomy, systems knowledge, and time management. All of these skills are either taught or acquired as residents assist patients with diagnosis and treatment; when residents go on to teach other, younger residents, they must model these behaviors and skills.

Beyond these types of patient care skills, pediatric hospitalists are also expected to have 4 core competencies deemed necessary by the American Academy of Pediatrics (AAP) and the Academic Pediatric Association (APA). These 4 domains of competency are: Common Clinical Diagnoses and Conditions; Core Skills; Specialized Clinical Services; and Health care Systems: Supporting and Advancing Child Health Care [see reference 1]. While this seems like a lot, pediatric hospitalists acquire these 4 main types of competency over a period of 3 years, which is generally the length of a pediatric medicine residency in the United States.

Surprisingly, however, as of 2012 there is no single organization in the United States that sets a standard curriculum or gives standardized training guidelines for fellowship programs in pediatric hospitalist medicine, which means that the fellowship programs may vary from institution to institution. Note that fellowships are an additional type of training which is undertaken after a residency program has already been completed. Physicians are thus adequately prepared to effectively diagnose and treat patients after completing their residencies, but may seek additional ways to hone their skills via a fellowship program.

References

1: Stucky ER, Ottolini MC, Maniscalco J. Pediatric hospital medicine core competencies: Development and methodology. Journal of Hospital Medicine 2010;5:339-43.

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