Current Roles and Perceived Needs of Pediatric Hospital Medicine Fellowship Graduates

Discussion/Conclusions

PHM fellowship graduates in this study have diverse professional responsibilities, are academically productive, and hold local and national leadership roles. As a group, PHM fellowship graduates report relatively few persistent training needs with residual needs reflecting advanced topics in their relative academic domains.

Pediatric hospitalists are becoming leaders in QI, patient safety, education, and research.⁹ More pediatric residents are reporting hospital medicine as a career path,¹⁰ and there is growing realization that residency alone may not provide all the skills needed to practice PHM.^7,11,12 Our study supports other findings that early career hospitalists with PHM fellowship training, when compared with those without PHM fellowship training, have greater perceived competency in a representative sample of items from the PHM Core Competencies.⁷ Many PHM fellowship graduates report training needs in hospital program management, practice guideline design, and development of educational curricula. Fellowship programs should expand training in these clinical and administrative areas, particularly as the field of PHM matures.^13–15

In research, the need for training in more advanced research topics did not differ by duration of training. Considering graduates of ≥2-year programs may have received more comprehensive research training, this may highlight the study limitation that these are only perceived training needs. Additionally, many PHM graduates may have chosen the fellowship duration based on personal career goals. Those with interest in research-focused careers may have picked ≥2-year fellowships. PHM fellowship directors should consider these perspectives as they enhance program curricula.

Current roles of PHM fellowship graduates mirror graduates from academic general pediatrics (AGP) and other primary care fellowships with regard to remaining in academia, producing scholarship, and obtaining grants.^16,17 Additionally, curriculum gaps in research and administration have been described in other early fellowship programs.¹⁸ The number of first-author manuscripts in peer-reviewed journals produced by our PHM graduates exceeds the number produced by a study of both fellowship and nonfellowship trained pediatric hospitalists.¹⁹ Practicing pediatric hospitalists indicate desire to do research, but cite lack of time, resources, and mentorship as common barriers.¹⁹ Hospitalists without mentors produce fewer presentations and publications.²⁰ Fellowship programs offer structured ways to overcome these barriers and increase research productivity through research training, mentorship, and national networking.^12,21,22

Clinician-educators are challenged with balancing trainee education with optimal patient care.^23,24 Effective clinical teaching likely requires additional training beyond residency.²⁴ Several studies have documented the positive role of hospitalists as clinician-educators,²⁵ but a previous study of PHM fellowship curricula indicated lack of formal education training.¹ Our study revealed PHM fellowship programs are meeting fellows’ needs with specific teaching skills, but enhanced training in curriculum development is needed, especially for fellows pursuing educational leadership or scholarship.

Although the number of graduates with leadership positions in our study was fewer than those held by Academic General Pediatric fellowship graduates, we suspect this is due to difference in the number of years in clinical practice at the time of the studies.¹⁶ If our graduates follow the same trajectory as AGP fellowship graduates, we would expect the number of leadership positions held by PHM fellowship graduates to increase.

Fellowship graduates report some uniformity regarding PHM fellowship curricular elements, which correlates with a recent survey of fellowship program directors.¹³ Interestingly, of the 20% of responding graduates who indicated training was too short, most completed 1-year programs. Given that graduates of longer programs have fewer training needs in research and greater likelihood of formal QI/roles in their current positions, ≥2-year fellowship programs may be more appropriate. In a study of fellowship training for primary care medical school faculty, 1 year of research during fellowship was associated with increased grant proposals, funding, publications, and higher academic rank.²⁶ These are important considerations as program directors solidify fellowship goals in response to certification options.²⁷

This study has several limitations. Although the authors attempted to identify all PHM fellowship graduates before 2014, there is potential for sampling bias. Additionally, there is potential for response bias as we measured self-assessment of training needs rather than objective measure of competency. A future investigation could compare current roles and training outcomes of PHM and non-PHM fellowship graduates.

In this study, PHM fellowship graduates are academic hospitalists with diverse leadership and professional responsibilities. Although many are early in their hospital medicine careers, they are academically productive and hold leadership roles at institutional and national levels. PHM fellowships are meeting the needs of graduates in many areas, but areas for curricular enhancement were identified, including procedural training, practice management, research, and QI. Future studies should target curricular innovation in these areas and development of standard assessment tools related to competency attainment for use across programs.