Lukela M

Persons aged 65 years or older represent only 14% of the US population, yet account for more than 34% of hospital discharges.^1-4 The population aged 65 years and older is growing at a faster rate than the total population, and the number of persons in this group is projected to double by 2050.^1-4 Because of decreased physiologic reserves, changes in pharmacokinetics of medications, and decreased functional capacity of organ systems, the hospitalized older patient is at risk for many poor outcomes. Such outcomes include cognitive and functional decline, prolonged length of stay, higher rates of readmission, and increased risk of death. Because of clinically significant functional decline experienced during hospitalization, more than 28% of older patients are discharged to nursing care facilities rather than home.¹ These outcomes have profound medical, psychosocial, and economic effects on individual patients, families, and society. In addition to disease-based management, care of the older inpatient must be approached within a specific psychosocial and functional context. Hospitalists must engage in a collaborative, interprofessional approach to optimize care provided to older patients, beginning at the time of hospital admission and continuing through all care transitions. Hospitalists should lead initiatives that improve the care of older patients. 

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Hospitalists should be able to:

• Describe common complications related to hospitalization in older patients.

• Describe physiologic changes with aging that create increased vulnerability to adverse events during hospitalization.

• Describe patient-specific, environmental, and iatrogenic risk factors for complications in hospitalized older patients.

• Describe the high-risk medication classes that lead to most unplanned emergency department visits and emergency hospitalizations in older patients.

• Describe the medical, psychosocial, and economic impact of hospitalization on older patients and their families.

• Describe interventions shown to improve outcomes in hospitalized older patients.

• Describe postacute care options that can enable older patients to regain functional capacity.

• Identify all forms of delirium.

• Describe the impact of delirium on patients’ functional and cognitive recovery from the acute illness.

• Recognize that agitation is a symptom of a disease, often delirium, and that the underlying cause must be addressed to ensure adequate care.

• Appreciate the risks and complications associated with restraint use.

• Summarize the costs and implications of the intersection between healthcare finance and obtaining resources to compensate for functional deficits in older patients.

Hospitalists should be able to:

• Elicit a thorough medical history and perform a physical examination to identify patient-specific risk factors for complications during hospitalization.

• Perform a focused cognitive and functional assessment of older patients.

• Formulate multidisciplinary care plans for the prevention of delirium, falls, and functional decline.

• Investigate and appropriately address underlying contributors to delirium.

• Provide nonpharmacologic alternatives (for example, behavioral plans) for the management of agitation and insomnia while minimizing exposure to potentially inappropriate medications.

• Avoid prescribing, whenever possible, medications associated with low benefit and/or increased risk of adverse drug reactions in older patients.

• Assess the complications and potential adverse effects associated with polypharmacy and work to avoid unnecessary medication exposure.

• Incorporate unique characteristics of older patients into the development and communication of therapeutic plans.

• Perform a social assessment of the patient’s living conditions and support systems and tailor the healthcare plan to each patient’s unique needs.

• Formulate and communicate safe multidisciplinary plans for care transitions for older patients with complex discharge needs.

• Connect elderly patients with social services early in the hospital course to provide institutional support, which may include referral for insurance and medication benefits, transportation, mental health services, and substance abuse services.

• Communicate effectively with primary care physicians and other postacute care providers to promote safe, coordinated care transitions.

• Educate patients and families about individual measures and community resources that can reduce potential complications after discharge.

• Recognize signs of potential elder abuse and use designated mechanisms to report suspected abuse or neglect.

• Lead, coordinate, and/or participate in multidisciplinary patient safety initiatives to reduce common complications experienced by older patients during hospitalization.

• Lead, coordinate, and/or participate in hospital initiatives to improve care transitions and reduce postacute care complications in older patients. 

Hospitalists should be able to:

• Promote a team approach to the care of the hospitalized older patient, which may include physicians, geriatricians, psychiatrists, nurses, pharmacists, social workers, and rehabilitation services.

• Establish and maintain an open dialogue with patients and families regarding care goals and limitations, palliative care, end-of-life concerns, and advance care plans.

Persons aged 65 years or older represent only 14% of the US population, yet account for more than 34% of hospital discharges.^1-4 The population aged 65 years and older is growing at a faster rate than the total population, and the number of persons in this group is projected to double by 2050.^1-4 Because of decreased physiologic reserves, changes in pharmacokinetics of medications, and decreased functional capacity of organ systems, the hospitalized older patient is at risk for many poor outcomes. Such outcomes include cognitive and functional decline, prolonged length of stay, higher rates of readmission, and increased risk of death. Because of clinically significant functional decline experienced during hospitalization, more than 28% of older patients are discharged to nursing care facilities rather than home.¹ These outcomes have profound medical, psychosocial, and economic effects on individual patients, families, and society. In addition to disease-based management, care of the older inpatient must be approached within a specific psychosocial and functional context. Hospitalists must engage in a collaborative, interprofessional approach to optimize care provided to older patients, beginning at the time of hospital admission and continuing through all care transitions. Hospitalists should lead initiatives that improve the care of older patients. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe common complications related to hospitalization in older patients.

• Describe physiologic changes with aging that create increased vulnerability to adverse events during hospitalization.

• Describe patient-specific, environmental, and iatrogenic risk factors for complications in hospitalized older patients.

• Describe the high-risk medication classes that lead to most unplanned emergency department visits and emergency hospitalizations in older patients.

• Describe the medical, psychosocial, and economic impact of hospitalization on older patients and their families.

• Describe interventions shown to improve outcomes in hospitalized older patients.

• Describe postacute care options that can enable older patients to regain functional capacity.

• Identify all forms of delirium.

• Describe the impact of delirium on patients’ functional and cognitive recovery from the acute illness.

• Recognize that agitation is a symptom of a disease, often delirium, and that the underlying cause must be addressed to ensure adequate care.

• Appreciate the risks and complications associated with restraint use.

• Summarize the costs and implications of the intersection between healthcare finance and obtaining resources to compensate for functional deficits in older patients.

Hospitalists should be able to:

• Elicit a thorough medical history and perform a physical examination to identify patient-specific risk factors for complications during hospitalization.

• Perform a focused cognitive and functional assessment of older patients.

• Formulate multidisciplinary care plans for the prevention of delirium, falls, and functional decline.

• Investigate and appropriately address underlying contributors to delirium.

• Provide nonpharmacologic alternatives (for example, behavioral plans) for the management of agitation and insomnia while minimizing exposure to potentially inappropriate medications.

• Avoid prescribing, whenever possible, medications associated with low benefit and/or increased risk of adverse drug reactions in older patients.

• Assess the complications and potential adverse effects associated with polypharmacy and work to avoid unnecessary medication exposure.

• Incorporate unique characteristics of older patients into the development and communication of therapeutic plans.

• Perform a social assessment of the patient’s living conditions and support systems and tailor the healthcare plan to each patient’s unique needs.

• Formulate and communicate safe multidisciplinary plans for care transitions for older patients with complex discharge needs.

• Connect elderly patients with social services early in the hospital course to provide institutional support, which may include referral for insurance and medication benefits, transportation, mental health services, and substance abuse services.

• Communicate effectively with primary care physicians and other postacute care providers to promote safe, coordinated care transitions.

• Educate patients and families about individual measures and community resources that can reduce potential complications after discharge.

• Recognize signs of potential elder abuse and use designated mechanisms to report suspected abuse or neglect.

• Lead, coordinate, and/or participate in multidisciplinary patient safety initiatives to reduce common complications experienced by older patients during hospitalization.

• Lead, coordinate, and/or participate in hospital initiatives to improve care transitions and reduce postacute care complications in older patients. 

Hospitalists should be able to:

• Promote a team approach to the care of the hospitalized older patient, which may include physicians, geriatricians, psychiatrists, nurses, pharmacists, social workers, and rehabilitation services.

• Establish and maintain an open dialogue with patients and families regarding care goals and limitations, palliative care, end-of-life concerns, and advance care plans.

Persons aged 65 years or older represent only 14% of the US population, yet account for more than 34% of hospital discharges.^1-4 The population aged 65 years and older is growing at a faster rate than the total population, and the number of persons in this group is projected to double by 2050.^1-4 Because of decreased physiologic reserves, changes in pharmacokinetics of medications, and decreased functional capacity of organ systems, the hospitalized older patient is at risk for many poor outcomes. Such outcomes include cognitive and functional decline, prolonged length of stay, higher rates of readmission, and increased risk of death. Because of clinically significant functional decline experienced during hospitalization, more than 28% of older patients are discharged to nursing care facilities rather than home.¹ These outcomes have profound medical, psychosocial, and economic effects on individual patients, families, and society. In addition to disease-based management, care of the older inpatient must be approached within a specific psychosocial and functional context. Hospitalists must engage in a collaborative, interprofessional approach to optimize care provided to older patients, beginning at the time of hospital admission and continuing through all care transitions. Hospitalists should lead initiatives that improve the care of older patients. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe common complications related to hospitalization in older patients.

• Describe physiologic changes with aging that create increased vulnerability to adverse events during hospitalization.

• Describe patient-specific, environmental, and iatrogenic risk factors for complications in hospitalized older patients.

• Describe the high-risk medication classes that lead to most unplanned emergency department visits and emergency hospitalizations in older patients.

• Describe the medical, psychosocial, and economic impact of hospitalization on older patients and their families.

• Describe interventions shown to improve outcomes in hospitalized older patients.

• Describe postacute care options that can enable older patients to regain functional capacity.

• Identify all forms of delirium.

• Describe the impact of delirium on patients’ functional and cognitive recovery from the acute illness.

• Recognize that agitation is a symptom of a disease, often delirium, and that the underlying cause must be addressed to ensure adequate care.

• Appreciate the risks and complications associated with restraint use.

• Summarize the costs and implications of the intersection between healthcare finance and obtaining resources to compensate for functional deficits in older patients.

Hospitalists should be able to:

• Elicit a thorough medical history and perform a physical examination to identify patient-specific risk factors for complications during hospitalization.

• Perform a focused cognitive and functional assessment of older patients.

• Formulate multidisciplinary care plans for the prevention of delirium, falls, and functional decline.

• Investigate and appropriately address underlying contributors to delirium.

• Provide nonpharmacologic alternatives (for example, behavioral plans) for the management of agitation and insomnia while minimizing exposure to potentially inappropriate medications.

• Avoid prescribing, whenever possible, medications associated with low benefit and/or increased risk of adverse drug reactions in older patients.

• Assess the complications and potential adverse effects associated with polypharmacy and work to avoid unnecessary medication exposure.

• Incorporate unique characteristics of older patients into the development and communication of therapeutic plans.

• Perform a social assessment of the patient’s living conditions and support systems and tailor the healthcare plan to each patient’s unique needs.

• Formulate and communicate safe multidisciplinary plans for care transitions for older patients with complex discharge needs.

• Connect elderly patients with social services early in the hospital course to provide institutional support, which may include referral for insurance and medication benefits, transportation, mental health services, and substance abuse services.

• Communicate effectively with primary care physicians and other postacute care providers to promote safe, coordinated care transitions.

• Educate patients and families about individual measures and community resources that can reduce potential complications after discharge.

• Recognize signs of potential elder abuse and use designated mechanisms to report suspected abuse or neglect.

• Lead, coordinate, and/or participate in multidisciplinary patient safety initiatives to reduce common complications experienced by older patients during hospitalization.

• Lead, coordinate, and/or participate in hospital initiatives to improve care transitions and reduce postacute care complications in older patients. 

Hospitalists should be able to:

• Promote a team approach to the care of the hospitalized older patient, which may include physicians, geriatricians, psychiatrists, nurses, pharmacists, social workers, and rehabilitation services.

• Establish and maintain an open dialogue with patients and families regarding care goals and limitations, palliative care, end-of-life concerns, and advance care plans.

Health disparities are differences in health outcomes that reflect social inequalities among groups. Vulnerable populations are defined as groups that are at increased risk of experiencing a disparity in medical care on the basis of characteristics such as age, sex, race, ethnicity, sexual orientation, spirituality, disability status, or socioeconomic or insurance status. When compared with patients from nonvulnerable populations, patients from vulnerable populations are prone to lower rates of health literacy, higher rates of preventable hospitalizations, higher rates of hospital patient safety events, and higher death rates from typically low-mortality diseases.¹ More than 30% of direct medical care expenditures for African American, Asian, and Hispanic patients are excess costs due to health disparities.² Hospitalists may have an important role in influencing the health status, healthcare access, and healthcare delivery to vulnerable populations given higher rates of hospital use and reduced access to outpatient care. In fact, hospitalists often serve as initial points of contact for the healthcare of these groups. Core competencies in communication, advocacy, and comprehension of the healthcare needs of vulnerable populations may influence healthcare expenditures, morbidity, and mortality. Hospitalists have the opportunity to lead initiatives that promote equity of healthcare provision. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain key factors leading to disparities in health status among specific vulnerable populations.

• Explain disease processes that disproportionately affect vulnerable populations.

• Describe key factors leading to disparities in the quality of care provided to vulnerable groups.

• List services in local healthcare systems designed to ameliorate barriers to care provision.

• Name local and institutional resources available to patients needing financial assistance.

• Identify key elements of discharge planning for uninsured, underinsured, and disabled patients.

Hospitalists should be able to:

• Elicit a thorough and relevant medical history and perform a physical examination to detect illnesses for which vulnerable populations may have increased risk.

• Elicit a social history to assess patient habits, identify patients at risk for breaks in transitions of care, and clarify patient values regarding treatment options.

• Facilitate communication between vulnerable patient groups and consultants.

• Select appropriate educational resources to inform vulnerable patients with low health literacy using terminology commensurate with the patient’s level of understanding.

• Provide education and systems interventions to minimize medication errors in patients with low health literacy.

• Secure medical interpreters to assist with interviewing, physical examination, and medical decision-making.

• Tailor the therapeutic plan, which includes the discharge plan and outpatient resources.

• Connect vulnerable patients with social services early in the hospital course to provide institutional support, which may include referral for insurance and drug benefits, transportation, mental health services, and substance abuse services.

• Target vulnerable groups for indicated vaccinations and preventive care services or referrals.

• Identify vulnerable patients whose outpatient environment might benefit from additional community resources.

• Coordinate adequate transitions of care from the inpatient to outpatient setting, including communication with outpatient providers. 

Hospitalists should be able to:

• Communicate openly to facilitate trust in patient-physician interactions.

• Actively involve patients and families in the design of care plans.

• Provide leadership to foster attitudes and systems improvements that promote quality healthcare provision to vulnerable populations.

Health disparities are differences in health outcomes that reflect social inequalities among groups. Vulnerable populations are defined as groups that are at increased risk of experiencing a disparity in medical care on the basis of characteristics such as age, sex, race, ethnicity, sexual orientation, spirituality, disability status, or socioeconomic or insurance status. When compared with patients from nonvulnerable populations, patients from vulnerable populations are prone to lower rates of health literacy, higher rates of preventable hospitalizations, higher rates of hospital patient safety events, and higher death rates from typically low-mortality diseases.¹ More than 30% of direct medical care expenditures for African American, Asian, and Hispanic patients are excess costs due to health disparities.² Hospitalists may have an important role in influencing the health status, healthcare access, and healthcare delivery to vulnerable populations given higher rates of hospital use and reduced access to outpatient care. In fact, hospitalists often serve as initial points of contact for the healthcare of these groups. Core competencies in communication, advocacy, and comprehension of the healthcare needs of vulnerable populations may influence healthcare expenditures, morbidity, and mortality. Hospitalists have the opportunity to lead initiatives that promote equity of healthcare provision. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain key factors leading to disparities in health status among specific vulnerable populations.

• Explain disease processes that disproportionately affect vulnerable populations.

• Describe key factors leading to disparities in the quality of care provided to vulnerable groups.

• List services in local healthcare systems designed to ameliorate barriers to care provision.

• Name local and institutional resources available to patients needing financial assistance.

• Identify key elements of discharge planning for uninsured, underinsured, and disabled patients.

Hospitalists should be able to:

• Elicit a thorough and relevant medical history and perform a physical examination to detect illnesses for which vulnerable populations may have increased risk.

• Elicit a social history to assess patient habits, identify patients at risk for breaks in transitions of care, and clarify patient values regarding treatment options.

• Facilitate communication between vulnerable patient groups and consultants.

• Select appropriate educational resources to inform vulnerable patients with low health literacy using terminology commensurate with the patient’s level of understanding.

• Provide education and systems interventions to minimize medication errors in patients with low health literacy.

• Secure medical interpreters to assist with interviewing, physical examination, and medical decision-making.

• Tailor the therapeutic plan, which includes the discharge plan and outpatient resources.

• Connect vulnerable patients with social services early in the hospital course to provide institutional support, which may include referral for insurance and drug benefits, transportation, mental health services, and substance abuse services.

• Target vulnerable groups for indicated vaccinations and preventive care services or referrals.

• Identify vulnerable patients whose outpatient environment might benefit from additional community resources.

• Coordinate adequate transitions of care from the inpatient to outpatient setting, including communication with outpatient providers. 

Hospitalists should be able to:

• Communicate openly to facilitate trust in patient-physician interactions.

• Actively involve patients and families in the design of care plans.

• Provide leadership to foster attitudes and systems improvements that promote quality healthcare provision to vulnerable populations.

Health disparities are differences in health outcomes that reflect social inequalities among groups. Vulnerable populations are defined as groups that are at increased risk of experiencing a disparity in medical care on the basis of characteristics such as age, sex, race, ethnicity, sexual orientation, spirituality, disability status, or socioeconomic or insurance status. When compared with patients from nonvulnerable populations, patients from vulnerable populations are prone to lower rates of health literacy, higher rates of preventable hospitalizations, higher rates of hospital patient safety events, and higher death rates from typically low-mortality diseases.¹ More than 30% of direct medical care expenditures for African American, Asian, and Hispanic patients are excess costs due to health disparities.² Hospitalists may have an important role in influencing the health status, healthcare access, and healthcare delivery to vulnerable populations given higher rates of hospital use and reduced access to outpatient care. In fact, hospitalists often serve as initial points of contact for the healthcare of these groups. Core competencies in communication, advocacy, and comprehension of the healthcare needs of vulnerable populations may influence healthcare expenditures, morbidity, and mortality. Hospitalists have the opportunity to lead initiatives that promote equity of healthcare provision. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain key factors leading to disparities in health status among specific vulnerable populations.

• Explain disease processes that disproportionately affect vulnerable populations.

• Describe key factors leading to disparities in the quality of care provided to vulnerable groups.

• List services in local healthcare systems designed to ameliorate barriers to care provision.

• Name local and institutional resources available to patients needing financial assistance.

• Identify key elements of discharge planning for uninsured, underinsured, and disabled patients.

Hospitalists should be able to:

• Elicit a thorough and relevant medical history and perform a physical examination to detect illnesses for which vulnerable populations may have increased risk.

• Elicit a social history to assess patient habits, identify patients at risk for breaks in transitions of care, and clarify patient values regarding treatment options.

• Facilitate communication between vulnerable patient groups and consultants.

• Select appropriate educational resources to inform vulnerable patients with low health literacy using terminology commensurate with the patient’s level of understanding.

• Provide education and systems interventions to minimize medication errors in patients with low health literacy.

• Secure medical interpreters to assist with interviewing, physical examination, and medical decision-making.

• Tailor the therapeutic plan, which includes the discharge plan and outpatient resources.

• Connect vulnerable patients with social services early in the hospital course to provide institutional support, which may include referral for insurance and drug benefits, transportation, mental health services, and substance abuse services.

• Target vulnerable groups for indicated vaccinations and preventive care services or referrals.

• Identify vulnerable patients whose outpatient environment might benefit from additional community resources.

• Coordinate adequate transitions of care from the inpatient to outpatient setting, including communication with outpatient providers. 

Hospitalists should be able to:

• Communicate openly to facilitate trust in patient-physician interactions.

• Actively involve patients and families in the design of care plans.

• Provide leadership to foster attitudes and systems improvements that promote quality healthcare provision to vulnerable populations.

Communication refers to the transfer of information among individuals, groups, or organizations. Hospitalists communicate in multiple modalities with patients, families, other healthcare providers, and administrators. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation of a care plan. An estimated 80% of serious medical errors are due to failures in communication.¹ Preventable adverse events are a leading cause of death and injury in the United States.² Therefore, effective communication is central to the role of the hospitalist to promote efficient, safe, and high-quality care and to minimize discontinuity of care. Hospitalists can lead initiatives to improve communication among team members, patients, families, primary care physicians, and receiving physicians within the hospital and at extended-care facilities beginning at admission and through all care transitions. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe key elements in a message.

• Describe the advantages and disadvantages of various communication modalities such as verbal, written, nonverbal, and listening approaches.

• Describe techniques of providing and eliciting feedback.

• Distinguish between formative and summative feedback.

• Define the role of effective communication in risk management.

Hospitalists should be able to:

• Communicate medical information in accordance with the recipient’s preferred style with language understandable to patients, family members, and other care providers.

• Effectively use various communication methods, including nonverbal communication, in patient and family interactions.

• Identify and incorporate the use of appropriate multimedia resources to improve effective communication of the message.

• Use a medical interpreter when communicating with patients and families speaking a different language.

• Lead, coordinate, and/or participate in hospital initiatives to ensure adequate interpreter services and cross-cultural sensitivity.

• Identify potentially problematic family and team dynamics and explore their effects on the patient.

• Use advance care planning skills to identify the patient’s choice of a surrogate decision maker.

• Ensure that input from surrogate decision makers accurately reflects the patient’s interests, with a minimum of personal bias.

• Facilitate family meetings when necessary, collaborating with nurses and other team members to identify goals for the meeting, summarize conclusions reached, and use support staff as needed.

• Identify and provide a suitable and comfortable setting for family meetings.

• Counsel patients and families objectively when considering various treatment options.

• Communicate with nursing staff and consultants on a regular basis to convey critical information. 

Hospitalists should be able to:

• Appreciate the positive impact that subtle changes in body language, such as sitting and appropriate touching, have on patient and family perceptions of an interaction.

• Demonstrate empathy for patient and family concerns.

• Demonstrate cultural sensitivity in all interactions with patients and families.

• Recognize the importance of allowing patients and families to have questions answered in a straightforward and timely manner.

• Discuss the patient’s illness realistically without negating hope.

• Appreciate the importance of active and reflective listening.

• Acknowledge and remain comfortable with uncertainty in issues of prognosis.

• Remain available to the patient and family for follow-up questions through all care transitions.

Communication refers to the transfer of information among individuals, groups, or organizations. Hospitalists communicate in multiple modalities with patients, families, other healthcare providers, and administrators. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation of a care plan. An estimated 80% of serious medical errors are due to failures in communication.¹ Preventable adverse events are a leading cause of death and injury in the United States.² Therefore, effective communication is central to the role of the hospitalist to promote efficient, safe, and high-quality care and to minimize discontinuity of care. Hospitalists can lead initiatives to improve communication among team members, patients, families, primary care physicians, and receiving physicians within the hospital and at extended-care facilities beginning at admission and through all care transitions. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe key elements in a message.

• Describe the advantages and disadvantages of various communication modalities such as verbal, written, nonverbal, and listening approaches.

• Describe techniques of providing and eliciting feedback.

• Distinguish between formative and summative feedback.

• Define the role of effective communication in risk management.

Hospitalists should be able to:

• Communicate medical information in accordance with the recipient’s preferred style with language understandable to patients, family members, and other care providers.

• Effectively use various communication methods, including nonverbal communication, in patient and family interactions.

• Identify and incorporate the use of appropriate multimedia resources to improve effective communication of the message.

• Use a medical interpreter when communicating with patients and families speaking a different language.

• Lead, coordinate, and/or participate in hospital initiatives to ensure adequate interpreter services and cross-cultural sensitivity.

• Identify potentially problematic family and team dynamics and explore their effects on the patient.

• Use advance care planning skills to identify the patient’s choice of a surrogate decision maker.

• Ensure that input from surrogate decision makers accurately reflects the patient’s interests, with a minimum of personal bias.

• Facilitate family meetings when necessary, collaborating with nurses and other team members to identify goals for the meeting, summarize conclusions reached, and use support staff as needed.

• Identify and provide a suitable and comfortable setting for family meetings.

• Counsel patients and families objectively when considering various treatment options.

• Communicate with nursing staff and consultants on a regular basis to convey critical information. 

Hospitalists should be able to:

• Appreciate the positive impact that subtle changes in body language, such as sitting and appropriate touching, have on patient and family perceptions of an interaction.

• Demonstrate empathy for patient and family concerns.

• Demonstrate cultural sensitivity in all interactions with patients and families.

• Recognize the importance of allowing patients and families to have questions answered in a straightforward and timely manner.

• Discuss the patient’s illness realistically without negating hope.

• Appreciate the importance of active and reflective listening.

• Acknowledge and remain comfortable with uncertainty in issues of prognosis.

• Remain available to the patient and family for follow-up questions through all care transitions.

Communication refers to the transfer of information among individuals, groups, or organizations. Hospitalists communicate in multiple modalities with patients, families, other healthcare providers, and administrators. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation of a care plan. An estimated 80% of serious medical errors are due to failures in communication.¹ Preventable adverse events are a leading cause of death and injury in the United States.² Therefore, effective communication is central to the role of the hospitalist to promote efficient, safe, and high-quality care and to minimize discontinuity of care. Hospitalists can lead initiatives to improve communication among team members, patients, families, primary care physicians, and receiving physicians within the hospital and at extended-care facilities beginning at admission and through all care transitions. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe key elements in a message.

• Describe the advantages and disadvantages of various communication modalities such as verbal, written, nonverbal, and listening approaches.

• Describe techniques of providing and eliciting feedback.

• Distinguish between formative and summative feedback.

• Define the role of effective communication in risk management.

Hospitalists should be able to:

• Communicate medical information in accordance with the recipient’s preferred style with language understandable to patients, family members, and other care providers.

• Effectively use various communication methods, including nonverbal communication, in patient and family interactions.

• Identify and incorporate the use of appropriate multimedia resources to improve effective communication of the message.

• Use a medical interpreter when communicating with patients and families speaking a different language.

• Lead, coordinate, and/or participate in hospital initiatives to ensure adequate interpreter services and cross-cultural sensitivity.

• Identify potentially problematic family and team dynamics and explore their effects on the patient.

• Use advance care planning skills to identify the patient’s choice of a surrogate decision maker.

• Ensure that input from surrogate decision makers accurately reflects the patient’s interests, with a minimum of personal bias.

• Facilitate family meetings when necessary, collaborating with nurses and other team members to identify goals for the meeting, summarize conclusions reached, and use support staff as needed.

• Identify and provide a suitable and comfortable setting for family meetings.

• Counsel patients and families objectively when considering various treatment options.

• Communicate with nursing staff and consultants on a regular basis to convey critical information. 

Hospitalists should be able to:

• Appreciate the positive impact that subtle changes in body language, such as sitting and appropriate touching, have on patient and family perceptions of an interaction.

• Demonstrate empathy for patient and family concerns.

• Demonstrate cultural sensitivity in all interactions with patients and families.

• Recognize the importance of allowing patients and families to have questions answered in a straightforward and timely manner.

• Discuss the patient’s illness realistically without negating hope.

• Appreciate the importance of active and reflective listening.

• Acknowledge and remain comfortable with uncertainty in issues of prognosis.

• Remain available to the patient and family for follow-up questions through all care transitions.

Diagnostic decision-making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Diagnostic errors account for more than 15% of all adverse events, and cognitive errors—resulting from faulty data gathering, flawed reasoning, or faulty verification—have a large role in most of these cases.^1-3 Hospitalists assess disease prevalence, pretest probability, and posttest probability to make a diagnostic decision while avoiding cognitive bias. By engaging in efficient and timely diagnostic decision-making, hospitalists can positively influence the quality and cost of medical care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the prevalence of common disease states in the local patient population.

• Define and differentiate problem-solving strategies, including hypothesis testing and pattern recognition.

• Define and differentiate prevalence, pretest probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and posttest probability.

• Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.

• Describe the sensitivity and specificity of key clinical features and diagnostic findings for common clinical syndromes.

• Describe the concepts that underlie Bayes’ theorem and explain how it is used in diagnostic decision-making.

• Describe the factors that account for excessive or indiscriminate testing.

• Describe types of cognitive biases that can influence decision-making.

Hospitalists should be able to:

• Elicit a targeted medical history and perform a physical examination to detect symptoms and data that help refine the diagnostic hypothesis.

• Access resources that contain relevant information such as prevalence and incidence rates of disease states.

• Analyze the value of each diagnostic test, especially testing procedures that carry clinically significant patient discomfort or risk.

• Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.

• Calculate posttest probabilities of disease using pretest probabilities and likelihood ratios.

• Communicate with patients and families to explain the differential diagnosis and evaluation of the patient’s presenting symptoms.

• Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.

• Communicate with other physicians, trainees, and healthcare providers to explain the rationale for use of diagnostic tests.

• Anticipate, identify, and avoid cognitive biases when making diagnostic decisions.

• Incorporate the principles of evidence-based medicine, healthcare costs, and individual patient characteristics and preferences into each patient’s diagnostic evaluation.

• Determine when sufficient evaluation has occurred in the absence of diagnostic certainty.

• Lead, coordinate, and/or participate in the development of clinical care pathways designed to simplify and/or improve the diagnostic process for a particular clinical condition. 

Hospitalists should be able to:

• Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated on the basis of test results.

• Appreciate that all tests have false-positive and false-negative results and rigorously scrutinize or repeat the test when the result is in question.

Diagnostic decision-making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Diagnostic errors account for more than 15% of all adverse events, and cognitive errors—resulting from faulty data gathering, flawed reasoning, or faulty verification—have a large role in most of these cases.^1-3 Hospitalists assess disease prevalence, pretest probability, and posttest probability to make a diagnostic decision while avoiding cognitive bias. By engaging in efficient and timely diagnostic decision-making, hospitalists can positively influence the quality and cost of medical care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the prevalence of common disease states in the local patient population.

• Define and differentiate problem-solving strategies, including hypothesis testing and pattern recognition.

• Define and differentiate prevalence, pretest probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and posttest probability.

• Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.

• Describe the sensitivity and specificity of key clinical features and diagnostic findings for common clinical syndromes.

• Describe the concepts that underlie Bayes’ theorem and explain how it is used in diagnostic decision-making.

• Describe the factors that account for excessive or indiscriminate testing.

• Describe types of cognitive biases that can influence decision-making.

Hospitalists should be able to:

• Elicit a targeted medical history and perform a physical examination to detect symptoms and data that help refine the diagnostic hypothesis.

• Access resources that contain relevant information such as prevalence and incidence rates of disease states.

• Analyze the value of each diagnostic test, especially testing procedures that carry clinically significant patient discomfort or risk.

• Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.

• Calculate posttest probabilities of disease using pretest probabilities and likelihood ratios.

• Communicate with patients and families to explain the differential diagnosis and evaluation of the patient’s presenting symptoms.

• Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.

• Communicate with other physicians, trainees, and healthcare providers to explain the rationale for use of diagnostic tests.

• Anticipate, identify, and avoid cognitive biases when making diagnostic decisions.

• Incorporate the principles of evidence-based medicine, healthcare costs, and individual patient characteristics and preferences into each patient’s diagnostic evaluation.

• Determine when sufficient evaluation has occurred in the absence of diagnostic certainty.

• Lead, coordinate, and/or participate in the development of clinical care pathways designed to simplify and/or improve the diagnostic process for a particular clinical condition. 

Hospitalists should be able to:

• Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated on the basis of test results.

• Appreciate that all tests have false-positive and false-negative results and rigorously scrutinize or repeat the test when the result is in question.

Diagnostic decision-making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Diagnostic errors account for more than 15% of all adverse events, and cognitive errors—resulting from faulty data gathering, flawed reasoning, or faulty verification—have a large role in most of these cases.^1-3 Hospitalists assess disease prevalence, pretest probability, and posttest probability to make a diagnostic decision while avoiding cognitive bias. By engaging in efficient and timely diagnostic decision-making, hospitalists can positively influence the quality and cost of medical care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the prevalence of common disease states in the local patient population.

• Define and differentiate problem-solving strategies, including hypothesis testing and pattern recognition.

• Define and differentiate prevalence, pretest probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and posttest probability.

• Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.

• Describe the sensitivity and specificity of key clinical features and diagnostic findings for common clinical syndromes.

• Describe the concepts that underlie Bayes’ theorem and explain how it is used in diagnostic decision-making.

• Describe the factors that account for excessive or indiscriminate testing.

• Describe types of cognitive biases that can influence decision-making.

Hospitalists should be able to:

• Elicit a targeted medical history and perform a physical examination to detect symptoms and data that help refine the diagnostic hypothesis.

• Access resources that contain relevant information such as prevalence and incidence rates of disease states.

• Analyze the value of each diagnostic test, especially testing procedures that carry clinically significant patient discomfort or risk.

• Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.

• Calculate posttest probabilities of disease using pretest probabilities and likelihood ratios.

• Communicate with patients and families to explain the differential diagnosis and evaluation of the patient’s presenting symptoms.

• Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.

• Communicate with other physicians, trainees, and healthcare providers to explain the rationale for use of diagnostic tests.

• Anticipate, identify, and avoid cognitive biases when making diagnostic decisions.

• Incorporate the principles of evidence-based medicine, healthcare costs, and individual patient characteristics and preferences into each patient’s diagnostic evaluation.

• Determine when sufficient evaluation has occurred in the absence of diagnostic certainty.

• Lead, coordinate, and/or participate in the development of clinical care pathways designed to simplify and/or improve the diagnostic process for a particular clinical condition. 

Hospitalists should be able to:

• Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated on the basis of test results.

• Appreciate that all tests have false-positive and false-negative results and rigorously scrutinize or repeat the test when the result is in question.

The availability and use of pharmaceutical agents has widely expanded in healthcare, as have concerns about adverse drug events (ADEs). When prescribing medications, hospitalists should strive to use evidence-based therapies and must evaluate the benefits, harms, and financial costs of drug therapy for individual patients. Annually in the United States, 380,000 to 450,000 preventable ADEs occur in hospitalized patients.¹ Notably, 82% of American adults take at least 1 medication and 29% take 5 or more, and drug-drug interactions account for 3% to 5% of ADEs.^2,3 The occurrence of ADEs is associated with increased mortality, morbidity, prolonged hospitalization, and higher costs of care.⁴ In clinical practice, hospitalists should promote and lead multidisciplinary teams to develop and implement protocols, guidelines, and clinical pathways that recommend preferred drug therapies. In addition, hospitalists should have familiarity in interpreting outcomes measurement (pharmacoepidemiology) and economic analyses (pharmacoeconomics). 

Hospitalists should be able to:

• Describe principles of evaluating clinical efficacy, pharmacokinetics, dosing, drug and food interactions, and adverse effects that can affect the choice of agent, dosing frequency, and route of administration.

• Explain the evidence-based rationale for prophylactic drug therapies, comparing the costs, risks, and benefits of competing strategies.

• Explain how pharmacodynamics may change with age, liver disease, and renal insufficiency.

• Describe the incidence of various types of ADEs in hospitalized patients, which may include adverse effects, interactions, and errors.

• Recognize the risk of ADEs during care transitions.

• Explain the role of polypharmacy in the development of delirium, ADEs, and noncompliance.

• Describe how the overuse of antibiotics promotes antibiotic resistance.

• Describe potential complications associated with administration of blood products.

• Describe key principles for interpreting pharmacoeconomic analyses, including inflation rate, discounting rate, incremental analysis, sensitivity analysis, and inherent bias.

• Describe the clinical efficacy, safety profile, pharmacokinetics, dosing, drug and food interactions, and costs of commonly prescribed medications and biological agents (eg, blood products).

Hospitalists should be able to:

• Adjust prescribing strategies for patients according to conditions that may influence pharmacokinetics, such as age or comorbidities.

• Apply treatment guidelines to individual patients to use antibiotics judiciously to reduce cost and the emergence of antibiotic resistance.

• Integrate knowledge of benefits and risks of drug therapies into medical decision-making for individual patients and routinely reassess decisions.

• Minimize ADEs by following best practice models of medication ordering and administration.

• Document medications accurately and legibly, taking into account approved abbreviations, and indicate start and stop dates for short-term medications.

• Arrange appropriate follow-up for therapies that require outpatient monitoring, dosage adjustment, and education (eg, anticoagulants, antibiotics).

• Balance the benefits, risks, and cost of prophylactic therapies, which may include venous thromboembolism and stress ulcer prophylaxis.

• Convert intravenous medications to the oral route when indicated to promote patient safety, satisfaction, and reduce cost.

• Follow standard practices for transfusion of blood products.

• Educate patients and families regarding the indications, benefits, potential adverse effects, alternatives, and directions for use of the prescribed medications.

• Educate patients and families about the importance of acquiring medication information and communicating medication history to clinicians at each transition of care.

• Reconcile outpatient medications with inpatient medications at the time of admission and discharge.

• Critically assess and apply results of outcome studies to improve drug treatment and safety for individual patients.

• Lead, coordinate, and/or participate in the development, use, and dissemination of local, regional, and national practice guidelines and patient safety alerts pertaining to the prevention of complications.

• Apply principles of pharmacoepidemiology and pharmacoeconomics to implement practice guidelines and protocols for a hospital. 

Hospitalists should be able to:

• Appreciate that ADEs must be monitored and that steps must be taken to reduce their incidence.

• Exemplify safe medication prescribing and administration practices.

• Engage collaboratively with multidisciplinary teams, which may include pharmacy, nursing service, social work, case management, long-term care facilities, and outpatient care teams, to improve drug safety for individual patients and reduce costs.

The availability and use of pharmaceutical agents has widely expanded in healthcare, as have concerns about adverse drug events (ADEs). When prescribing medications, hospitalists should strive to use evidence-based therapies and must evaluate the benefits, harms, and financial costs of drug therapy for individual patients. Annually in the United States, 380,000 to 450,000 preventable ADEs occur in hospitalized patients.¹ Notably, 82% of American adults take at least 1 medication and 29% take 5 or more, and drug-drug interactions account for 3% to 5% of ADEs.^2,3 The occurrence of ADEs is associated with increased mortality, morbidity, prolonged hospitalization, and higher costs of care.⁴ In clinical practice, hospitalists should promote and lead multidisciplinary teams to develop and implement protocols, guidelines, and clinical pathways that recommend preferred drug therapies. In addition, hospitalists should have familiarity in interpreting outcomes measurement (pharmacoepidemiology) and economic analyses (pharmacoeconomics). 

Hospitalists should be able to:

• Describe principles of evaluating clinical efficacy, pharmacokinetics, dosing, drug and food interactions, and adverse effects that can affect the choice of agent, dosing frequency, and route of administration.

• Explain the evidence-based rationale for prophylactic drug therapies, comparing the costs, risks, and benefits of competing strategies.

• Explain how pharmacodynamics may change with age, liver disease, and renal insufficiency.

• Describe the incidence of various types of ADEs in hospitalized patients, which may include adverse effects, interactions, and errors.

• Recognize the risk of ADEs during care transitions.

• Explain the role of polypharmacy in the development of delirium, ADEs, and noncompliance.

• Describe how the overuse of antibiotics promotes antibiotic resistance.

• Describe potential complications associated with administration of blood products.

• Describe key principles for interpreting pharmacoeconomic analyses, including inflation rate, discounting rate, incremental analysis, sensitivity analysis, and inherent bias.

• Describe the clinical efficacy, safety profile, pharmacokinetics, dosing, drug and food interactions, and costs of commonly prescribed medications and biological agents (eg, blood products).

Hospitalists should be able to:

• Adjust prescribing strategies for patients according to conditions that may influence pharmacokinetics, such as age or comorbidities.

• Apply treatment guidelines to individual patients to use antibiotics judiciously to reduce cost and the emergence of antibiotic resistance.

• Integrate knowledge of benefits and risks of drug therapies into medical decision-making for individual patients and routinely reassess decisions.

• Minimize ADEs by following best practice models of medication ordering and administration.

• Document medications accurately and legibly, taking into account approved abbreviations, and indicate start and stop dates for short-term medications.

• Arrange appropriate follow-up for therapies that require outpatient monitoring, dosage adjustment, and education (eg, anticoagulants, antibiotics).

• Balance the benefits, risks, and cost of prophylactic therapies, which may include venous thromboembolism and stress ulcer prophylaxis.

• Convert intravenous medications to the oral route when indicated to promote patient safety, satisfaction, and reduce cost.

• Follow standard practices for transfusion of blood products.

• Educate patients and families regarding the indications, benefits, potential adverse effects, alternatives, and directions for use of the prescribed medications.

• Educate patients and families about the importance of acquiring medication information and communicating medication history to clinicians at each transition of care.

• Reconcile outpatient medications with inpatient medications at the time of admission and discharge.

• Critically assess and apply results of outcome studies to improve drug treatment and safety for individual patients.

• Lead, coordinate, and/or participate in the development, use, and dissemination of local, regional, and national practice guidelines and patient safety alerts pertaining to the prevention of complications.

• Apply principles of pharmacoepidemiology and pharmacoeconomics to implement practice guidelines and protocols for a hospital. 

Hospitalists should be able to:

• Appreciate that ADEs must be monitored and that steps must be taken to reduce their incidence.

• Exemplify safe medication prescribing and administration practices.

• Engage collaboratively with multidisciplinary teams, which may include pharmacy, nursing service, social work, case management, long-term care facilities, and outpatient care teams, to improve drug safety for individual patients and reduce costs.

The availability and use of pharmaceutical agents has widely expanded in healthcare, as have concerns about adverse drug events (ADEs). When prescribing medications, hospitalists should strive to use evidence-based therapies and must evaluate the benefits, harms, and financial costs of drug therapy for individual patients. Annually in the United States, 380,000 to 450,000 preventable ADEs occur in hospitalized patients.¹ Notably, 82% of American adults take at least 1 medication and 29% take 5 or more, and drug-drug interactions account for 3% to 5% of ADEs.^2,3 The occurrence of ADEs is associated with increased mortality, morbidity, prolonged hospitalization, and higher costs of care.⁴ In clinical practice, hospitalists should promote and lead multidisciplinary teams to develop and implement protocols, guidelines, and clinical pathways that recommend preferred drug therapies. In addition, hospitalists should have familiarity in interpreting outcomes measurement (pharmacoepidemiology) and economic analyses (pharmacoeconomics). 

Hospitalists should be able to:

• Describe principles of evaluating clinical efficacy, pharmacokinetics, dosing, drug and food interactions, and adverse effects that can affect the choice of agent, dosing frequency, and route of administration.

• Explain the evidence-based rationale for prophylactic drug therapies, comparing the costs, risks, and benefits of competing strategies.

• Explain how pharmacodynamics may change with age, liver disease, and renal insufficiency.

• Describe the incidence of various types of ADEs in hospitalized patients, which may include adverse effects, interactions, and errors.

• Recognize the risk of ADEs during care transitions.

• Explain the role of polypharmacy in the development of delirium, ADEs, and noncompliance.

• Describe how the overuse of antibiotics promotes antibiotic resistance.

• Describe potential complications associated with administration of blood products.

• Describe key principles for interpreting pharmacoeconomic analyses, including inflation rate, discounting rate, incremental analysis, sensitivity analysis, and inherent bias.

• Describe the clinical efficacy, safety profile, pharmacokinetics, dosing, drug and food interactions, and costs of commonly prescribed medications and biological agents (eg, blood products).

Hospitalists should be able to:

• Adjust prescribing strategies for patients according to conditions that may influence pharmacokinetics, such as age or comorbidities.

• Apply treatment guidelines to individual patients to use antibiotics judiciously to reduce cost and the emergence of antibiotic resistance.

• Integrate knowledge of benefits and risks of drug therapies into medical decision-making for individual patients and routinely reassess decisions.

• Minimize ADEs by following best practice models of medication ordering and administration.

• Document medications accurately and legibly, taking into account approved abbreviations, and indicate start and stop dates for short-term medications.

• Arrange appropriate follow-up for therapies that require outpatient monitoring, dosage adjustment, and education (eg, anticoagulants, antibiotics).

• Balance the benefits, risks, and cost of prophylactic therapies, which may include venous thromboembolism and stress ulcer prophylaxis.

• Convert intravenous medications to the oral route when indicated to promote patient safety, satisfaction, and reduce cost.

• Follow standard practices for transfusion of blood products.

• Educate patients and families regarding the indications, benefits, potential adverse effects, alternatives, and directions for use of the prescribed medications.

• Educate patients and families about the importance of acquiring medication information and communicating medication history to clinicians at each transition of care.

• Reconcile outpatient medications with inpatient medications at the time of admission and discharge.

• Critically assess and apply results of outcome studies to improve drug treatment and safety for individual patients.

• Lead, coordinate, and/or participate in the development, use, and dissemination of local, regional, and national practice guidelines and patient safety alerts pertaining to the prevention of complications.

• Apply principles of pharmacoepidemiology and pharmacoeconomics to implement practice guidelines and protocols for a hospital. 

Hospitalists should be able to:

• Appreciate that ADEs must be monitored and that steps must be taken to reduce their incidence.

• Exemplify safe medication prescribing and administration practices.

• Engage collaboratively with multidisciplinary teams, which may include pharmacy, nursing service, social work, case management, long-term care facilities, and outpatient care teams, to improve drug safety for individual patients and reduce costs.

Healthcare expenditures in the United States (totaling almost 18% of the gross domestic product on an annual basis) continue to rise, with hospital spending accounting for the largest portion.¹ According to the Congressional Budget Office, up to 5% of the gross domestic product each year ($700 billion) is spent on tests and procedures that do not improve health outcomes.²Efficient and equitable distribution of healthcare resources is critical for overall population health, as the uninsured and underinsured, the poor, and members of certain minority groups often have inadequate healthcare access and substandard health outcomes.^3,4 Hospitals are under constant pressure to provide more efficient care with limited resources, with hospitalists acting as coordinators of care and resource use. In addition, hospitalists are positioned to identify healthcare disparities, optimize care for all patients, and advocate for equitable and cost-effective allocation of hospital resources. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the concepts of equity and cost-effectiveness.

• Identify patient populations at risk for healthcare disparities.

• Identify health resources that are prone to inequitable allocations.

• Differentiate among decision analysis, cost-effectiveness analysis, and cost-benefit analysis.

• Explain how cost-effectiveness may conflict with equity in healthcare policies.

• Describe patient factors that affect the allocation of healthcare resources.

• Explain how equity in healthcare is cost effective.

• Explain the relationship between healthcare disparities and healthcare quality.

Hospitalists should be able to:

• Measure patient access to healthcare resources.

• Incorporate equity concerns into cost-effectiveness analysis.

• Triage patients to appropriate hospital resources.

• Construct cost-effective care pathways that allocate resources equitably.

• Practice evidence-based, cost-effective care for all patients.

• Use cost-effectiveness analysis, cost-benefit analysis, evidence-based medicine, and measurements of healthcare equity to shape hospital policy on the allocation of its resources.

• Lead, coordinate, and/or participate in multidisciplinary teams, which may include radiology, pharmacy, nursing, and social services, to decrease hospital costs and provide evidence-based, cost-effective care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve resource allocation.

• Lead, coordinate, and/or participate in multidisciplinary hospital and community efforts to ensure proper access to care for all individuals. 

Hospitalists should be able to:

• Actively listen to the concerns of all patients.

• Advocate for every patient’s healthcare needs.

• Recognize that overuse of resources, including excessive test ordering, may not improve patient safety, patient satisfaction, or quality of care.

• Engage collaboratively with information technologists and healthcare economists to track resource use and outcomes.

• Advocate for cross-cultural education and interpreter services in hospital systems to decrease barriers to equitable healthcare allocation.

Healthcare expenditures in the United States (totaling almost 18% of the gross domestic product on an annual basis) continue to rise, with hospital spending accounting for the largest portion.¹ According to the Congressional Budget Office, up to 5% of the gross domestic product each year ($700 billion) is spent on tests and procedures that do not improve health outcomes.²Efficient and equitable distribution of healthcare resources is critical for overall population health, as the uninsured and underinsured, the poor, and members of certain minority groups often have inadequate healthcare access and substandard health outcomes.^3,4 Hospitals are under constant pressure to provide more efficient care with limited resources, with hospitalists acting as coordinators of care and resource use. In addition, hospitalists are positioned to identify healthcare disparities, optimize care for all patients, and advocate for equitable and cost-effective allocation of hospital resources. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the concepts of equity and cost-effectiveness.

• Identify patient populations at risk for healthcare disparities.

• Identify health resources that are prone to inequitable allocations.

• Differentiate among decision analysis, cost-effectiveness analysis, and cost-benefit analysis.

• Explain how cost-effectiveness may conflict with equity in healthcare policies.

• Describe patient factors that affect the allocation of healthcare resources.

• Explain how equity in healthcare is cost effective.

• Explain the relationship between healthcare disparities and healthcare quality.

Hospitalists should be able to:

• Measure patient access to healthcare resources.

• Incorporate equity concerns into cost-effectiveness analysis.

• Triage patients to appropriate hospital resources.

• Construct cost-effective care pathways that allocate resources equitably.

• Practice evidence-based, cost-effective care for all patients.

• Use cost-effectiveness analysis, cost-benefit analysis, evidence-based medicine, and measurements of healthcare equity to shape hospital policy on the allocation of its resources.

• Lead, coordinate, and/or participate in multidisciplinary teams, which may include radiology, pharmacy, nursing, and social services, to decrease hospital costs and provide evidence-based, cost-effective care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve resource allocation.

• Lead, coordinate, and/or participate in multidisciplinary hospital and community efforts to ensure proper access to care for all individuals. 

Hospitalists should be able to:

• Actively listen to the concerns of all patients.

• Advocate for every patient’s healthcare needs.

• Recognize that overuse of resources, including excessive test ordering, may not improve patient safety, patient satisfaction, or quality of care.

• Engage collaboratively with information technologists and healthcare economists to track resource use and outcomes.

• Advocate for cross-cultural education and interpreter services in hospital systems to decrease barriers to equitable healthcare allocation.

Healthcare expenditures in the United States (totaling almost 18% of the gross domestic product on an annual basis) continue to rise, with hospital spending accounting for the largest portion.¹ According to the Congressional Budget Office, up to 5% of the gross domestic product each year ($700 billion) is spent on tests and procedures that do not improve health outcomes.²Efficient and equitable distribution of healthcare resources is critical for overall population health, as the uninsured and underinsured, the poor, and members of certain minority groups often have inadequate healthcare access and substandard health outcomes.^3,4 Hospitals are under constant pressure to provide more efficient care with limited resources, with hospitalists acting as coordinators of care and resource use. In addition, hospitalists are positioned to identify healthcare disparities, optimize care for all patients, and advocate for equitable and cost-effective allocation of hospital resources. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the concepts of equity and cost-effectiveness.

• Identify patient populations at risk for healthcare disparities.

• Identify health resources that are prone to inequitable allocations.

• Differentiate among decision analysis, cost-effectiveness analysis, and cost-benefit analysis.

• Explain how cost-effectiveness may conflict with equity in healthcare policies.

• Describe patient factors that affect the allocation of healthcare resources.

• Explain how equity in healthcare is cost effective.

• Explain the relationship between healthcare disparities and healthcare quality.

Hospitalists should be able to:

• Measure patient access to healthcare resources.

• Incorporate equity concerns into cost-effectiveness analysis.

• Triage patients to appropriate hospital resources.

• Construct cost-effective care pathways that allocate resources equitably.

• Practice evidence-based, cost-effective care for all patients.

• Use cost-effectiveness analysis, cost-benefit analysis, evidence-based medicine, and measurements of healthcare equity to shape hospital policy on the allocation of its resources.

• Lead, coordinate, and/or participate in multidisciplinary teams, which may include radiology, pharmacy, nursing, and social services, to decrease hospital costs and provide evidence-based, cost-effective care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve resource allocation.

• Lead, coordinate, and/or participate in multidisciplinary hospital and community efforts to ensure proper access to care for all individuals. 

Hospitalists should be able to:

• Actively listen to the concerns of all patients.

• Advocate for every patient’s healthcare needs.

• Recognize that overuse of resources, including excessive test ordering, may not improve patient safety, patient satisfaction, or quality of care.

• Engage collaboratively with information technologists and healthcare economists to track resource use and outcomes.

• Advocate for cross-cultural education and interpreter services in hospital systems to decrease barriers to equitable healthcare allocation.

Evidence-based medicine (EBM) uses a systematic approach to medical decision-making and patient care, combining the highest available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, using an EBM approach helps them collaborate with patients to make the best possible individualized decisions. In the current environment, in which hospitalists have immediate access to vast amounts of information, knowledge management skills are critical so hospitalists can find, synthesize, and organize the best available information. Hospitalists also use their EBM skills to find current scientific evidence to develop quality improvement projects, including protocols and clinical pathways that improve the efficiency and quality of care within their organizations. Additionally, hospitalists lead and participate in educational efforts that foster the adoption of a rigorous evidence-based approach among medical trainees, hospital staff, and physician colleagues. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Identify peer-reviewed databases and other resources to search for scientific evidence to answer clinical and systems questions.

• Distinguish between filtered and nonfiltered resources by providing examples and describing their advantages and disadvantages.

• Describe major study types, including therapy, diagnosis, prognosis, harm, meta-analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the salient features of the following study designs: randomized controlled trials, meta-analyses, cohort studies, case-control studies, case series, cost-effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and intention-to-treat analysis.

• Explain the core components and core statistical concepts used in diagnosis studies, including Bayes’ theorem, sensitivity, specificity, and likelihood ratios.

Hospitalists should be able to:

• Formulate a well-designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Identify the most appropriate study design(s) for any given clinical- or systems-based question.

• Search filtered and nonfiltered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Lead, coordinate, and/or participate in educational initiatives aimed at teaching and practicing EBM.

• Lead, coordinate, and/or participate in evidence-based systems interventions to improve care quality and efficiency. 

Hospitalists should be able to:

• Reflect upon individual practice patterns to identify new questions.

• Serve as a role model for evidence-based point-of-care practice.

• Advocate for institutional access to high-quality point-of-care EBM information resources.

Evidence-based medicine (EBM) uses a systematic approach to medical decision-making and patient care, combining the highest available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, using an EBM approach helps them collaborate with patients to make the best possible individualized decisions. In the current environment, in which hospitalists have immediate access to vast amounts of information, knowledge management skills are critical so hospitalists can find, synthesize, and organize the best available information. Hospitalists also use their EBM skills to find current scientific evidence to develop quality improvement projects, including protocols and clinical pathways that improve the efficiency and quality of care within their organizations. Additionally, hospitalists lead and participate in educational efforts that foster the adoption of a rigorous evidence-based approach among medical trainees, hospital staff, and physician colleagues. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Identify peer-reviewed databases and other resources to search for scientific evidence to answer clinical and systems questions.

• Distinguish between filtered and nonfiltered resources by providing examples and describing their advantages and disadvantages.

• Describe major study types, including therapy, diagnosis, prognosis, harm, meta-analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the salient features of the following study designs: randomized controlled trials, meta-analyses, cohort studies, case-control studies, case series, cost-effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and intention-to-treat analysis.

• Explain the core components and core statistical concepts used in diagnosis studies, including Bayes’ theorem, sensitivity, specificity, and likelihood ratios.

Hospitalists should be able to:

• Formulate a well-designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Identify the most appropriate study design(s) for any given clinical- or systems-based question.

• Search filtered and nonfiltered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Lead, coordinate, and/or participate in educational initiatives aimed at teaching and practicing EBM.

• Lead, coordinate, and/or participate in evidence-based systems interventions to improve care quality and efficiency. 

Hospitalists should be able to:

• Reflect upon individual practice patterns to identify new questions.

• Serve as a role model for evidence-based point-of-care practice.

• Advocate for institutional access to high-quality point-of-care EBM information resources.

Evidence-based medicine (EBM) uses a systematic approach to medical decision-making and patient care, combining the highest available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, using an EBM approach helps them collaborate with patients to make the best possible individualized decisions. In the current environment, in which hospitalists have immediate access to vast amounts of information, knowledge management skills are critical so hospitalists can find, synthesize, and organize the best available information. Hospitalists also use their EBM skills to find current scientific evidence to develop quality improvement projects, including protocols and clinical pathways that improve the efficiency and quality of care within their organizations. Additionally, hospitalists lead and participate in educational efforts that foster the adoption of a rigorous evidence-based approach among medical trainees, hospital staff, and physician colleagues. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Identify peer-reviewed databases and other resources to search for scientific evidence to answer clinical and systems questions.

• Distinguish between filtered and nonfiltered resources by providing examples and describing their advantages and disadvantages.

• Describe major study types, including therapy, diagnosis, prognosis, harm, meta-analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the salient features of the following study designs: randomized controlled trials, meta-analyses, cohort studies, case-control studies, case series, cost-effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and intention-to-treat analysis.

• Explain the core components and core statistical concepts used in diagnosis studies, including Bayes’ theorem, sensitivity, specificity, and likelihood ratios.

Hospitalists should be able to:

• Formulate a well-designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Identify the most appropriate study design(s) for any given clinical- or systems-based question.

• Search filtered and nonfiltered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Lead, coordinate, and/or participate in educational initiatives aimed at teaching and practicing EBM.

• Lead, coordinate, and/or participate in evidence-based systems interventions to improve care quality and efficiency. 

Hospitalists should be able to:

• Reflect upon individual practice patterns to identify new questions.

• Serve as a role model for evidence-based point-of-care practice.

• Advocate for institutional access to high-quality point-of-care EBM information resources.

Hospitalists serve as educators and role models for all members of the multidisciplinary care team, including student learners, fellow physicians, allied health professionals, and hospital administrators. “Hospitalist as educator” refers to specific interactions with these team members to educate them about a wide range of knowledge and clinical skills such as patient care plans, treatment protocols, aspects of patient safety, and evidence-based problem-solving exercises. In this role as educators, hospitalists facilitate team building. They instruct students in an optimal learning environment, provide feedback, and promote independent thinking. They model efficient clinical decision-making and communication skills during physician-patient encounters. Hospitalists must attend to the learning needs of a generation of medical trainees that has an affinity for technology, interaction, and group-based learning, while also operating in an environment of restricted resident work hours. The hospitalist as educator core competency is essential to effecting organizational excellence. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the role of the hospitalist as an educator.

• Describe adult education principles.

• Explain factors that may facilitate or inhibit learning.

• Define the concept of a teachable moment.

• Describe the benefits and limitations of various teaching modalities.

• Identify resources for training materials.

• Describe the process of developing a formal educational session, including performing a needs assessment, determining teaching goals and objectives, developing teaching materials and activities, and evaluating a learner’s comprehension of the target material.

• Describe practical steps for delivering dynamic presentations for multiple venues, including bedside teaching to trainees, small group discussions with coworkers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.

• Describe models for clinical teaching (eg, the “microskills” model).

• Explain the process of applying competencies to curricular development.

Hospitalists should be able to:

• Establish a comfortable and safe learning environment.

• Establish expectations for each teaching session and clearly articulate the objectives.

• Determine the information needs of the intended recipient and tailor messages to the needs, abilities, and preferences of the intended recipient.

• Effectively assess learners’ progress towards the goals of the teaching session.

• Frame educational interventions in a manner that sets up trainees for success.

• Provide prompt, explicit, and action-oriented feedback in a manner conducive to self-improvement.

• Facilitate learners’ self-assessment of comprehension of target information and development of plans for further self-education.

• Promote evaluation standards that are fair and facilitate personal and professional development.

• Instruct at the level of learners’ experience and knowledge and accommodate for learners at different levels.

• Seek feedback on the effectiveness of instruction methods, modalities, and materials.

• Encourage and provide tools for lifelong, self-directed learning and clinical problem-solving.

• Structure the timing and delivery of information and learning experiences to maximize comprehension.

• Use adult learning principles in the development or selection of educational programs, methods, and materials.

• Promote the effective use of the “teachable moment” in the education of patients, students, and healthcare professionals.

• Use explicit and accessible language to explain clinical decision-making to learners.

• Make the clinical reasoning process understandable, explicit, and relevant to learners.

• Promote efficient, up-to-date clinical problem-solving during every patient encounter.

• Model the integration of quality initiatives and patient feedback into clinical decision-making.

• Provide bedside teaching that is informative and comfortable for patients, trainees, and members of the multidisciplinary care team.

• Demonstrate effective mentoring, including role modeling and active feedback techniques.

• Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the performance of the procedure, and necessary follow-up.

• Lead, coordinate, and/or participate in efforts to formulate a needs assessment program for hospitalists’ continued professional development.

• Lead, coordinate, and/or participate in educational scholarship. 

Hospitalists should be able to:

• Project enthusiasm for the teaching role.

• Respect learners from all backgrounds, knowledge, and skill levels.

• Promote an atmosphere of cooperation among patients, trainees, and multidisciplinary team members.

• Advocate the importance of lifelong learning and mentorship.

• Advocate the dual role of all healthcare professionals as simultaneous educators and students.

• Balance patient care and teaching regarding relevant time constraints.

• Promote an organizational environment in which knowledge deficiencies are identified and targeted.

• Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.

• Admit the limitations of one’s knowledge and respond appropriately to mistakes.

• Reflect on teaching moments to identify opportunities for improvement.

• Promote evidence-based information acquisition and clinical decision-making.

• Use the role of the “hospitalist as educator” to lead, coordinate, and/or participate in performance improvement initiatives.

Hospitalists serve as educators and role models for all members of the multidisciplinary care team, including student learners, fellow physicians, allied health professionals, and hospital administrators. “Hospitalist as educator” refers to specific interactions with these team members to educate them about a wide range of knowledge and clinical skills such as patient care plans, treatment protocols, aspects of patient safety, and evidence-based problem-solving exercises. In this role as educators, hospitalists facilitate team building. They instruct students in an optimal learning environment, provide feedback, and promote independent thinking. They model efficient clinical decision-making and communication skills during physician-patient encounters. Hospitalists must attend to the learning needs of a generation of medical trainees that has an affinity for technology, interaction, and group-based learning, while also operating in an environment of restricted resident work hours. The hospitalist as educator core competency is essential to effecting organizational excellence. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the role of the hospitalist as an educator.

• Describe adult education principles.

• Explain factors that may facilitate or inhibit learning.

• Define the concept of a teachable moment.

• Describe the benefits and limitations of various teaching modalities.

• Identify resources for training materials.

• Describe the process of developing a formal educational session, including performing a needs assessment, determining teaching goals and objectives, developing teaching materials and activities, and evaluating a learner’s comprehension of the target material.

• Describe practical steps for delivering dynamic presentations for multiple venues, including bedside teaching to trainees, small group discussions with coworkers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.

• Describe models for clinical teaching (eg, the “microskills” model).

• Explain the process of applying competencies to curricular development.

Hospitalists should be able to:

• Establish a comfortable and safe learning environment.

• Establish expectations for each teaching session and clearly articulate the objectives.

• Determine the information needs of the intended recipient and tailor messages to the needs, abilities, and preferences of the intended recipient.

• Effectively assess learners’ progress towards the goals of the teaching session.

• Frame educational interventions in a manner that sets up trainees for success.

• Provide prompt, explicit, and action-oriented feedback in a manner conducive to self-improvement.

• Facilitate learners’ self-assessment of comprehension of target information and development of plans for further self-education.

• Promote evaluation standards that are fair and facilitate personal and professional development.

• Instruct at the level of learners’ experience and knowledge and accommodate for learners at different levels.

• Seek feedback on the effectiveness of instruction methods, modalities, and materials.

• Encourage and provide tools for lifelong, self-directed learning and clinical problem-solving.

• Structure the timing and delivery of information and learning experiences to maximize comprehension.

• Use adult learning principles in the development or selection of educational programs, methods, and materials.

• Promote the effective use of the “teachable moment” in the education of patients, students, and healthcare professionals.

• Use explicit and accessible language to explain clinical decision-making to learners.

• Make the clinical reasoning process understandable, explicit, and relevant to learners.

• Promote efficient, up-to-date clinical problem-solving during every patient encounter.

• Model the integration of quality initiatives and patient feedback into clinical decision-making.

• Provide bedside teaching that is informative and comfortable for patients, trainees, and members of the multidisciplinary care team.

• Demonstrate effective mentoring, including role modeling and active feedback techniques.

• Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the performance of the procedure, and necessary follow-up.

• Lead, coordinate, and/or participate in efforts to formulate a needs assessment program for hospitalists’ continued professional development.

• Lead, coordinate, and/or participate in educational scholarship. 

Hospitalists should be able to:

• Project enthusiasm for the teaching role.

• Respect learners from all backgrounds, knowledge, and skill levels.

• Promote an atmosphere of cooperation among patients, trainees, and multidisciplinary team members.

• Advocate the importance of lifelong learning and mentorship.

• Advocate the dual role of all healthcare professionals as simultaneous educators and students.

• Balance patient care and teaching regarding relevant time constraints.

• Promote an organizational environment in which knowledge deficiencies are identified and targeted.

• Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.

• Admit the limitations of one’s knowledge and respond appropriately to mistakes.

• Reflect on teaching moments to identify opportunities for improvement.

• Promote evidence-based information acquisition and clinical decision-making.

• Use the role of the “hospitalist as educator” to lead, coordinate, and/or participate in performance improvement initiatives.

Hospitalists serve as educators and role models for all members of the multidisciplinary care team, including student learners, fellow physicians, allied health professionals, and hospital administrators. “Hospitalist as educator” refers to specific interactions with these team members to educate them about a wide range of knowledge and clinical skills such as patient care plans, treatment protocols, aspects of patient safety, and evidence-based problem-solving exercises. In this role as educators, hospitalists facilitate team building. They instruct students in an optimal learning environment, provide feedback, and promote independent thinking. They model efficient clinical decision-making and communication skills during physician-patient encounters. Hospitalists must attend to the learning needs of a generation of medical trainees that has an affinity for technology, interaction, and group-based learning, while also operating in an environment of restricted resident work hours. The hospitalist as educator core competency is essential to effecting organizational excellence. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the role of the hospitalist as an educator.

• Describe adult education principles.

• Explain factors that may facilitate or inhibit learning.

• Define the concept of a teachable moment.

• Describe the benefits and limitations of various teaching modalities.

• Identify resources for training materials.

• Describe the process of developing a formal educational session, including performing a needs assessment, determining teaching goals and objectives, developing teaching materials and activities, and evaluating a learner’s comprehension of the target material.

• Describe practical steps for delivering dynamic presentations for multiple venues, including bedside teaching to trainees, small group discussions with coworkers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.

• Describe models for clinical teaching (eg, the “microskills” model).

• Explain the process of applying competencies to curricular development.

Hospitalists should be able to:

• Establish a comfortable and safe learning environment.

• Establish expectations for each teaching session and clearly articulate the objectives.

• Determine the information needs of the intended recipient and tailor messages to the needs, abilities, and preferences of the intended recipient.

• Effectively assess learners’ progress towards the goals of the teaching session.

• Frame educational interventions in a manner that sets up trainees for success.

• Provide prompt, explicit, and action-oriented feedback in a manner conducive to self-improvement.

• Facilitate learners’ self-assessment of comprehension of target information and development of plans for further self-education.

• Promote evaluation standards that are fair and facilitate personal and professional development.

• Instruct at the level of learners’ experience and knowledge and accommodate for learners at different levels.

• Seek feedback on the effectiveness of instruction methods, modalities, and materials.

• Encourage and provide tools for lifelong, self-directed learning and clinical problem-solving.

• Structure the timing and delivery of information and learning experiences to maximize comprehension.

• Use adult learning principles in the development or selection of educational programs, methods, and materials.

• Promote the effective use of the “teachable moment” in the education of patients, students, and healthcare professionals.

• Use explicit and accessible language to explain clinical decision-making to learners.

• Make the clinical reasoning process understandable, explicit, and relevant to learners.

• Promote efficient, up-to-date clinical problem-solving during every patient encounter.

• Model the integration of quality initiatives and patient feedback into clinical decision-making.

• Provide bedside teaching that is informative and comfortable for patients, trainees, and members of the multidisciplinary care team.

• Demonstrate effective mentoring, including role modeling and active feedback techniques.

• Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the performance of the procedure, and necessary follow-up.

• Lead, coordinate, and/or participate in efforts to formulate a needs assessment program for hospitalists’ continued professional development.

• Lead, coordinate, and/or participate in educational scholarship. 

Hospitalists should be able to:

• Project enthusiasm for the teaching role.

• Respect learners from all backgrounds, knowledge, and skill levels.

• Promote an atmosphere of cooperation among patients, trainees, and multidisciplinary team members.

• Advocate the importance of lifelong learning and mentorship.

• Advocate the dual role of all healthcare professionals as simultaneous educators and students.

• Balance patient care and teaching regarding relevant time constraints.

• Promote an organizational environment in which knowledge deficiencies are identified and targeted.

• Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.

• Admit the limitations of one’s knowledge and respond appropriately to mistakes.

• Reflect on teaching moments to identify opportunities for improvement.

• Promote evidence-based information acquisition and clinical decision-making.

• Use the role of the “hospitalist as educator” to lead, coordinate, and/or participate in performance improvement initiatives.

Information management refers to the acquisition and use of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal workflow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computerized provider order entry (CPOE), event monitoring, electronic charting, and bar coding. Successful information management may have positive effects on quality of care, including patient safety, effectiveness, and efficiency. For example, CPOE has been shown to reduce prescribing errors by 48%, and an electronic health record combined with clinical decision support tools reduces the ordering of redundant tests.^1-4 Hospitalists use local systems to acquire data and information that support optimal medical decision-making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, use, and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the use of hospital information systems by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe the process to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators, and practice guidelines to support optimal patient care.

• Describe information systems that can facilitate the practice of evidence-based medical decision-making.

• Explain the impact of CPOE with decision support on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include cardiac or bedside monitors, glucometers, and pulse oximeters.

• Access and interpret information from internet-based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

• Recognize the limitations of acquisition devices or equipment and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework. 

Hospitalists should be able to:

• Adhere to principles of data integrity, security, and confidentiality.

• Adhere to principles of professionalism and avoid “cut and paste” plagiarism within one’s own electronic medical documentation.

• Advocate for information decision support to facilitate efficient and optimal medical management.

Information management refers to the acquisition and use of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal workflow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computerized provider order entry (CPOE), event monitoring, electronic charting, and bar coding. Successful information management may have positive effects on quality of care, including patient safety, effectiveness, and efficiency. For example, CPOE has been shown to reduce prescribing errors by 48%, and an electronic health record combined with clinical decision support tools reduces the ordering of redundant tests.^1-4 Hospitalists use local systems to acquire data and information that support optimal medical decision-making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, use, and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the use of hospital information systems by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe the process to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators, and practice guidelines to support optimal patient care.

• Describe information systems that can facilitate the practice of evidence-based medical decision-making.

• Explain the impact of CPOE with decision support on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include cardiac or bedside monitors, glucometers, and pulse oximeters.

• Access and interpret information from internet-based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

• Recognize the limitations of acquisition devices or equipment and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework. 

Hospitalists should be able to:

• Adhere to principles of data integrity, security, and confidentiality.

• Adhere to principles of professionalism and avoid “cut and paste” plagiarism within one’s own electronic medical documentation.

• Advocate for information decision support to facilitate efficient and optimal medical management.

Information management refers to the acquisition and use of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal workflow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computerized provider order entry (CPOE), event monitoring, electronic charting, and bar coding. Successful information management may have positive effects on quality of care, including patient safety, effectiveness, and efficiency. For example, CPOE has been shown to reduce prescribing errors by 48%, and an electronic health record combined with clinical decision support tools reduces the ordering of redundant tests.^1-4 Hospitalists use local systems to acquire data and information that support optimal medical decision-making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, use, and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the use of hospital information systems by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe the process to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators, and practice guidelines to support optimal patient care.

• Describe information systems that can facilitate the practice of evidence-based medical decision-making.

• Explain the impact of CPOE with decision support on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include cardiac or bedside monitors, glucometers, and pulse oximeters.

• Access and interpret information from internet-based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

• Recognize the limitations of acquisition devices or equipment and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework. 

Hospitalists should be able to:

• Adhere to principles of data integrity, security, and confidentiality.

• Adhere to principles of professionalism and avoid “cut and paste” plagiarism within one’s own electronic medical documentation.

• Advocate for information decision support to facilitate efficient and optimal medical management.

Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Distinguish between management and leadership.

• Describe hospitalist responsibilities and opportunities to provide active leadership.

• Explain the attributes and effects of modeling positive and negative behaviors.

• Explain the importance of finding mentor(s) and serving as a mentor.

• Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.

• Describe the key elements of a message.

• Name the key elements of strategic planning processes.

• Explain factors that predict the success or failure of strategic plans.

• Describe styles of leadership.

• Explain the attributes of effective leadership.

• Articulate the business and financial motivators that affect decision-making.

• Explain the specific factors that effect positive change.

• Explain effective negotiation and conflict resolution techniques.b.

Hospitalists should be able to:

• Tailor messages to specific target audiences.

• Develop effective communication skills using multiple modalities.

• Plan and conduct an effective meeting.

• Construct program mission and vision statements.

• Develop personal, team, and program goals and identify indicators of achievement.

• Establish, measure, and report key performance metrics.

• Use established metrics to assess progress and set new goals for performance and outcomes.

• Analyze personal leadership style.

• Demonstrate the ability to effectively work with colleagues who have various leadership styles.

• Develop budgets to support goals using accepted financial principles.

• Translate performance into measurable financial outcomes.

• Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.

• Demonstrate effective and creative problem-solving techniques.

• Resolve conflicts with specific negotiation techniques.

• Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.

• Advocate for financial and other resources needed to support goals and initiatives. 

Hospitalists should be able to:

• Lead by example.

• Practice active listening techniques.

• Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.

• Recognize the importance and influence of positive role modeling.

• Assess and address personal leadership strengths and weaknesses.

• Seek and participate in opportunities for professional development.

• Exemplify professionalism.

• Accept responsibility and accountability for management decisions.

• Build consensus in support of key decisions.

Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Distinguish between management and leadership.

• Describe hospitalist responsibilities and opportunities to provide active leadership.

• Explain the attributes and effects of modeling positive and negative behaviors.

• Explain the importance of finding mentor(s) and serving as a mentor.

• Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.

• Describe the key elements of a message.

• Name the key elements of strategic planning processes.

• Explain factors that predict the success or failure of strategic plans.

• Describe styles of leadership.

• Explain the attributes of effective leadership.

• Articulate the business and financial motivators that affect decision-making.

• Explain the specific factors that effect positive change.

• Explain effective negotiation and conflict resolution techniques.b.

Hospitalists should be able to:

• Tailor messages to specific target audiences.

• Develop effective communication skills using multiple modalities.

• Plan and conduct an effective meeting.

• Construct program mission and vision statements.

• Develop personal, team, and program goals and identify indicators of achievement.

• Establish, measure, and report key performance metrics.

• Use established metrics to assess progress and set new goals for performance and outcomes.

• Analyze personal leadership style.

• Demonstrate the ability to effectively work with colleagues who have various leadership styles.

• Develop budgets to support goals using accepted financial principles.

• Translate performance into measurable financial outcomes.

• Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.

• Demonstrate effective and creative problem-solving techniques.

• Resolve conflicts with specific negotiation techniques.

• Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.

• Advocate for financial and other resources needed to support goals and initiatives. 

Hospitalists should be able to:

• Lead by example.

• Practice active listening techniques.

• Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.

• Recognize the importance and influence of positive role modeling.

• Assess and address personal leadership strengths and weaknesses.

• Seek and participate in opportunities for professional development.

• Exemplify professionalism.

• Accept responsibility and accountability for management decisions.

• Build consensus in support of key decisions.

Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Distinguish between management and leadership.

• Describe hospitalist responsibilities and opportunities to provide active leadership.

• Explain the attributes and effects of modeling positive and negative behaviors.

• Explain the importance of finding mentor(s) and serving as a mentor.

• Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.

• Describe the key elements of a message.

• Name the key elements of strategic planning processes.

• Explain factors that predict the success or failure of strategic plans.

• Describe styles of leadership.

• Explain the attributes of effective leadership.

• Articulate the business and financial motivators that affect decision-making.

• Explain the specific factors that effect positive change.

• Explain effective negotiation and conflict resolution techniques.b.

Hospitalists should be able to:

• Tailor messages to specific target audiences.

• Develop effective communication skills using multiple modalities.

• Plan and conduct an effective meeting.

• Construct program mission and vision statements.

• Develop personal, team, and program goals and identify indicators of achievement.

• Establish, measure, and report key performance metrics.

• Use established metrics to assess progress and set new goals for performance and outcomes.

• Analyze personal leadership style.

• Demonstrate the ability to effectively work with colleagues who have various leadership styles.

• Develop budgets to support goals using accepted financial principles.

• Translate performance into measurable financial outcomes.

• Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.

• Demonstrate effective and creative problem-solving techniques.

• Resolve conflicts with specific negotiation techniques.

• Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.

• Advocate for financial and other resources needed to support goals and initiatives. 

Hospitalists should be able to:

• Lead by example.

• Practice active listening techniques.

• Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.

• Recognize the importance and influence of positive role modeling.

• Assess and address personal leadership strengths and weaknesses.

• Seek and participate in opportunities for professional development.

• Exemplify professionalism.

• Accept responsibility and accountability for management decisions.

• Build consensus in support of key decisions.