Rebecca Harrison, MD

The structure and function of academic hospital medicine programs (AHPs) has evolved significantly with the growth of hospital medicine.[1, 2, 3, 4] Many AHPs formed in response to regulatory and financial changes, which drove demand for increased trainee oversight, improved clinical efficiency, and growth in nonteaching services staffed by hospitalists. Differences in local organizational contexts and needs have contributed to great variability in AHP program design and operations. As AHPs have become more established, the need to engage academic hospitalists in scholarship and activities that support professional development and promotion has been recognized. Defining sustainable and successful positions for academic hospitalists is a priority called for by leaders in the field.[5, 6]

In this rapidly evolving context, AHPs have employed a variety of approaches to organizing clinical and academic faculty roles, without guiding evidence or consensus‐based performance benchmarks. A number of AHPs have achieved success along traditional academic metrics of research, scholarship, and education. Currently, it is not known whether specific approaches to AHP organization, structure, or definition of faculty roles are associated with achievement of more traditional markers of academic success.

The Academic Committee of the Society of Hospital Medicine (SHM), and the Academic Hospitalist Task Force of the Society of General Internal Medicine (SGIM) had separately initiated projects to explore characteristics associated with success in AHPs. In 2012, these organizations combined efforts to jointly develop and implement the SCHOLAR (SuCcessful HOspitaLists in Academics and Research) project. The goals were to identify successful AHPs using objective criteria, and to then study those groups in greater detail to generate insights that would be broadly relevant to the field. Efforts to clarify the factors within AHPs linked to success by traditional academic metrics will benefit hospitalists, their leaders, and key stakeholders striving to achieve optimal balance between clinical and academic roles. We describe the initial work of the SCHOLAR project, our definitions of academic success in AHPs, and the characteristics of a cohort of exemplary AHPs who achieved the highest levels on these metrics.

METHODS

RESULTS

Faculty Promotion

Figure 1 demonstrates the proportion of faculty at various academic ranks. The percent of faculty above the rank of assistant professor in the SCHOLAR programs exceeded those in the overall LAHP‐50 by 5% (17.9% vs 12.8%, P = 0.01). Of note, 6% of the hospitalists at AHPs in the SCHOLAR programs were on nonfaculty tracks.

Figure 1

DISCUSSION

Using a definition of academic success that incorporated metrics of grant funding, faculty promotion, and scholarly output, we identified a unique subset of successful AHPsthe SCHOLAR cohort. The programs represented in the SCHOLAR cohort were generally large and relatively mature. Despite this, the cohort consisted of mostly junior faculty, had a paucity of fellowship‐trained hospitalists, and not all reported grant funding.

Prior published work reported complementary findings.[6, 8, 9] A survey of 20 large, well‐established academic hospitalist programs in 2008 found that the majority of hospitalists were junior faculty with a limited publication portfolio. Of the 266 respondents in that study, 86% reported an academic rank at or below assistant professor; funding was not explored.[9] Our similar findings 4 years later add to this work by demonstrating trends over time, and suggest that progress toward creating successful pathways for academic advancement has been slow. In a 2012 survey of the SHM membership, 28% of hospitalists with academic appointments reported no current or future plans to engage in research.[8] These findings suggest that faculty in AHPs may define scholarship through nontraditional pathways, or in some cases choose not to pursue or prioritize scholarship altogether.

Our findings also add to the literature with regard to our assessment of funding, which was variable across the SCHOLAR group. The broad range of funding in the SCHOLAR programs for which we have data (grant dollars $0$15 million per program) suggests that opportunities to improve supported scholarship remain, even among a selected cohort of successful AHPs. The predominance of junior faculty in the SCHOLAR programs may be a reason for this variation. Junior faculty may be engaged in research with funding directed to senior mentors outside their AHP. Alternatively, they may pursue meaningful local hospital quality improvement or educational innovations not supported by external grants, or hold leadership roles in education, quality, or information technology that allow for advancement and promotion without external grant funding. As the scope and impact of these roles increases, senior leaders with alternate sources of support may rely less on research funds; this too may explain some of the differences. Our findings are congruent with results of a study that reviewed original research published by hospitalists, and concluded that the majority of hospitalist research was not externally funded.[8] Our approach for assessing grant funding by adjusting for FTE had the potential to inadvertently favor smaller well‐funded groups over larger ones; however, programs in our sample were similarly represented when ranked by funding/FTE or total grant dollars. As many successful AHPs do concentrate their research funding among a core of focused hospitalist researchers, our definition may not be the ideal metric for some programs.

We chose to define scholarship based on abstract output, rather than peer‐reviewed publications. Although this choice was necessary from a feasibility perspective, it may have excluded programs that prioritize peer‐reviewed publications over abstracts. Although we were unable to incorporate a search strategy to accurately and comprehensively track the publication output attributed specifically to hospitalist researchers and quantify it by program, others have since defined such an approach.[8] However, tracking abstracts theoretically allowed insights into a larger volume of innovative and creative work generated by top AHPs by potentially including work in the earlier stages of development.

We used a consensus‐based definition of success to define our SCHOLAR cohort. There are other ways to measure academic success, which if applied, may have yielded a different sample of programs. For example, over half of the original research articles published in the Journal of Hospital Medicine over a 7‐year span were generated from 5 academic centers.[8] This definition of success may be equally credible, though we note that 4 of these 5 programs were also included in the SCHOLAR cohort. We feel our broader approach was more reflective of the variety of pathways to success available to academic hospitalists. Before our metrics are applied as a benchmarking tool, however, they should ideally be combined with factors not measured in our study to ensure a more comprehensive or balanced reflection of academic success. Factors such as mentorship, level of hospitalist engagement,[10] prevalence of leadership opportunities, operational and fiscal infrastructure, and the impact of local quality, safety, and value efforts should be considered.

Comparison of successfully promoted faculty at AHPs across the country is inherently limited by the wide variation in promotion standards across different institutions; controlling for such differences was not possible with our methodology. For example, it appears that several programs with relatively few senior faculty may have met metrics leading to their inclusion in the SCHOLAR group because of their small program size. Future benchmarking efforts for promotion at AHPs should take scaling into account and consider both total number as well as percentage of senior faculty when evaluating success.

Our methodology has several limitations. Survey data were self‐reported and not independently validated, and as such are subject to recall and reporting biases. Response bias inherently excluded some AHPs that may have met our grant funding or promotions criteria had they participated in the initial LAHP‐50 survey, though we identified and included additional programs through our scholarship metric, increasing the representativeness of the SCHOLAR cohort. Given the dynamic nature of the field, the age of the data we relied upon for analysis limits the generalizability of our specific benchmarks to current practice. However, the development of academic success occurs over the long‐term, and published data on academic hospitalist productivity are consistent with this slower time course.[8] Despite these limitations, our data inform the general topic of gauging performance of AHPs, underscoring the challenges of developing and applying metrics of success, and highlight the variability of performance on selected metrics even among a relatively small group of 17 programs.

In conclusion, we have created a method to quantify academic success that may be useful to academic hospitalists and their group leaders as they set targets for improvement in the field. Even among our SCHOLAR cohort, room for ongoing improvement in development of funded scholarship and a core of senior faculty exists. Further investigation into the unique features of successful groups will offer insight to leaders in academic hospital medicine regarding infrastructure and processes that should be embraced to raise the bar for all AHPs. In addition, efforts to further define and validate nontraditional approaches to scholarship that allow for successful promotion at AHPs would be informative. We view our work less as a singular approach to benchmarking standards for AHPs, and more a call to action to continue efforts to balance scholarly activity and broad professional development of academic hospitalists with increasing clinical demands.

The structure and function of academic hospital medicine programs (AHPs) has evolved significantly with the growth of hospital medicine.[1, 2, 3, 4] Many AHPs formed in response to regulatory and financial changes, which drove demand for increased trainee oversight, improved clinical efficiency, and growth in nonteaching services staffed by hospitalists. Differences in local organizational contexts and needs have contributed to great variability in AHP program design and operations. As AHPs have become more established, the need to engage academic hospitalists in scholarship and activities that support professional development and promotion has been recognized. Defining sustainable and successful positions for academic hospitalists is a priority called for by leaders in the field.[5, 6]

In this rapidly evolving context, AHPs have employed a variety of approaches to organizing clinical and academic faculty roles, without guiding evidence or consensus‐based performance benchmarks. A number of AHPs have achieved success along traditional academic metrics of research, scholarship, and education. Currently, it is not known whether specific approaches to AHP organization, structure, or definition of faculty roles are associated with achievement of more traditional markers of academic success.

The Academic Committee of the Society of Hospital Medicine (SHM), and the Academic Hospitalist Task Force of the Society of General Internal Medicine (SGIM) had separately initiated projects to explore characteristics associated with success in AHPs. In 2012, these organizations combined efforts to jointly develop and implement the SCHOLAR (SuCcessful HOspitaLists in Academics and Research) project. The goals were to identify successful AHPs using objective criteria, and to then study those groups in greater detail to generate insights that would be broadly relevant to the field. Efforts to clarify the factors within AHPs linked to success by traditional academic metrics will benefit hospitalists, their leaders, and key stakeholders striving to achieve optimal balance between clinical and academic roles. We describe the initial work of the SCHOLAR project, our definitions of academic success in AHPs, and the characteristics of a cohort of exemplary AHPs who achieved the highest levels on these metrics.

METHODS

RESULTS

Faculty Promotion

Figure 1 demonstrates the proportion of faculty at various academic ranks. The percent of faculty above the rank of assistant professor in the SCHOLAR programs exceeded those in the overall LAHP‐50 by 5% (17.9% vs 12.8%, P = 0.01). Of note, 6% of the hospitalists at AHPs in the SCHOLAR programs were on nonfaculty tracks.

Figure 1

DISCUSSION

Using a definition of academic success that incorporated metrics of grant funding, faculty promotion, and scholarly output, we identified a unique subset of successful AHPsthe SCHOLAR cohort. The programs represented in the SCHOLAR cohort were generally large and relatively mature. Despite this, the cohort consisted of mostly junior faculty, had a paucity of fellowship‐trained hospitalists, and not all reported grant funding.

Prior published work reported complementary findings.[6, 8, 9] A survey of 20 large, well‐established academic hospitalist programs in 2008 found that the majority of hospitalists were junior faculty with a limited publication portfolio. Of the 266 respondents in that study, 86% reported an academic rank at or below assistant professor; funding was not explored.[9] Our similar findings 4 years later add to this work by demonstrating trends over time, and suggest that progress toward creating successful pathways for academic advancement has been slow. In a 2012 survey of the SHM membership, 28% of hospitalists with academic appointments reported no current or future plans to engage in research.[8] These findings suggest that faculty in AHPs may define scholarship through nontraditional pathways, or in some cases choose not to pursue or prioritize scholarship altogether.

Our findings also add to the literature with regard to our assessment of funding, which was variable across the SCHOLAR group. The broad range of funding in the SCHOLAR programs for which we have data (grant dollars $0$15 million per program) suggests that opportunities to improve supported scholarship remain, even among a selected cohort of successful AHPs. The predominance of junior faculty in the SCHOLAR programs may be a reason for this variation. Junior faculty may be engaged in research with funding directed to senior mentors outside their AHP. Alternatively, they may pursue meaningful local hospital quality improvement or educational innovations not supported by external grants, or hold leadership roles in education, quality, or information technology that allow for advancement and promotion without external grant funding. As the scope and impact of these roles increases, senior leaders with alternate sources of support may rely less on research funds; this too may explain some of the differences. Our findings are congruent with results of a study that reviewed original research published by hospitalists, and concluded that the majority of hospitalist research was not externally funded.[8] Our approach for assessing grant funding by adjusting for FTE had the potential to inadvertently favor smaller well‐funded groups over larger ones; however, programs in our sample were similarly represented when ranked by funding/FTE or total grant dollars. As many successful AHPs do concentrate their research funding among a core of focused hospitalist researchers, our definition may not be the ideal metric for some programs.

We chose to define scholarship based on abstract output, rather than peer‐reviewed publications. Although this choice was necessary from a feasibility perspective, it may have excluded programs that prioritize peer‐reviewed publications over abstracts. Although we were unable to incorporate a search strategy to accurately and comprehensively track the publication output attributed specifically to hospitalist researchers and quantify it by program, others have since defined such an approach.[8] However, tracking abstracts theoretically allowed insights into a larger volume of innovative and creative work generated by top AHPs by potentially including work in the earlier stages of development.

We used a consensus‐based definition of success to define our SCHOLAR cohort. There are other ways to measure academic success, which if applied, may have yielded a different sample of programs. For example, over half of the original research articles published in the Journal of Hospital Medicine over a 7‐year span were generated from 5 academic centers.[8] This definition of success may be equally credible, though we note that 4 of these 5 programs were also included in the SCHOLAR cohort. We feel our broader approach was more reflective of the variety of pathways to success available to academic hospitalists. Before our metrics are applied as a benchmarking tool, however, they should ideally be combined with factors not measured in our study to ensure a more comprehensive or balanced reflection of academic success. Factors such as mentorship, level of hospitalist engagement,[10] prevalence of leadership opportunities, operational and fiscal infrastructure, and the impact of local quality, safety, and value efforts should be considered.

Comparison of successfully promoted faculty at AHPs across the country is inherently limited by the wide variation in promotion standards across different institutions; controlling for such differences was not possible with our methodology. For example, it appears that several programs with relatively few senior faculty may have met metrics leading to their inclusion in the SCHOLAR group because of their small program size. Future benchmarking efforts for promotion at AHPs should take scaling into account and consider both total number as well as percentage of senior faculty when evaluating success.

Our methodology has several limitations. Survey data were self‐reported and not independently validated, and as such are subject to recall and reporting biases. Response bias inherently excluded some AHPs that may have met our grant funding or promotions criteria had they participated in the initial LAHP‐50 survey, though we identified and included additional programs through our scholarship metric, increasing the representativeness of the SCHOLAR cohort. Given the dynamic nature of the field, the age of the data we relied upon for analysis limits the generalizability of our specific benchmarks to current practice. However, the development of academic success occurs over the long‐term, and published data on academic hospitalist productivity are consistent with this slower time course.[8] Despite these limitations, our data inform the general topic of gauging performance of AHPs, underscoring the challenges of developing and applying metrics of success, and highlight the variability of performance on selected metrics even among a relatively small group of 17 programs.

In conclusion, we have created a method to quantify academic success that may be useful to academic hospitalists and their group leaders as they set targets for improvement in the field. Even among our SCHOLAR cohort, room for ongoing improvement in development of funded scholarship and a core of senior faculty exists. Further investigation into the unique features of successful groups will offer insight to leaders in academic hospital medicine regarding infrastructure and processes that should be embraced to raise the bar for all AHPs. In addition, efforts to further define and validate nontraditional approaches to scholarship that allow for successful promotion at AHPs would be informative. We view our work less as a singular approach to benchmarking standards for AHPs, and more a call to action to continue efforts to balance scholarly activity and broad professional development of academic hospitalists with increasing clinical demands.

The structure and function of academic hospital medicine programs (AHPs) has evolved significantly with the growth of hospital medicine.[1, 2, 3, 4] Many AHPs formed in response to regulatory and financial changes, which drove demand for increased trainee oversight, improved clinical efficiency, and growth in nonteaching services staffed by hospitalists. Differences in local organizational contexts and needs have contributed to great variability in AHP program design and operations. As AHPs have become more established, the need to engage academic hospitalists in scholarship and activities that support professional development and promotion has been recognized. Defining sustainable and successful positions for academic hospitalists is a priority called for by leaders in the field.[5, 6]

In this rapidly evolving context, AHPs have employed a variety of approaches to organizing clinical and academic faculty roles, without guiding evidence or consensus‐based performance benchmarks. A number of AHPs have achieved success along traditional academic metrics of research, scholarship, and education. Currently, it is not known whether specific approaches to AHP organization, structure, or definition of faculty roles are associated with achievement of more traditional markers of academic success.

The Academic Committee of the Society of Hospital Medicine (SHM), and the Academic Hospitalist Task Force of the Society of General Internal Medicine (SGIM) had separately initiated projects to explore characteristics associated with success in AHPs. In 2012, these organizations combined efforts to jointly develop and implement the SCHOLAR (SuCcessful HOspitaLists in Academics and Research) project. The goals were to identify successful AHPs using objective criteria, and to then study those groups in greater detail to generate insights that would be broadly relevant to the field. Efforts to clarify the factors within AHPs linked to success by traditional academic metrics will benefit hospitalists, their leaders, and key stakeholders striving to achieve optimal balance between clinical and academic roles. We describe the initial work of the SCHOLAR project, our definitions of academic success in AHPs, and the characteristics of a cohort of exemplary AHPs who achieved the highest levels on these metrics.

METHODS

RESULTS

Faculty Promotion

Figure 1 demonstrates the proportion of faculty at various academic ranks. The percent of faculty above the rank of assistant professor in the SCHOLAR programs exceeded those in the overall LAHP‐50 by 5% (17.9% vs 12.8%, P = 0.01). Of note, 6% of the hospitalists at AHPs in the SCHOLAR programs were on nonfaculty tracks.

Figure 1

DISCUSSION

Using a definition of academic success that incorporated metrics of grant funding, faculty promotion, and scholarly output, we identified a unique subset of successful AHPsthe SCHOLAR cohort. The programs represented in the SCHOLAR cohort were generally large and relatively mature. Despite this, the cohort consisted of mostly junior faculty, had a paucity of fellowship‐trained hospitalists, and not all reported grant funding.

Prior published work reported complementary findings.[6, 8, 9] A survey of 20 large, well‐established academic hospitalist programs in 2008 found that the majority of hospitalists were junior faculty with a limited publication portfolio. Of the 266 respondents in that study, 86% reported an academic rank at or below assistant professor; funding was not explored.[9] Our similar findings 4 years later add to this work by demonstrating trends over time, and suggest that progress toward creating successful pathways for academic advancement has been slow. In a 2012 survey of the SHM membership, 28% of hospitalists with academic appointments reported no current or future plans to engage in research.[8] These findings suggest that faculty in AHPs may define scholarship through nontraditional pathways, or in some cases choose not to pursue or prioritize scholarship altogether.

Our findings also add to the literature with regard to our assessment of funding, which was variable across the SCHOLAR group. The broad range of funding in the SCHOLAR programs for which we have data (grant dollars $0$15 million per program) suggests that opportunities to improve supported scholarship remain, even among a selected cohort of successful AHPs. The predominance of junior faculty in the SCHOLAR programs may be a reason for this variation. Junior faculty may be engaged in research with funding directed to senior mentors outside their AHP. Alternatively, they may pursue meaningful local hospital quality improvement or educational innovations not supported by external grants, or hold leadership roles in education, quality, or information technology that allow for advancement and promotion without external grant funding. As the scope and impact of these roles increases, senior leaders with alternate sources of support may rely less on research funds; this too may explain some of the differences. Our findings are congruent with results of a study that reviewed original research published by hospitalists, and concluded that the majority of hospitalist research was not externally funded.[8] Our approach for assessing grant funding by adjusting for FTE had the potential to inadvertently favor smaller well‐funded groups over larger ones; however, programs in our sample were similarly represented when ranked by funding/FTE or total grant dollars. As many successful AHPs do concentrate their research funding among a core of focused hospitalist researchers, our definition may not be the ideal metric for some programs.

We chose to define scholarship based on abstract output, rather than peer‐reviewed publications. Although this choice was necessary from a feasibility perspective, it may have excluded programs that prioritize peer‐reviewed publications over abstracts. Although we were unable to incorporate a search strategy to accurately and comprehensively track the publication output attributed specifically to hospitalist researchers and quantify it by program, others have since defined such an approach.[8] However, tracking abstracts theoretically allowed insights into a larger volume of innovative and creative work generated by top AHPs by potentially including work in the earlier stages of development.

We used a consensus‐based definition of success to define our SCHOLAR cohort. There are other ways to measure academic success, which if applied, may have yielded a different sample of programs. For example, over half of the original research articles published in the Journal of Hospital Medicine over a 7‐year span were generated from 5 academic centers.[8] This definition of success may be equally credible, though we note that 4 of these 5 programs were also included in the SCHOLAR cohort. We feel our broader approach was more reflective of the variety of pathways to success available to academic hospitalists. Before our metrics are applied as a benchmarking tool, however, they should ideally be combined with factors not measured in our study to ensure a more comprehensive or balanced reflection of academic success. Factors such as mentorship, level of hospitalist engagement,[10] prevalence of leadership opportunities, operational and fiscal infrastructure, and the impact of local quality, safety, and value efforts should be considered.

Comparison of successfully promoted faculty at AHPs across the country is inherently limited by the wide variation in promotion standards across different institutions; controlling for such differences was not possible with our methodology. For example, it appears that several programs with relatively few senior faculty may have met metrics leading to their inclusion in the SCHOLAR group because of their small program size. Future benchmarking efforts for promotion at AHPs should take scaling into account and consider both total number as well as percentage of senior faculty when evaluating success.

Our methodology has several limitations. Survey data were self‐reported and not independently validated, and as such are subject to recall and reporting biases. Response bias inherently excluded some AHPs that may have met our grant funding or promotions criteria had they participated in the initial LAHP‐50 survey, though we identified and included additional programs through our scholarship metric, increasing the representativeness of the SCHOLAR cohort. Given the dynamic nature of the field, the age of the data we relied upon for analysis limits the generalizability of our specific benchmarks to current practice. However, the development of academic success occurs over the long‐term, and published data on academic hospitalist productivity are consistent with this slower time course.[8] Despite these limitations, our data inform the general topic of gauging performance of AHPs, underscoring the challenges of developing and applying metrics of success, and highlight the variability of performance on selected metrics even among a relatively small group of 17 programs.

In conclusion, we have created a method to quantify academic success that may be useful to academic hospitalists and their group leaders as they set targets for improvement in the field. Even among our SCHOLAR cohort, room for ongoing improvement in development of funded scholarship and a core of senior faculty exists. Further investigation into the unique features of successful groups will offer insight to leaders in academic hospital medicine regarding infrastructure and processes that should be embraced to raise the bar for all AHPs. In addition, efforts to further define and validate nontraditional approaches to scholarship that allow for successful promotion at AHPs would be informative. We view our work less as a singular approach to benchmarking standards for AHPs, and more a call to action to continue efforts to balance scholarly activity and broad professional development of academic hospitalists with increasing clinical demands.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) announced the first in a series of guidelines related to the regulation and oversight of residency training.1 The initial iteration specifically focused on the total and consecutive numbers of duty hours worked by trainees. These limitations began a new era of shift work in internal medicine residency training. With decreases in housestaff admitting capacity, clinical work has frequently been offloaded to non‐teaching or attending‐only services, increasing the demand for hospitalists to fill the void in physician‐staffed care in the hospital.2, 3 Since the implementation of the 2003 ACGME guidelines and a growing focus on patient safety, there has been increased study of, and call for, oversight of trainees in medicine; among these was the 2008 Institute of Medicine report,4 calling for 24/7 attending‐level supervision. The updated ACGME requirements,5 effective July 1, 2011, mandate enhanced on‐site supervision of trainee physicians. These new regulations not only define varying levels of supervision for trainees, including direct supervision with the physical presence of a supervisor and the degree of availability of said supervisor, they also describe ensuring the quality of supervision provided.5 While continuous attending‐level supervision is not yet mandated, many residency programs look to their academic hospitalists to fill the supervisory void, particularly at night. However, what specific roles hospitalists play in the nighttime supervision of trainees or the impact of this supervision remains unclear. To date, no study has examined a broad sample of hospitalist programs in teaching hospitals and the types of resident oversight they provide. We aimed to describe the current state of academic hospitalists in the clinical supervision of housestaff, specifically during the overnight period, and hospitalist perceptions of how the new ACGME requirements would impact traineehospitalist interactions.

METHODS

The Housestaff Oversight Subcommittee, a working group of the Society of General Internal Medicine (SGIM) Academic Hospitalist Task Force, surveyed a sample of academic hospitalist program leaders to assess the current status of trainee supervision performed by hospitalists. Programs were considered academic if they were located in the primary hospital of a residency that participates in the National Resident Matching Program for Internal Medicine. To obtain a broad geographic spectrum of academic hospitalist programs, all programs, both university and community‐based, in 4 states and 2 metropolitan regions were sampled: Washington, Oregon, Texas, Maryland, and the Philadelphia and Chicago metropolitan areas. Hospitalist program leaders were identified by members of the Taskforce using individual program websites and by querying departmental leadership at eligible teaching hospitals. Respondents were contacted by e‐mail for participation. None of the authors of the manuscript were participants in the survey.

The survey was developed by consensus of the working group after reviewing the salient literature and included additional questions queried to internal medicine program directors.6 The 19‐item SurveyMonkey instrument included questions about hospitalists' role in trainees' education and evaluation. A Likert‐type scale was used to assess perceptions regarding the impact of on‐site hospitalist supervision on trainee autonomy and hospitalist workload (1 = strongly disagree to 5 = strongly agree). Descriptive statistics were performed and, where appropriate, t test and Fisher's exact test were performed to identify associations between program characteristics and perceptions. Stata SE was used (STATA Corp, College Station, TX) for all statistical analysis.

RESULTS

The survey was sent to 47 individuals identified as likely hospitalist program leaders and completed by 41 individuals (87%). However, 7 respondents turned out not to be program leaders and were therefore excluded, resulting in a 72% (34/47) survey response rate.

The programs for which we did not obtain responses were similar to respondent programs, and did not include a larger proportion of community‐based programs or overrepresent a specific geographic region. Twenty‐five (73%) of the 34 hospitalist program leaders were male, with an average age of 44.3 years, and an average of 12 years post‐residency training (range, 530 years). They reported leading groups with an average of 18 full‐time equivalent (FTE) faculty (range, 350 persons).

DISCUSSION

This study provides important information about how academic hospitalists currently contribute to the supervision of internal medicine residents. While academic hospitalist groups frequently have faculty providing clinical care on‐site at night, and often hospitalists provide overnight supervision of internal medicine trainees, formal supervision of trainees is not uniform, and few hospitalists groups have a mechanism to provide training or faculty development on how to effectively supervise resident trainees. Hospitalist leaders expressed concerns that creating additional formal overnight supervisory responsibilities may add to an already burdened overnight hospitalist. Formalizing this supervisory role, including explicit role definitions and faculty training for trainee supervision, is necessary.

Though our sample size is small, we captured a diverse geographic range of both university and community‐based academic hospitalist programs by surveying group leaders in several distinct regions. We are unable to comment on differences between responding and non‐responding hospitalist programs, but there does not appear to be a systematic difference between these groups.

Our findings are consistent with work describing a lack of structured conceptual frameworks in effectively supervising trainees,7, 8 and also, at times, nebulous expectations for hospitalist faculty. We found that the existence of a formal supervisory policy within the associated residency program, as well as defined roles for hospitalists, increases the likelihood of positive perceptions of the new ACGME supervisory recommendations. However, the existence of these requirements does not mean that all programs are capable of following them. While additional discussion is required to best delineate a formal overnight hospitalist role in trainee supervision, clearly defining expectations for both faculty and trainees, and their interactions, may alleviate the struggles that exist in programs with ill‐defined roles for hospitalist faculty supervision. While faculty duty hours standards do not exist, additional duties of nighttime coverage for hospitalists suggests that close attention should be paid to burn‐out.9 Faculty development on nighttime supervision and teaching may help maximize both learning and patient care efficiency, and provide a framework for this often unstructured educational time.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) announced the first in a series of guidelines related to the regulation and oversight of residency training.1 The initial iteration specifically focused on the total and consecutive numbers of duty hours worked by trainees. These limitations began a new era of shift work in internal medicine residency training. With decreases in housestaff admitting capacity, clinical work has frequently been offloaded to non‐teaching or attending‐only services, increasing the demand for hospitalists to fill the void in physician‐staffed care in the hospital.2, 3 Since the implementation of the 2003 ACGME guidelines and a growing focus on patient safety, there has been increased study of, and call for, oversight of trainees in medicine; among these was the 2008 Institute of Medicine report,4 calling for 24/7 attending‐level supervision. The updated ACGME requirements,5 effective July 1, 2011, mandate enhanced on‐site supervision of trainee physicians. These new regulations not only define varying levels of supervision for trainees, including direct supervision with the physical presence of a supervisor and the degree of availability of said supervisor, they also describe ensuring the quality of supervision provided.5 While continuous attending‐level supervision is not yet mandated, many residency programs look to their academic hospitalists to fill the supervisory void, particularly at night. However, what specific roles hospitalists play in the nighttime supervision of trainees or the impact of this supervision remains unclear. To date, no study has examined a broad sample of hospitalist programs in teaching hospitals and the types of resident oversight they provide. We aimed to describe the current state of academic hospitalists in the clinical supervision of housestaff, specifically during the overnight period, and hospitalist perceptions of how the new ACGME requirements would impact traineehospitalist interactions.

METHODS

The Housestaff Oversight Subcommittee, a working group of the Society of General Internal Medicine (SGIM) Academic Hospitalist Task Force, surveyed a sample of academic hospitalist program leaders to assess the current status of trainee supervision performed by hospitalists. Programs were considered academic if they were located in the primary hospital of a residency that participates in the National Resident Matching Program for Internal Medicine. To obtain a broad geographic spectrum of academic hospitalist programs, all programs, both university and community‐based, in 4 states and 2 metropolitan regions were sampled: Washington, Oregon, Texas, Maryland, and the Philadelphia and Chicago metropolitan areas. Hospitalist program leaders were identified by members of the Taskforce using individual program websites and by querying departmental leadership at eligible teaching hospitals. Respondents were contacted by e‐mail for participation. None of the authors of the manuscript were participants in the survey.

The survey was developed by consensus of the working group after reviewing the salient literature and included additional questions queried to internal medicine program directors.6 The 19‐item SurveyMonkey instrument included questions about hospitalists' role in trainees' education and evaluation. A Likert‐type scale was used to assess perceptions regarding the impact of on‐site hospitalist supervision on trainee autonomy and hospitalist workload (1 = strongly disagree to 5 = strongly agree). Descriptive statistics were performed and, where appropriate, t test and Fisher's exact test were performed to identify associations between program characteristics and perceptions. Stata SE was used (STATA Corp, College Station, TX) for all statistical analysis.

RESULTS

The survey was sent to 47 individuals identified as likely hospitalist program leaders and completed by 41 individuals (87%). However, 7 respondents turned out not to be program leaders and were therefore excluded, resulting in a 72% (34/47) survey response rate.

The programs for which we did not obtain responses were similar to respondent programs, and did not include a larger proportion of community‐based programs or overrepresent a specific geographic region. Twenty‐five (73%) of the 34 hospitalist program leaders were male, with an average age of 44.3 years, and an average of 12 years post‐residency training (range, 530 years). They reported leading groups with an average of 18 full‐time equivalent (FTE) faculty (range, 350 persons).

DISCUSSION

This study provides important information about how academic hospitalists currently contribute to the supervision of internal medicine residents. While academic hospitalist groups frequently have faculty providing clinical care on‐site at night, and often hospitalists provide overnight supervision of internal medicine trainees, formal supervision of trainees is not uniform, and few hospitalists groups have a mechanism to provide training or faculty development on how to effectively supervise resident trainees. Hospitalist leaders expressed concerns that creating additional formal overnight supervisory responsibilities may add to an already burdened overnight hospitalist. Formalizing this supervisory role, including explicit role definitions and faculty training for trainee supervision, is necessary.

Though our sample size is small, we captured a diverse geographic range of both university and community‐based academic hospitalist programs by surveying group leaders in several distinct regions. We are unable to comment on differences between responding and non‐responding hospitalist programs, but there does not appear to be a systematic difference between these groups.

Our findings are consistent with work describing a lack of structured conceptual frameworks in effectively supervising trainees,7, 8 and also, at times, nebulous expectations for hospitalist faculty. We found that the existence of a formal supervisory policy within the associated residency program, as well as defined roles for hospitalists, increases the likelihood of positive perceptions of the new ACGME supervisory recommendations. However, the existence of these requirements does not mean that all programs are capable of following them. While additional discussion is required to best delineate a formal overnight hospitalist role in trainee supervision, clearly defining expectations for both faculty and trainees, and their interactions, may alleviate the struggles that exist in programs with ill‐defined roles for hospitalist faculty supervision. While faculty duty hours standards do not exist, additional duties of nighttime coverage for hospitalists suggests that close attention should be paid to burn‐out.9 Faculty development on nighttime supervision and teaching may help maximize both learning and patient care efficiency, and provide a framework for this often unstructured educational time.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) announced the first in a series of guidelines related to the regulation and oversight of residency training.1 The initial iteration specifically focused on the total and consecutive numbers of duty hours worked by trainees. These limitations began a new era of shift work in internal medicine residency training. With decreases in housestaff admitting capacity, clinical work has frequently been offloaded to non‐teaching or attending‐only services, increasing the demand for hospitalists to fill the void in physician‐staffed care in the hospital.2, 3 Since the implementation of the 2003 ACGME guidelines and a growing focus on patient safety, there has been increased study of, and call for, oversight of trainees in medicine; among these was the 2008 Institute of Medicine report,4 calling for 24/7 attending‐level supervision. The updated ACGME requirements,5 effective July 1, 2011, mandate enhanced on‐site supervision of trainee physicians. These new regulations not only define varying levels of supervision for trainees, including direct supervision with the physical presence of a supervisor and the degree of availability of said supervisor, they also describe ensuring the quality of supervision provided.5 While continuous attending‐level supervision is not yet mandated, many residency programs look to their academic hospitalists to fill the supervisory void, particularly at night. However, what specific roles hospitalists play in the nighttime supervision of trainees or the impact of this supervision remains unclear. To date, no study has examined a broad sample of hospitalist programs in teaching hospitals and the types of resident oversight they provide. We aimed to describe the current state of academic hospitalists in the clinical supervision of housestaff, specifically during the overnight period, and hospitalist perceptions of how the new ACGME requirements would impact traineehospitalist interactions.

METHODS

The Housestaff Oversight Subcommittee, a working group of the Society of General Internal Medicine (SGIM) Academic Hospitalist Task Force, surveyed a sample of academic hospitalist program leaders to assess the current status of trainee supervision performed by hospitalists. Programs were considered academic if they were located in the primary hospital of a residency that participates in the National Resident Matching Program for Internal Medicine. To obtain a broad geographic spectrum of academic hospitalist programs, all programs, both university and community‐based, in 4 states and 2 metropolitan regions were sampled: Washington, Oregon, Texas, Maryland, and the Philadelphia and Chicago metropolitan areas. Hospitalist program leaders were identified by members of the Taskforce using individual program websites and by querying departmental leadership at eligible teaching hospitals. Respondents were contacted by e‐mail for participation. None of the authors of the manuscript were participants in the survey.

The survey was developed by consensus of the working group after reviewing the salient literature and included additional questions queried to internal medicine program directors.6 The 19‐item SurveyMonkey instrument included questions about hospitalists' role in trainees' education and evaluation. A Likert‐type scale was used to assess perceptions regarding the impact of on‐site hospitalist supervision on trainee autonomy and hospitalist workload (1 = strongly disagree to 5 = strongly agree). Descriptive statistics were performed and, where appropriate, t test and Fisher's exact test were performed to identify associations between program characteristics and perceptions. Stata SE was used (STATA Corp, College Station, TX) for all statistical analysis.

RESULTS

The survey was sent to 47 individuals identified as likely hospitalist program leaders and completed by 41 individuals (87%). However, 7 respondents turned out not to be program leaders and were therefore excluded, resulting in a 72% (34/47) survey response rate.

The programs for which we did not obtain responses were similar to respondent programs, and did not include a larger proportion of community‐based programs or overrepresent a specific geographic region. Twenty‐five (73%) of the 34 hospitalist program leaders were male, with an average age of 44.3 years, and an average of 12 years post‐residency training (range, 530 years). They reported leading groups with an average of 18 full‐time equivalent (FTE) faculty (range, 350 persons).

DISCUSSION

This study provides important information about how academic hospitalists currently contribute to the supervision of internal medicine residents. While academic hospitalist groups frequently have faculty providing clinical care on‐site at night, and often hospitalists provide overnight supervision of internal medicine trainees, formal supervision of trainees is not uniform, and few hospitalists groups have a mechanism to provide training or faculty development on how to effectively supervise resident trainees. Hospitalist leaders expressed concerns that creating additional formal overnight supervisory responsibilities may add to an already burdened overnight hospitalist. Formalizing this supervisory role, including explicit role definitions and faculty training for trainee supervision, is necessary.

Though our sample size is small, we captured a diverse geographic range of both university and community‐based academic hospitalist programs by surveying group leaders in several distinct regions. We are unable to comment on differences between responding and non‐responding hospitalist programs, but there does not appear to be a systematic difference between these groups.

Our findings are consistent with work describing a lack of structured conceptual frameworks in effectively supervising trainees,7, 8 and also, at times, nebulous expectations for hospitalist faculty. We found that the existence of a formal supervisory policy within the associated residency program, as well as defined roles for hospitalists, increases the likelihood of positive perceptions of the new ACGME supervisory recommendations. However, the existence of these requirements does not mean that all programs are capable of following them. While additional discussion is required to best delineate a formal overnight hospitalist role in trainee supervision, clearly defining expectations for both faculty and trainees, and their interactions, may alleviate the struggles that exist in programs with ill‐defined roles for hospitalist faculty supervision. While faculty duty hours standards do not exist, additional duties of nighttime coverage for hospitalists suggests that close attention should be paid to burn‐out.9 Faculty development on nighttime supervision and teaching may help maximize both learning and patient care efficiency, and provide a framework for this often unstructured educational time.