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The SHM Nominating Committee is requesting nominations for three open seats on the Board of Directors for a three-year term, beginning May 2, 2006. In addition there will be one pediatric hospitalist seat on the SHM Board for a three-year term, beginning May 2, 2006. Pediatricians may submit their nomination for either the open seats or for the specific designated pediatric seat. All SHM members will vote in both the open and pediatric board elections.
Who is eligible to be nominated? Any SHM member in good standing who is:
- Board certified in their primary specialty;
- Available to travel to board meetings twice a year;
- Prepared to respond to e-mails on a daily basis and actively participate in board list serve;
- Willing to serve on SHM committees; and
- Able to commit to a three-year term, ending in 2009.
Candidates may self-nominate or may be nominated by another SHM member. Nominated candidates must submit the following materials for consideration on the board:
- A one-page curriculum vitae (CV) (12-point font size with 1” margins);
- A one-page nominating letter (12-point font size with 1” margins);
- A recent headshot; and
- An optional additional letter of support (one page, 12-point font size with 1” margins)—although these may not come from any current SHM board members. All letters should be addressed to Steven Pantilat, MD, chair, SHM Nominations Committee. Note: The letter of support is only for Nominations Committee use, but for those candidates who are on the election ballot, the CV, headshot, and the nominating letter will be sent as submitted to all voting members of SHM. Letters will be accepted by mail or e-mail only. No faxes accepted due to potential poor quality of transmission.
The criteria used when considering nominees for ballot include:
- Duration of SHM membership;
- Activity as a hospitalist;
- Activity in or contributions to SHM;
- Activity at a local or regional level;
- Prominence as a hospitalist;
- Ability to provide skills or experience not currently found on the board; and
- Ability to add to the diversity of the board.
Timeline
Some of the critical milestone dates for the board nomination process include the following:
October 31, 2005: Deadline for submitting candidates for nomination;
November 28, 2005: Ballots mailed to SHM members
January 5, 2006: Ballots must be received at SHM offices;
January 20, 2006: Notification of candidates of results of election;
January 23, 2006: Election results posted on SHM Web site;
May 2, 2006: Elected board members take office.
If you are interested in being considered as a nominee for the SHM Board, please submit your nomination materials by October 31, 2005, to the SHM Nominations Committee, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.
Questions? Send them via e-mail to nominations@hospitalmedicine.org or call (800) 843-3360.
Core Competencies Are Coming!
Hospital medicine core competencies to be published in January 2006
The Society of Hospital Medicine Core Competencies project continues to move toward publication in early 2006. The goals of the project are to define hospital medicine and provide a framework for the development of hospital medicine curricula throughout the continuum of professional education and training.
The Core Competencies Task Force is chaired by Mike Pistoria, DO, with key input from Dan Dressler, MD, MSc, Sylvia McKean, MD, Alpesh Amin, MD, MBA, and staffed by Tina Budnitz, MPH.
The Core Competencies Task Force developed the methods for the project and overall template for the resulting document. The template divided topic areas into three sections: Clinical, Systems Organization, and Improvement and Procedures. Topics were selected based on the frequency with which they are seen by hospitalists and the areas in which hospitalists lend a particular expertise. The Systems Organization and Improvement section is a perfect example of the latter topics. This section consists of chapters dealing with the nonclinical issues in which a practicing hospitalist should be a proficient expert. Contributors—mostly from within SHM—were recruited to write the chapters.
Once the original chapters were received, an extensive editing process began. This process ensured consistency within and across chapters. In the initial planning process, the task force decided to utilize the Knowledge, Skills, and Attitudes (KSA) domains within each chapter. Additionally, a Systems Organization and Improvement domain was added to each chapter to reflect hospitalist efforts to promote systemwide improvements in care.
As will be detailed when the Competencies are published, the KSA domains follow established definitions in the educational literature and not those commonly used in medical literature. Competencies within each domain were carefully crafted to reflect a specific level of proficiency. In other words, for each competency, it is obvious to the reader exactly what a hospitalist should be able to do and how proficiency would be evaluated.
Another part of the editing process focused on revising each chapter to stand on its own. Given the desire that the Competencies be used for curriculum development and continuing medical education, the members of the task force felt strongly that each chapter should be self-contained so an individual could pull a chapter on Community-Acquired Pneumonia, for example, and have the relevant competencies at his or her disposal.
When the first draft of the document was completed, it was sent out for review by SHM leadership and professional medical organizations. Reviewers from the Association of American Medical Colleges, the Society of General Internal Medicine, the Society of Critical Care Medicine, and the American College of Physicians provided feedback on the Competencies. Comments from other organizations invited to participate are still pending.
The Competencies will be published as a supplement to the forthcoming Journal of Hospital Medicine (JHM) in early 2006. Several related articles are also being prepared to submit to the Journal’s review process. One article will fully detail the Competencies development, while the other will be a primer on using the Competencies. The task force and the JHM editorial staff have discussed the possibility of an ongoing series within the Journal that will highlight examples of the Competencies translated into curricula and program improvements or provide an evidence-based content outline to accompany chapters. SHM is developing several Web-based resources to provide content and training tools that support the Core Competencies.
It is important to realize the publication of the Competencies is the first of many steps to standardize and establish a core curriculum for hospital medicine. The task force recognizes the Core Competencies as a fluid document. Chapters will be added over time and specific competencies within chapters may change as medicine changes and hospitalists’ roles continue to evolve.
Over the next year, the SHM Core Curriculum Task Force will be focused on evaluating the effects of the core competencies, promoting their use, and encouraging the development of curricula based on the framework provided by the competencies. If you are interested in participating in these activities please forward your nomination to participate in the Core Curriculum Task Force to Lillian Higgins at lhiggins@hospitalmedicine.org.
COMMITTEE REPORT
How to Build a Sustainable Career in Hospital Medicine
An interim report from the SHM Career Satisfaction Task Force
By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD
In 2005 SHM recognized the importance of establishing work standards for hospitalists by charging a task force to articulate key work conditions that promote success and wellness for a career in hospital medicine. As a professional society SHM is committed to developing resources for hospitalists that facilitate long and satisfying careers in hospital medicine in diverse work settings.
Since the first SHM survey of hospitalists in 1999, the role of the hospitalist has evolved to address the needs of multiple stakeholders. Reports of stress and dissatisfaction have subsequently generated dialogue on the SHM list serve. In March a recent SHM member commented: “These messages obviously concern me, and I hope the individuals can find a reasonable solution. However, I was wondering: Are management problems like these the exception or the rule?”
As a new specialty, ill-defined and evolving job descriptions can promote burnout along with other factors. Traditional residency programs in internal medicine and pediatrics don’t adequately train physicians to become hospitalists. Lack of clarity about the hospitalist role may create a mismatch between expectations of hospital leaders and junior physicians who have not yet assumed leadership roles. Hospitalists at academic medical centers are faced with additional burdens brought on by Accreditation Council for Graduate Medical Education resident workload restrictions. The absence of career promotion tracks in medical schools may limit advancement and recognition. These issues are not unique to hospital medicine and have surfaced as problems for critical care and emergency medicine.
According to the 1999 survey, burnout in general is correlated with a lower level of perceived autonomy to perform work as one sees fit and to control the professional experience.1 Less recognition by patients, families, and other professionals for a job well done and poor integration with nonphysician team members is associated with burnout. Lacking occupational solidarity as part of a team of professionals, sharing the joys and frustrations with peers, negatively affects job satisfaction.
Although the 1999 SHM study found that burnout was not independently correlated with workload, clearly there is a ceiling beyond which physicians should not work. Consistent with what the literature says about emergency medicine, professions with high demands are more likely to experience burnout. The American College of Emergency Physicians has its own wellness section that includes consensus statements about specific work parameters.
SHM has raised awareness that the hospitalist model cannot be equivalent to office practice. It’s not feasible for hospitalists to work a volume of annual hours equivalent to those worked by primary care physicians and medical specialists How Hospitalists Add Value (a special supplement to The Hospitalist published in April 2005) reinforces the need to structure reimbursement accordingly. At the SHM 2005 Annual Meeting, Tosha Wetterneck, MD, a member of the SHM Career Satisfaction Task Force and an expert on physician burnout, led a workshop on “Burnout and Hospitalists” with Michael Williams.
Progress Report to Date
The work of the task force intersects activities of other SHM committees and task forces. Practice support, education, leadership, benchmarks, and research are fundamental to providing hospitalists with the necessary skill set to succeed. Modifiable factors in the practice (or work environment) of local hospitals will be identified in the near future to optimally support hospitalists. In addition, the SHM 2005 Education Summit identified ongoing education as critical for the development of skills required for academic and administrative advancement.
The task force is focusing on job engagement rather than burnout—its antithesis. A profile of engagement is expected to include a sustainable workload, empowered decision-making, appropriate recognition and compensation, a supportive work environment, a sense of fairness, and meaningful and valued responsibilities appropriate to level of experience.2 Learning opportunities are highly correlated with engagement. Promising approaches to career satisfaction focus on organizational changes that enhance the capacity of hospitalists to cope with the demands of caring for hospitalized patients.
Review of data specific to hospital medicine support the need to define a sustainable workload. Findings on burnout and satisfaction from an Agency for Healthcare Research and Quality-Funded Multicenter Trial of Academic Hospitalists (David Meltzer, MD, PhD, is the principle investigator) at six medical centers provide new information, but may not be applicable to other hospitalist programs. Additional research is needed to identify the key ingredients for a long and professionally rewarding career in hospital medicine and to examine the link between clinician burnout and patient safety in diverse hospital settings.
Short-Term Next Steps—By Jan. 2006
One of the major goals of the Career Satisfaction Task Force is to establish national benchmarks for sustainable work conditions for hospitalists so they are engaged in a career of hospital medicine. The task force identified the following workplace domains:
- Control/autonomy;
- Workload/schedule;
- Community/environment; and
- Reward/recognition.
The task force will:
- Articulate predictors of job satisfaction and engagement in terms of the key domains of work life;
- Define and prioritize educational outreach programs to assist in the development of Core Competencies; and
- Develop a tool kit for building engagement and identifying modifiable factors in the workplace.
Building on the work of other SHM committees, the task force will make specific recommendations about education and practice management support to promote high productivity and career satisfaction despite high workload. Value-added information will be incorporated into the recommendations to promote adequate and fair compensation. The tool kit would be an “ideal model” that SHM would support with an explanation of how to bridge the gap between existing practice and a new flexible work structure that would meet the individual needs of hospitalists. Future revisions of the tool kit would be based on research findings.
Long -Term Next Steps: Two-Year Concurrent Time Line
Dr. Wetterneck will lead an effort to survey the SHM membership about work-life, satisfaction, and burnout to further define key aspects of hospital medicine programs and work life that maximize physician career satisfaction. Information from interviews, focus groups, and prior hospitalist surveys will guide the development of a Hospitalist Worklife and Satisfaction Survey that will be administered to the SHM membership in 2006. The SHM Board has approved funding for this initiative.
The task force will:
- Promote future research into career satisfaction and engagement in hospital medicine to understand the magnitude of the problem of career satisfaction;
- Specify how to structure hospital medicine programs based on actionable data;
- Recommend how SHM can participate in improving the hospital setting as a patient care environment that not only facilitates improved patient outcomes, but also clinician workplace satisfaction for hospitalists;
- Draft a consensus statement for the peer reviewed SHM Journal of Hospital Medicine similar to the Task Force Report on Continuous Personal, Professional and Practice Development in Family Medicine;3 and
- Hold a workshop at the 2006 SHM Annual Meeting on Career Satisfaction.
The Career Satisfaction Committee Task Force welcomes your comments. Contact them at smckean@partners.org (Sylvia McKean, MD), tbw@medicine.wisc.edu (Tosha Wetterneck, MD), or wfwhit@comcast.net (Win Whitcomb, MD).
References
- Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav. 2002;43:72-91.
- Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422.
- Task Force Report on Continuous Personal, Professional and Practice Development in Family Medicine. Ann Fam Med. 2004;2(1):S65-74.
WHAT’S ONLINE AT THE SHM WEB SITE
Improve Inpatient Outcomes with New SHM Online Resource
SHM Web site launches Quality Improvement Resource Rooms
In August SHM announced the first in a new online series to help hospitalists improve inpatient outcomes: the SHM Quality Improvement Resource Rooms. Although performance improvement is ultimately a local phenomenon, certain knowledge, approaches, methods, and tools transcend institution and disease.
When it comes to leading quality improvement in the hospital there has never been a pack-and-go road map—until now. With the launch of the SHM Resource Rooms, a hospitalist with nothing more than the motivation to lead measurable performance improvement in the hospital can do just that. The first Resource Room—focused on reducing venous thromboembolism (VTE), the leading cause of preventable hospital deaths—features a downloadable workbook and companion project outline that walks the hospitalist through every step in the improvement process (see details in “How to Use the VTE Resource Room,” below).
Hospitalists who extract the most out of the VTE Resource Room will be able to:
- Understand and use fundamental quality improvement concepts in the hospital;
- Command and teach the VTE prevention literature; and
- Engineer and lead improvement in the hospital.
The Quality Improvement Resource Rooms will support the hospitalist across domains integral to any quality improvement effort: raising collective awareness of a performance gap, knowing what evidence to put into practice, and leveraging experience with the disease as well as the improvement process.
Print and carry a ready-made workbook to guide and document your work. View a presentation depicting the key elements in quality improvement theory. Download a ready-made slide set to propel teaching of VTE prevention in the didactic setting. Adapt practical teaching tips to implement immediately. Review a listing of the pertinent literature. View and modify VTE tools shared by other hospitalists. Or post questions to a moderated forum of VTE and quality improvement experts.
By offering the new online Resource Rooms, the SHM has taken a significant step toward realizing the potential in hospital medicine: to enhance your ability to improve inpatient outcomes. The next step is yours.
At the SHM Web site, navigate to “Quality and Safety,” select “Quality Improvement Resource Rooms,” and then “Venous Thromboembolism (VTE) Resource Room.” TH
The SHM Nominating Committee is requesting nominations for three open seats on the Board of Directors for a three-year term, beginning May 2, 2006. In addition there will be one pediatric hospitalist seat on the SHM Board for a three-year term, beginning May 2, 2006. Pediatricians may submit their nomination for either the open seats or for the specific designated pediatric seat. All SHM members will vote in both the open and pediatric board elections.
Who is eligible to be nominated? Any SHM member in good standing who is:
- Board certified in their primary specialty;
- Available to travel to board meetings twice a year;
- Prepared to respond to e-mails on a daily basis and actively participate in board list serve;
- Willing to serve on SHM committees; and
- Able to commit to a three-year term, ending in 2009.
Candidates may self-nominate or may be nominated by another SHM member. Nominated candidates must submit the following materials for consideration on the board:
- A one-page curriculum vitae (CV) (12-point font size with 1” margins);
- A one-page nominating letter (12-point font size with 1” margins);
- A recent headshot; and
- An optional additional letter of support (one page, 12-point font size with 1” margins)—although these may not come from any current SHM board members. All letters should be addressed to Steven Pantilat, MD, chair, SHM Nominations Committee. Note: The letter of support is only for Nominations Committee use, but for those candidates who are on the election ballot, the CV, headshot, and the nominating letter will be sent as submitted to all voting members of SHM. Letters will be accepted by mail or e-mail only. No faxes accepted due to potential poor quality of transmission.
The criteria used when considering nominees for ballot include:
- Duration of SHM membership;
- Activity as a hospitalist;
- Activity in or contributions to SHM;
- Activity at a local or regional level;
- Prominence as a hospitalist;
- Ability to provide skills or experience not currently found on the board; and
- Ability to add to the diversity of the board.
Timeline
Some of the critical milestone dates for the board nomination process include the following:
October 31, 2005: Deadline for submitting candidates for nomination;
November 28, 2005: Ballots mailed to SHM members
January 5, 2006: Ballots must be received at SHM offices;
January 20, 2006: Notification of candidates of results of election;
January 23, 2006: Election results posted on SHM Web site;
May 2, 2006: Elected board members take office.
If you are interested in being considered as a nominee for the SHM Board, please submit your nomination materials by October 31, 2005, to the SHM Nominations Committee, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.
Questions? Send them via e-mail to nominations@hospitalmedicine.org or call (800) 843-3360.
Core Competencies Are Coming!
Hospital medicine core competencies to be published in January 2006
The Society of Hospital Medicine Core Competencies project continues to move toward publication in early 2006. The goals of the project are to define hospital medicine and provide a framework for the development of hospital medicine curricula throughout the continuum of professional education and training.
The Core Competencies Task Force is chaired by Mike Pistoria, DO, with key input from Dan Dressler, MD, MSc, Sylvia McKean, MD, Alpesh Amin, MD, MBA, and staffed by Tina Budnitz, MPH.
The Core Competencies Task Force developed the methods for the project and overall template for the resulting document. The template divided topic areas into three sections: Clinical, Systems Organization, and Improvement and Procedures. Topics were selected based on the frequency with which they are seen by hospitalists and the areas in which hospitalists lend a particular expertise. The Systems Organization and Improvement section is a perfect example of the latter topics. This section consists of chapters dealing with the nonclinical issues in which a practicing hospitalist should be a proficient expert. Contributors—mostly from within SHM—were recruited to write the chapters.
Once the original chapters were received, an extensive editing process began. This process ensured consistency within and across chapters. In the initial planning process, the task force decided to utilize the Knowledge, Skills, and Attitudes (KSA) domains within each chapter. Additionally, a Systems Organization and Improvement domain was added to each chapter to reflect hospitalist efforts to promote systemwide improvements in care.
As will be detailed when the Competencies are published, the KSA domains follow established definitions in the educational literature and not those commonly used in medical literature. Competencies within each domain were carefully crafted to reflect a specific level of proficiency. In other words, for each competency, it is obvious to the reader exactly what a hospitalist should be able to do and how proficiency would be evaluated.
Another part of the editing process focused on revising each chapter to stand on its own. Given the desire that the Competencies be used for curriculum development and continuing medical education, the members of the task force felt strongly that each chapter should be self-contained so an individual could pull a chapter on Community-Acquired Pneumonia, for example, and have the relevant competencies at his or her disposal.
When the first draft of the document was completed, it was sent out for review by SHM leadership and professional medical organizations. Reviewers from the Association of American Medical Colleges, the Society of General Internal Medicine, the Society of Critical Care Medicine, and the American College of Physicians provided feedback on the Competencies. Comments from other organizations invited to participate are still pending.
The Competencies will be published as a supplement to the forthcoming Journal of Hospital Medicine (JHM) in early 2006. Several related articles are also being prepared to submit to the Journal’s review process. One article will fully detail the Competencies development, while the other will be a primer on using the Competencies. The task force and the JHM editorial staff have discussed the possibility of an ongoing series within the Journal that will highlight examples of the Competencies translated into curricula and program improvements or provide an evidence-based content outline to accompany chapters. SHM is developing several Web-based resources to provide content and training tools that support the Core Competencies.
It is important to realize the publication of the Competencies is the first of many steps to standardize and establish a core curriculum for hospital medicine. The task force recognizes the Core Competencies as a fluid document. Chapters will be added over time and specific competencies within chapters may change as medicine changes and hospitalists’ roles continue to evolve.
Over the next year, the SHM Core Curriculum Task Force will be focused on evaluating the effects of the core competencies, promoting their use, and encouraging the development of curricula based on the framework provided by the competencies. If you are interested in participating in these activities please forward your nomination to participate in the Core Curriculum Task Force to Lillian Higgins at lhiggins@hospitalmedicine.org.
COMMITTEE REPORT
How to Build a Sustainable Career in Hospital Medicine
An interim report from the SHM Career Satisfaction Task Force
By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD
In 2005 SHM recognized the importance of establishing work standards for hospitalists by charging a task force to articulate key work conditions that promote success and wellness for a career in hospital medicine. As a professional society SHM is committed to developing resources for hospitalists that facilitate long and satisfying careers in hospital medicine in diverse work settings.
Since the first SHM survey of hospitalists in 1999, the role of the hospitalist has evolved to address the needs of multiple stakeholders. Reports of stress and dissatisfaction have subsequently generated dialogue on the SHM list serve. In March a recent SHM member commented: “These messages obviously concern me, and I hope the individuals can find a reasonable solution. However, I was wondering: Are management problems like these the exception or the rule?”
As a new specialty, ill-defined and evolving job descriptions can promote burnout along with other factors. Traditional residency programs in internal medicine and pediatrics don’t adequately train physicians to become hospitalists. Lack of clarity about the hospitalist role may create a mismatch between expectations of hospital leaders and junior physicians who have not yet assumed leadership roles. Hospitalists at academic medical centers are faced with additional burdens brought on by Accreditation Council for Graduate Medical Education resident workload restrictions. The absence of career promotion tracks in medical schools may limit advancement and recognition. These issues are not unique to hospital medicine and have surfaced as problems for critical care and emergency medicine.
According to the 1999 survey, burnout in general is correlated with a lower level of perceived autonomy to perform work as one sees fit and to control the professional experience.1 Less recognition by patients, families, and other professionals for a job well done and poor integration with nonphysician team members is associated with burnout. Lacking occupational solidarity as part of a team of professionals, sharing the joys and frustrations with peers, negatively affects job satisfaction.
Although the 1999 SHM study found that burnout was not independently correlated with workload, clearly there is a ceiling beyond which physicians should not work. Consistent with what the literature says about emergency medicine, professions with high demands are more likely to experience burnout. The American College of Emergency Physicians has its own wellness section that includes consensus statements about specific work parameters.
SHM has raised awareness that the hospitalist model cannot be equivalent to office practice. It’s not feasible for hospitalists to work a volume of annual hours equivalent to those worked by primary care physicians and medical specialists How Hospitalists Add Value (a special supplement to The Hospitalist published in April 2005) reinforces the need to structure reimbursement accordingly. At the SHM 2005 Annual Meeting, Tosha Wetterneck, MD, a member of the SHM Career Satisfaction Task Force and an expert on physician burnout, led a workshop on “Burnout and Hospitalists” with Michael Williams.
Progress Report to Date
The work of the task force intersects activities of other SHM committees and task forces. Practice support, education, leadership, benchmarks, and research are fundamental to providing hospitalists with the necessary skill set to succeed. Modifiable factors in the practice (or work environment) of local hospitals will be identified in the near future to optimally support hospitalists. In addition, the SHM 2005 Education Summit identified ongoing education as critical for the development of skills required for academic and administrative advancement.
The task force is focusing on job engagement rather than burnout—its antithesis. A profile of engagement is expected to include a sustainable workload, empowered decision-making, appropriate recognition and compensation, a supportive work environment, a sense of fairness, and meaningful and valued responsibilities appropriate to level of experience.2 Learning opportunities are highly correlated with engagement. Promising approaches to career satisfaction focus on organizational changes that enhance the capacity of hospitalists to cope with the demands of caring for hospitalized patients.
Review of data specific to hospital medicine support the need to define a sustainable workload. Findings on burnout and satisfaction from an Agency for Healthcare Research and Quality-Funded Multicenter Trial of Academic Hospitalists (David Meltzer, MD, PhD, is the principle investigator) at six medical centers provide new information, but may not be applicable to other hospitalist programs. Additional research is needed to identify the key ingredients for a long and professionally rewarding career in hospital medicine and to examine the link between clinician burnout and patient safety in diverse hospital settings.
Short-Term Next Steps—By Jan. 2006
One of the major goals of the Career Satisfaction Task Force is to establish national benchmarks for sustainable work conditions for hospitalists so they are engaged in a career of hospital medicine. The task force identified the following workplace domains:
- Control/autonomy;
- Workload/schedule;
- Community/environment; and
- Reward/recognition.
The task force will:
- Articulate predictors of job satisfaction and engagement in terms of the key domains of work life;
- Define and prioritize educational outreach programs to assist in the development of Core Competencies; and
- Develop a tool kit for building engagement and identifying modifiable factors in the workplace.
Building on the work of other SHM committees, the task force will make specific recommendations about education and practice management support to promote high productivity and career satisfaction despite high workload. Value-added information will be incorporated into the recommendations to promote adequate and fair compensation. The tool kit would be an “ideal model” that SHM would support with an explanation of how to bridge the gap between existing practice and a new flexible work structure that would meet the individual needs of hospitalists. Future revisions of the tool kit would be based on research findings.
Long -Term Next Steps: Two-Year Concurrent Time Line
Dr. Wetterneck will lead an effort to survey the SHM membership about work-life, satisfaction, and burnout to further define key aspects of hospital medicine programs and work life that maximize physician career satisfaction. Information from interviews, focus groups, and prior hospitalist surveys will guide the development of a Hospitalist Worklife and Satisfaction Survey that will be administered to the SHM membership in 2006. The SHM Board has approved funding for this initiative.
The task force will:
- Promote future research into career satisfaction and engagement in hospital medicine to understand the magnitude of the problem of career satisfaction;
- Specify how to structure hospital medicine programs based on actionable data;
- Recommend how SHM can participate in improving the hospital setting as a patient care environment that not only facilitates improved patient outcomes, but also clinician workplace satisfaction for hospitalists;
- Draft a consensus statement for the peer reviewed SHM Journal of Hospital Medicine similar to the Task Force Report on Continuous Personal, Professional and Practice Development in Family Medicine;3 and
- Hold a workshop at the 2006 SHM Annual Meeting on Career Satisfaction.
The Career Satisfaction Committee Task Force welcomes your comments. Contact them at smckean@partners.org (Sylvia McKean, MD), tbw@medicine.wisc.edu (Tosha Wetterneck, MD), or wfwhit@comcast.net (Win Whitcomb, MD).
References
- Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav. 2002;43:72-91.
- Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422.
- Task Force Report on Continuous Personal, Professional and Practice Development in Family Medicine. Ann Fam Med. 2004;2(1):S65-74.
WHAT’S ONLINE AT THE SHM WEB SITE
Improve Inpatient Outcomes with New SHM Online Resource
SHM Web site launches Quality Improvement Resource Rooms
In August SHM announced the first in a new online series to help hospitalists improve inpatient outcomes: the SHM Quality Improvement Resource Rooms. Although performance improvement is ultimately a local phenomenon, certain knowledge, approaches, methods, and tools transcend institution and disease.
When it comes to leading quality improvement in the hospital there has never been a pack-and-go road map—until now. With the launch of the SHM Resource Rooms, a hospitalist with nothing more than the motivation to lead measurable performance improvement in the hospital can do just that. The first Resource Room—focused on reducing venous thromboembolism (VTE), the leading cause of preventable hospital deaths—features a downloadable workbook and companion project outline that walks the hospitalist through every step in the improvement process (see details in “How to Use the VTE Resource Room,” below).
Hospitalists who extract the most out of the VTE Resource Room will be able to:
- Understand and use fundamental quality improvement concepts in the hospital;
- Command and teach the VTE prevention literature; and
- Engineer and lead improvement in the hospital.
The Quality Improvement Resource Rooms will support the hospitalist across domains integral to any quality improvement effort: raising collective awareness of a performance gap, knowing what evidence to put into practice, and leveraging experience with the disease as well as the improvement process.
Print and carry a ready-made workbook to guide and document your work. View a presentation depicting the key elements in quality improvement theory. Download a ready-made slide set to propel teaching of VTE prevention in the didactic setting. Adapt practical teaching tips to implement immediately. Review a listing of the pertinent literature. View and modify VTE tools shared by other hospitalists. Or post questions to a moderated forum of VTE and quality improvement experts.
By offering the new online Resource Rooms, the SHM has taken a significant step toward realizing the potential in hospital medicine: to enhance your ability to improve inpatient outcomes. The next step is yours.
At the SHM Web site, navigate to “Quality and Safety,” select “Quality Improvement Resource Rooms,” and then “Venous Thromboembolism (VTE) Resource Room.” TH
The SHM Nominating Committee is requesting nominations for three open seats on the Board of Directors for a three-year term, beginning May 2, 2006. In addition there will be one pediatric hospitalist seat on the SHM Board for a three-year term, beginning May 2, 2006. Pediatricians may submit their nomination for either the open seats or for the specific designated pediatric seat. All SHM members will vote in both the open and pediatric board elections.
Who is eligible to be nominated? Any SHM member in good standing who is:
- Board certified in their primary specialty;
- Available to travel to board meetings twice a year;
- Prepared to respond to e-mails on a daily basis and actively participate in board list serve;
- Willing to serve on SHM committees; and
- Able to commit to a three-year term, ending in 2009.
Candidates may self-nominate or may be nominated by another SHM member. Nominated candidates must submit the following materials for consideration on the board:
- A one-page curriculum vitae (CV) (12-point font size with 1” margins);
- A one-page nominating letter (12-point font size with 1” margins);
- A recent headshot; and
- An optional additional letter of support (one page, 12-point font size with 1” margins)—although these may not come from any current SHM board members. All letters should be addressed to Steven Pantilat, MD, chair, SHM Nominations Committee. Note: The letter of support is only for Nominations Committee use, but for those candidates who are on the election ballot, the CV, headshot, and the nominating letter will be sent as submitted to all voting members of SHM. Letters will be accepted by mail or e-mail only. No faxes accepted due to potential poor quality of transmission.
The criteria used when considering nominees for ballot include:
- Duration of SHM membership;
- Activity as a hospitalist;
- Activity in or contributions to SHM;
- Activity at a local or regional level;
- Prominence as a hospitalist;
- Ability to provide skills or experience not currently found on the board; and
- Ability to add to the diversity of the board.
Timeline
Some of the critical milestone dates for the board nomination process include the following:
October 31, 2005: Deadline for submitting candidates for nomination;
November 28, 2005: Ballots mailed to SHM members
January 5, 2006: Ballots must be received at SHM offices;
January 20, 2006: Notification of candidates of results of election;
January 23, 2006: Election results posted on SHM Web site;
May 2, 2006: Elected board members take office.
If you are interested in being considered as a nominee for the SHM Board, please submit your nomination materials by October 31, 2005, to the SHM Nominations Committee, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.
Questions? Send them via e-mail to nominations@hospitalmedicine.org or call (800) 843-3360.
Core Competencies Are Coming!
Hospital medicine core competencies to be published in January 2006
The Society of Hospital Medicine Core Competencies project continues to move toward publication in early 2006. The goals of the project are to define hospital medicine and provide a framework for the development of hospital medicine curricula throughout the continuum of professional education and training.
The Core Competencies Task Force is chaired by Mike Pistoria, DO, with key input from Dan Dressler, MD, MSc, Sylvia McKean, MD, Alpesh Amin, MD, MBA, and staffed by Tina Budnitz, MPH.
The Core Competencies Task Force developed the methods for the project and overall template for the resulting document. The template divided topic areas into three sections: Clinical, Systems Organization, and Improvement and Procedures. Topics were selected based on the frequency with which they are seen by hospitalists and the areas in which hospitalists lend a particular expertise. The Systems Organization and Improvement section is a perfect example of the latter topics. This section consists of chapters dealing with the nonclinical issues in which a practicing hospitalist should be a proficient expert. Contributors—mostly from within SHM—were recruited to write the chapters.
Once the original chapters were received, an extensive editing process began. This process ensured consistency within and across chapters. In the initial planning process, the task force decided to utilize the Knowledge, Skills, and Attitudes (KSA) domains within each chapter. Additionally, a Systems Organization and Improvement domain was added to each chapter to reflect hospitalist efforts to promote systemwide improvements in care.
As will be detailed when the Competencies are published, the KSA domains follow established definitions in the educational literature and not those commonly used in medical literature. Competencies within each domain were carefully crafted to reflect a specific level of proficiency. In other words, for each competency, it is obvious to the reader exactly what a hospitalist should be able to do and how proficiency would be evaluated.
Another part of the editing process focused on revising each chapter to stand on its own. Given the desire that the Competencies be used for curriculum development and continuing medical education, the members of the task force felt strongly that each chapter should be self-contained so an individual could pull a chapter on Community-Acquired Pneumonia, for example, and have the relevant competencies at his or her disposal.
When the first draft of the document was completed, it was sent out for review by SHM leadership and professional medical organizations. Reviewers from the Association of American Medical Colleges, the Society of General Internal Medicine, the Society of Critical Care Medicine, and the American College of Physicians provided feedback on the Competencies. Comments from other organizations invited to participate are still pending.
The Competencies will be published as a supplement to the forthcoming Journal of Hospital Medicine (JHM) in early 2006. Several related articles are also being prepared to submit to the Journal’s review process. One article will fully detail the Competencies development, while the other will be a primer on using the Competencies. The task force and the JHM editorial staff have discussed the possibility of an ongoing series within the Journal that will highlight examples of the Competencies translated into curricula and program improvements or provide an evidence-based content outline to accompany chapters. SHM is developing several Web-based resources to provide content and training tools that support the Core Competencies.
It is important to realize the publication of the Competencies is the first of many steps to standardize and establish a core curriculum for hospital medicine. The task force recognizes the Core Competencies as a fluid document. Chapters will be added over time and specific competencies within chapters may change as medicine changes and hospitalists’ roles continue to evolve.
Over the next year, the SHM Core Curriculum Task Force will be focused on evaluating the effects of the core competencies, promoting their use, and encouraging the development of curricula based on the framework provided by the competencies. If you are interested in participating in these activities please forward your nomination to participate in the Core Curriculum Task Force to Lillian Higgins at lhiggins@hospitalmedicine.org.
COMMITTEE REPORT
How to Build a Sustainable Career in Hospital Medicine
An interim report from the SHM Career Satisfaction Task Force
By Sylvia McKean, MD, Tosha Wetterneck, MD, and Win Whitcomb, MD
In 2005 SHM recognized the importance of establishing work standards for hospitalists by charging a task force to articulate key work conditions that promote success and wellness for a career in hospital medicine. As a professional society SHM is committed to developing resources for hospitalists that facilitate long and satisfying careers in hospital medicine in diverse work settings.
Since the first SHM survey of hospitalists in 1999, the role of the hospitalist has evolved to address the needs of multiple stakeholders. Reports of stress and dissatisfaction have subsequently generated dialogue on the SHM list serve. In March a recent SHM member commented: “These messages obviously concern me, and I hope the individuals can find a reasonable solution. However, I was wondering: Are management problems like these the exception or the rule?”
As a new specialty, ill-defined and evolving job descriptions can promote burnout along with other factors. Traditional residency programs in internal medicine and pediatrics don’t adequately train physicians to become hospitalists. Lack of clarity about the hospitalist role may create a mismatch between expectations of hospital leaders and junior physicians who have not yet assumed leadership roles. Hospitalists at academic medical centers are faced with additional burdens brought on by Accreditation Council for Graduate Medical Education resident workload restrictions. The absence of career promotion tracks in medical schools may limit advancement and recognition. These issues are not unique to hospital medicine and have surfaced as problems for critical care and emergency medicine.
According to the 1999 survey, burnout in general is correlated with a lower level of perceived autonomy to perform work as one sees fit and to control the professional experience.1 Less recognition by patients, families, and other professionals for a job well done and poor integration with nonphysician team members is associated with burnout. Lacking occupational solidarity as part of a team of professionals, sharing the joys and frustrations with peers, negatively affects job satisfaction.
Although the 1999 SHM study found that burnout was not independently correlated with workload, clearly there is a ceiling beyond which physicians should not work. Consistent with what the literature says about emergency medicine, professions with high demands are more likely to experience burnout. The American College of Emergency Physicians has its own wellness section that includes consensus statements about specific work parameters.
SHM has raised awareness that the hospitalist model cannot be equivalent to office practice. It’s not feasible for hospitalists to work a volume of annual hours equivalent to those worked by primary care physicians and medical specialists How Hospitalists Add Value (a special supplement to The Hospitalist published in April 2005) reinforces the need to structure reimbursement accordingly. At the SHM 2005 Annual Meeting, Tosha Wetterneck, MD, a member of the SHM Career Satisfaction Task Force and an expert on physician burnout, led a workshop on “Burnout and Hospitalists” with Michael Williams.
Progress Report to Date
The work of the task force intersects activities of other SHM committees and task forces. Practice support, education, leadership, benchmarks, and research are fundamental to providing hospitalists with the necessary skill set to succeed. Modifiable factors in the practice (or work environment) of local hospitals will be identified in the near future to optimally support hospitalists. In addition, the SHM 2005 Education Summit identified ongoing education as critical for the development of skills required for academic and administrative advancement.
The task force is focusing on job engagement rather than burnout—its antithesis. A profile of engagement is expected to include a sustainable workload, empowered decision-making, appropriate recognition and compensation, a supportive work environment, a sense of fairness, and meaningful and valued responsibilities appropriate to level of experience.2 Learning opportunities are highly correlated with engagement. Promising approaches to career satisfaction focus on organizational changes that enhance the capacity of hospitalists to cope with the demands of caring for hospitalized patients.
Review of data specific to hospital medicine support the need to define a sustainable workload. Findings on burnout and satisfaction from an Agency for Healthcare Research and Quality-Funded Multicenter Trial of Academic Hospitalists (David Meltzer, MD, PhD, is the principle investigator) at six medical centers provide new information, but may not be applicable to other hospitalist programs. Additional research is needed to identify the key ingredients for a long and professionally rewarding career in hospital medicine and to examine the link between clinician burnout and patient safety in diverse hospital settings.
Short-Term Next Steps—By Jan. 2006
One of the major goals of the Career Satisfaction Task Force is to establish national benchmarks for sustainable work conditions for hospitalists so they are engaged in a career of hospital medicine. The task force identified the following workplace domains:
- Control/autonomy;
- Workload/schedule;
- Community/environment; and
- Reward/recognition.
The task force will:
- Articulate predictors of job satisfaction and engagement in terms of the key domains of work life;
- Define and prioritize educational outreach programs to assist in the development of Core Competencies; and
- Develop a tool kit for building engagement and identifying modifiable factors in the workplace.
Building on the work of other SHM committees, the task force will make specific recommendations about education and practice management support to promote high productivity and career satisfaction despite high workload. Value-added information will be incorporated into the recommendations to promote adequate and fair compensation. The tool kit would be an “ideal model” that SHM would support with an explanation of how to bridge the gap between existing practice and a new flexible work structure that would meet the individual needs of hospitalists. Future revisions of the tool kit would be based on research findings.
Long -Term Next Steps: Two-Year Concurrent Time Line
Dr. Wetterneck will lead an effort to survey the SHM membership about work-life, satisfaction, and burnout to further define key aspects of hospital medicine programs and work life that maximize physician career satisfaction. Information from interviews, focus groups, and prior hospitalist surveys will guide the development of a Hospitalist Worklife and Satisfaction Survey that will be administered to the SHM membership in 2006. The SHM Board has approved funding for this initiative.
The task force will:
- Promote future research into career satisfaction and engagement in hospital medicine to understand the magnitude of the problem of career satisfaction;
- Specify how to structure hospital medicine programs based on actionable data;
- Recommend how SHM can participate in improving the hospital setting as a patient care environment that not only facilitates improved patient outcomes, but also clinician workplace satisfaction for hospitalists;
- Draft a consensus statement for the peer reviewed SHM Journal of Hospital Medicine similar to the Task Force Report on Continuous Personal, Professional and Practice Development in Family Medicine;3 and
- Hold a workshop at the 2006 SHM Annual Meeting on Career Satisfaction.
The Career Satisfaction Committee Task Force welcomes your comments. Contact them at smckean@partners.org (Sylvia McKean, MD), tbw@medicine.wisc.edu (Tosha Wetterneck, MD), or wfwhit@comcast.net (Win Whitcomb, MD).
References
- Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav. 2002;43:72-91.
- Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422.
- Task Force Report on Continuous Personal, Professional and Practice Development in Family Medicine. Ann Fam Med. 2004;2(1):S65-74.
WHAT’S ONLINE AT THE SHM WEB SITE
Improve Inpatient Outcomes with New SHM Online Resource
SHM Web site launches Quality Improvement Resource Rooms
In August SHM announced the first in a new online series to help hospitalists improve inpatient outcomes: the SHM Quality Improvement Resource Rooms. Although performance improvement is ultimately a local phenomenon, certain knowledge, approaches, methods, and tools transcend institution and disease.
When it comes to leading quality improvement in the hospital there has never been a pack-and-go road map—until now. With the launch of the SHM Resource Rooms, a hospitalist with nothing more than the motivation to lead measurable performance improvement in the hospital can do just that. The first Resource Room—focused on reducing venous thromboembolism (VTE), the leading cause of preventable hospital deaths—features a downloadable workbook and companion project outline that walks the hospitalist through every step in the improvement process (see details in “How to Use the VTE Resource Room,” below).
Hospitalists who extract the most out of the VTE Resource Room will be able to:
- Understand and use fundamental quality improvement concepts in the hospital;
- Command and teach the VTE prevention literature; and
- Engineer and lead improvement in the hospital.
The Quality Improvement Resource Rooms will support the hospitalist across domains integral to any quality improvement effort: raising collective awareness of a performance gap, knowing what evidence to put into practice, and leveraging experience with the disease as well as the improvement process.
Print and carry a ready-made workbook to guide and document your work. View a presentation depicting the key elements in quality improvement theory. Download a ready-made slide set to propel teaching of VTE prevention in the didactic setting. Adapt practical teaching tips to implement immediately. Review a listing of the pertinent literature. View and modify VTE tools shared by other hospitalists. Or post questions to a moderated forum of VTE and quality improvement experts.
By offering the new online Resource Rooms, the SHM has taken a significant step toward realizing the potential in hospital medicine: to enhance your ability to improve inpatient outcomes. The next step is yours.
At the SHM Web site, navigate to “Quality and Safety,” select “Quality Improvement Resource Rooms,” and then “Venous Thromboembolism (VTE) Resource Room.” TH