Objective: The Pediatric Hospital Medicine Core Competencies (PHMCC), published in 2010, serve as the foundation for development of pediatric hospital medicine curricula to standardize and improve inpatient pediatric training and practice. Here the authors describe development of a PHMCC-based curriculum for faculty development, improved teaching, and evidence-based care, and as the basis for scholarly projects.
Methods: A 2-year repeating curriculum of 51 topics based on the PHMCC was designed, presented by hospitalists for division members at weekly division conferences, and recorded for asynchronous learning. Fourteen of those topics were created for online viewing only. Topic development included use of pertinent medical research, guidelines, and local experts. Presentations followed a standardized format and were reviewed by senior division members before delivery. Attendees evaluated all presentations.
Results: Twenty live topics were presented. All talks received ratings of 4.3 or higher (on a scale of 1 to 5) on evaluation by attendees, and 70% of presentations were reported as likely to change practice by 80% or more of attendees. Opportunities for increased mentorship were realized. The division was recognized for its work through an invitation to present topics 4 times annually at a community-wide continuing medical education program and regional pediatric meetings, and proposals have been submitted for national meetings.
Conclusions: The PHMCC-based curriculum has led to increased opportunities for education, mentorship, and improvement in the quality of care by attendees. Other academic divisions may benefit from a curriculum to enhance professional development and standardize clinical care and teaching.
- career development
- continuing medical education
- hospitalists as educators
- practice-based learning
- care standardization
The Society of Hospital Medicine published the Pediatric Hospital Medicine Core Competencies1 (PHMCCs) in 2010. Contributed to by pediatric hospitalists, the PHMCC were formally validated by the American Academy of Pediatrics, the Academic Pediatric Association (APA), and the Society of Hospital Medicine. Although the knowledge, attitudes, and skills covered in the competencies can be attained through experience, independent study, and formalized training,2 they were designed to be the foundation for development of pediatric hospital medicine curricula.3 Ideally, the PHMCCs serve to standardize and improve inpatient training and practice.
The pediatric hospitalist division at Washington University School of Medicine has grown rapidly since it was established in 2009. Fifty-one hospitalists cover general pediatric inpatient and hospital-based services, including the emergency department, newborn nursery, procedural sedation, and interhospital transfers for 2 community-based hospitals and the quaternary children’s hospital. Division members participate in quality improvement initiatives, clinical and academic leadership, and graduate and continuing medical education (CME).
The rapid growth of the division resulted in several challenges. Many hospitalists were recent residency graduates and none were fellowship-trained. The elevated ratio of junior to senior faculty presented challenges in mentorship. The broad range of clinical responsibilities presented a risk of unwanted variability of clinical care and teaching skills. However, like hospitalists across the country, division members were highly motivated to be clinically and educationally versed in the topics covered in the PHMCCs.4 Historically, the division’s faculty development (FD) included journal club, a peer mentorship program, and orientation for new hospitalists. Although educational topics were delivered at division meetings, there was no formal curriculum and most activities were inaccessible to hospitalists working at night or off site.
In this article, we describe development of a curriculum based in the PHMCCs, tailored to institution-specific needs, and designed to address the previously mentioned challenges by enhancing FD through an asynchronous educational series delivered by the faculty themselves. This curriculum was designed to promote FD via mentorship and scholarly projects. We envisioned a curriculum that would empower hospitalists to “excel as educators,” and foster a community that values both teaching and learning.5
In 2012, division-wide awareness of the need for enhanced faculty education and a desire for competence in the PHMCCs led to a targeted needs assessment by using several concurrent methods. Medical education literature and online academic pediatric resources were reviewed to determine if existing curricula might meet division needs. The APA FD goals provided a reference for curriculum goal development.6 Workshops at the APA Leadership Meeting and the Pediatric Hospital Medicine Conference provided design and leadership guidance. Hospitalist fellowship program curricula at other institutions were reviewed to establish resources required to develop a curriculum. A hospital medicine fellowship director (N.S.) helped identify techniques for maximizing the applicability and efficacy of the curriculum.
Internal consultation with the Department of Pediatrics Office of Faculty Development and senior faculty further defined the division’s FD needs. Clinical needs assessment was done through peer-to-peer observation, interdivisional dialogue, and review of divisional clinical metrics, such as emergency department return visits within 48 hours. These visits were evaluated for variability in clinical care, and most common diagnoses resulting in return (Fig 1). Hospitalists’ perceived needs and interests were assessed via an online survey and a focus group (Fig 2). This focus group ultimately became a planning committee for initial hospitalist core curriculum (HCC) educational content, program design, and implementation.
From this assessment, the planning committee developed goals and specific measurable objectives for the HCC (Table 1). With these in mind, the HCC was designed as a lecture series covering 51 topics and delivered over a repeating 2-year cycle. Most topics were presented as lectures given by hospitalists at division meetings and recorded for online viewing to provide asynchronous education. Additional topics were available online only. The live presentations were audio recorded with a synchronized video showing presented slides. Recordings were uploaded to a password-protected link on the division Web site for subsequent access.7
An advisory board (the board) was established consisting of faculty with varying levels of experience in education, mentorship, and research. Preference was given to senior hospitalists with education experience.
The board selected 26 HCC topics from the PHMCCs by reviewing the 54 chapters in the PHMCCs and the results of the needs assessment. The remaining chapters from the PHMCCs were removed or combined with another topic. PHMCC topics were removed from the HCC if they were deemed redundant based on education already in place, inapplicable to division needs, or incompatible with the HCC format. The board added 12 topics to those chosen from the PHMCCs based on the results of the needs assessment (Fig 3). To enhance buy-in, presentation priority was determined by highest perceived need based on data from the division survey. Topics were then divided into live or online categories. Most topics selected as online-only were subjects typically taught by subspecialists at Saint Louis Children’s Hospital. Others were deemed unlikely to engage participation in a live presentation, but useful as a reference.
An example of this process are the topics on respiratory failure, oxygen delivery, and airway management from the PHMCCs. Oxygen delivery was combined with respiratory failure for live presentation. Topic development included the cognitive, affective, and psychomotor objectives from both. Airway management was removed because it was covered in pediatric advanced life support certification and advanced airway management training required for procedural sedation certification.
Because HCC topics were broad, board members each mentored 4 to 5 hospitalists through presentation development by using topic-specific needs-assessment data, published PHMCC goals and objectives, current medical literature, and guidelines to help determine their area of focus. These mentor assignments were based on topic knowledge and relationship with the presenter. For junior board members, peer-to-peer mentor assignments were preferred. The board met monthly to review the progress of topic development, and to troubleshoot challenges encountered in mentor relationships.
The needs assessment survey demonstrated that 47% of hospitalists felt improved education techniques would most strongly impact their development as a clinical educator (Fig 2). In response, the board created standards for presentations. Slide templates and ideal presentation length were recommended, presentation techniques were reviewed, and division-wide education on adult learning principles was provided.8,9 Emphasis was placed on the concept that presentations should be tailored to the needs of practicing physicians.
As HCC implementation began, board mentors collaborated with hospitalists developing presentations, supported the HCC goals and objectives, and emphasized scholarly opportunities that could stem from each topic. Previous surveys of pediatric hospitalists demonstrate that adequate mentorship is significantly correlated with overall career satisfaction,10 so the quality of this work was a priority.
Educational outcomes for each topic were measured starting at the lowest level of Kirkpatrick’s Hierarchy: trainee’s immediate reaction to the learning experience.11 Anonymous evaluations measured participants’ immediate impressions and attitudes about the talk and recommendations. A 5-point Likert scale was used to evaluate organization, pacing and overall quality of the presentation. Assessment of anticipated practice change was included. This evaluation ensured CME credit for attendees and provided the board with a means for initial outcomes assessment. Mentors delivered feedback to presenters as a written summary of their evaluations.12
The Washington University Institutional Review Board determined this project to be exempt.
Over the first 12 months of the curriculum cycle, 20 topics were presented. Seventeen of these presentations are now available on the division Web site for viewing. Fourteen online presentations have been created.
Written evaluations of all live presentations rated the overall quality as very good (4) or excellent (5) on a 5-point Likert scale with an average score of 4.73. Participants anticipated making practice changes after most of the presentations (Table 2).
The HCC was recognized for excellence after division members presented their topics in other educational settings. This has led to invitations to present curriculum topics at community-wide CME programs and regional pediatric meetings. Topic-based workshops have been accepted at national meetings.
This article describes a curriculum based in the PHMCCs but designed to meet the faculty development needs on a local level. The HCC has developed into a high-quality educational program that benefits participants by developing strong mentorship relationships and promoting faculty development with regard to clinical care and teaching skills.
In the future, we will assess the effect of the curriculum on participant knowledge and confidence. Additionally, we will use existing clinical metrics and quality measures as proxies for change in provider practice and patient health outcomes.11 Tracking topic-based practice performance and patient outcomes remain a challenge.
Overall, the HCC is well received by participants despite the effort it requires, because support from the division director and the board focuses on the long-term professional benefits being realized. Attendance at live sessions is limited because many hospitalists work off-site or overnight. High-quality online educational modules are needed to serve the population of hospitalists who are unable to attend. Assessment of online materials requires quantifying their use to ensure that we achieve our goal of asynchronous education. Software capable of tracking use and embedding content-based questions has been identified for implementation.
In summary, we have found that a curriculum based on the PHMCCs has led to a more vibrant academic community with renewed dedication to education and quality care. Opportunities for the development of scholarly work related to the HCC topics are just being realized. Divisions similar to ours may benefit from this curriculum to enhance professional development and standardize clinical care and teaching.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
This project was presented as a poster at the Pediatric Hospital Medicine Conference, August 2013, New Orleans, Louisiana.
- Academic Pediatric Association
- continuing medical education
- faculty development
- hospitalist core curriculum
- Pediatric Hospital Medicine Core Competencies
- Stucky ER,
- Maniscalco J,
- Ottolini MC,
- et al
- 6.↵Academic Pediatric Association. Six domains of faculty development Web site. Available at: http://www.ambpeds.org/education/education_sixDomains.cfm. Accessed July 11, 2012.
- 7.↵Washington University in Saint Louis Department of Pediatrics Division of Hospitalist Medicine Web site. Available at: http://peds.wustl.edu/hospitalists/Home. Accessed January 16, 2013.
- 8.↵Wikipedia. Design for Six Sigma. Available at: http://en.wikipedia.org/wiki/Design_for_Six_Sigma. Accessed August 14, 2012.
- Kaufman DM
- Pane L,
- Davis A,
- Ottolini M
- Morrison J
- Kern D,
- Thomas P,
- Hughs M
- Copyright © 2014 by the American Academy of Pediatrics