In the diverse landscape of internal medicine, hospitalists, or hospital medicine physicians, play a crucial role in shaping the care of some of the most vulnerable patients. Hospitalists are trained in many competencies, ranging from focused bedside procedures and clinical skills to broader systems-level proficiencies like institutional billing and quality improvement. A new paper by Yale School of Medicine researchers published in the Journal of General Internal Medicine examines hospital medicine training among internal medicine residents to identify educational gaps and assess resident confidence in the field.
According to the paper's lead author, Christopher Sankey, MD, associate professor of medicine (general medicine), the investigation stemmed from the results of a local needs assessment he conducted among Yale internal medicine residents. "I first looked at the number of graduates from our medicine residency programs who took hospital medicine jobs from 2017 through 2022—it was about 70 residents, more than gastroenterology and cardiology combined,” stated Sankey. “I realized that if so many of our graduates are entering hospital medicine, they need to be prepared.”
Sankey crafted a survey for Yale learners and discovered gaps in self-assessed confidence in pertinent hospital-medicine proficiencies. “I began wondering—was this just a Yale phenomenon, or part of a larger trend among internal medicine trainees?" he said.
To investigate this broader question, Sankey worked with senior author Donna Windish, MD, MPH, professor of medicine (general medicine), and a collaborator from Oregon Health Sciences University. The researchers surveyed almost 600 internal medicine residents at institutions across the United States, representing both academic and community-based centers. The participants included residents from various training levels (PGY1 through PGY4), as well as residents considering and not considering a future career as a hospitalist. This was the first study of its kind to include such a large and diverse sample size. “Having a broad representation of internal medicine residents who train at different programs helps us better understand the generalizability of these findings,” said Windish.
Participants were asked to rank their confidence and desire for further education in 44 specific hospital medicine competencies gathered from published guidelines. The researchers received responses from 272 residents, reflecting a 46% response rate. Responses were dichotomized, with PGY1 and PGY2 trainees termed junior residents, while PGY3 and PGY4 trainees were marked as senior residents. Unsurprisingly, junior residents expressed lower confidence in all domains except patient-level competencies. They also expressed a higher desire for further teaching in all domains compared to the senior residents.
Interestingly, no differences were observed in confidence or desire for more teaching between residents pursuing hospital medicine careers and those who weren’t. “This showed that the responses weren’t driven by a subset of residents focused on hospital medicine, but rather were emblematic of the broader views of trainees regarding general medical core training," stated Sankey.
Overall, the results of the study reflected similar findings to the local needs assessment Sankey had previously administered at Yale; all residents had lower than expected confidence for each hospital medicine competency surveyed, showing the lowest confidence for procedures, point-of-care ultrasound, and systems-level competencies. Confidence was highest for patient-level competencies, care transitions, and palliative care.
Windish emphasized the importance of these findings and their implications for the future of hospital medicine education. “This study brings to light that hospital medicine competencies may not be adequately taught in resident training,” she said. “This could be problematic for future hospital medicine providers who may not be prepared to meet the expectations of their jobs upon entry into the field.”
Going forward, Sankey is hopeful that this study will positively impact hospital medicine education. He emphasized the importance of learner feedback.
“Philosophically, the question is: What do learners want, and what do we think they need?” he said. “This study is a small but important first step toward incorporating learner feedback into the curricula we design, something that hasn’t been common in the past but will be crucial moving forward."
To learn more, read the paper “Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.”
The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.