PHM Fellowships: Advanced Training for an Evolving Field

We read with interest “A Changing Landscape: Understanding Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.”¹ The publication is timely, given the recent designation of Pediatric Hospital Medicine (PHM) as a subspecialty by the American Board of Medical Specialties and the American Board of Pediatrics (ABP), as well as initial accreditation of PHM fellowships by the Accreditation Council for Graduate Medical Education. Through this commentary, we seek to discuss the study findings and highlight the current landscape of PHM fellowship training as influenced by the PHM fellowship curricular framework, the ABP PHM subboard content, and the newly revised PHM Core Competencies.

The authors sought to characterize categorical pediatric and combined pediatric residents’ perceptions of PHM fellowships, including barriers and facilitators to pursuing such training. In 2018, an anonymous online survey was sent to residency program directors and 23% agreed to distribute the survey. A total of 2657 residents were surveyed; 32.2% (855) responded. Study findings suggest that although many residents saw value in PHM fellowships, they also reported concerns. A majority of respondents cited potential for higher future earnings and opportunity to gain new skills in both clinical and scholarly domains as important factors encouraging them to pursue fellowship. Specifically, half of respondents stated that they would value training in each of the following areas: medical education, quality improvement, hospital administration, research, and clinical medicine. However, a majority reported that they were “somewhat” or “less likely” to pursue a position in PHM after PHM fellowship became required for board eligibility. Personal and financial factors, including family obligations, forfeited earnings while in fellowship, and existing educational debt, influenced the decision to pursue fellowship for some. The authors …