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Pediatric Hospital Medicine Fellowship: Curriculum

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This two-year Pediatric Hospital Medicine Fellowship aims to provide a foundation for the development of academic pediatric hospitalists in the following domains:

  • Clinical Care
  • Leadership
  • Education
  • Quality Improvement
  • Scholarship

The curriculum is learner-centered and flexible in recognition of the fact that each fellow brings a unique array of background experiences and innate interests that will drive their ongoing development as an academic hospitalist. Some basic components of our curriculum are provided below.

Clinical Care

The fellow will spend approximately 50% of their time on clinical care duties. The fellow will rotate through our clinical services as well as our call-based shifts (day, evening, and overnight). There will be a supervised progression towards increasing autonomy in this process, based on the comfort level of the fellow, colleagues (attendings) and the fellowship director. Off-hour shifts (weekends, evenings, overnights) will be scheduled variably from block to block depending on scheduling demands and the clinical progress of the fellow.

Leadership

Our hospitalist faculty group represents a diverse collection of leadership experiences, current and past, and individuals have achieved the highest levels of physician leadership within our organization. An area of focus for all faculty has been the ongoing development of leadership skills through ownership of projects deemed to be of strategic merit to the group’s ongoing growth. Because leadership styles vary, the fellow will spend time accompanying various hospitalists through their leadership activities in an implicit and explicit attempt to provide education in these arenas.

Education

Education is an integral part of the core mission and vision of our hospitalist group and central to the academic setting. Our hospitalist faculty are considered core faculty of the Pediatric Residency Program and medical student clerkships in Austin. With a wealth of experience and insight into the increasingly complex world of medical education, our faculty represent a tremendous resource for not only the fellowship but also all medical learners and educators in the Austin programs. In addition to direct observation of the different educational activities in which faculty participate, the fellow will have direct responsibility for education during:

  • Their clinical care activities
  • The Teaching Attending rotation, where 2nd year residents are trained as educators
  • Small group teaching (morning report) and lecture (noon conference) activities
  • The completion of an educational project, to be discussed early in the year with the fellowship director

Quality Improvement

Quality improvement is now universally recognized as an integral part of any hospitalist group’s contributions to their patients and institutions. However, very few clinicians have received formal training in this science. We are fortunate to have access to a structured, project-based and multidisciplinary Quality Improvement course offered by Seton, our sponsoring institution, here at Dell Children’s. The fellows will participate in this course during their first year of fellowship, with the option of using their QI project as their fellow’s scholarly project, and the expectation of the project being submitted to a national conference at the conclusion of the first year. 
Time throughout fellowship will be spent surveying the numerous leadership roles in which our core faculty are engaged with respect to hospital-based improvement activities. From patient- and family-centered care initiatives to partnership with unit nurses on safety to improving communication with PCPs on discharge to leading hospital-wide education in efforts to become a High Reliability Organization, we are involved in the full spectrum health care delivery improvement. Exposure to these efforts should provide a base for the fellow’s project-based learning experience in the Quality Improvement Course.

Scholarship

If achievement of excellence is a core goal of the academic mission, then scholarship is the currency by which this effort is measured. Similarly, as scientists we are obligated to objectively demonstrate and disseminate our efforts through scholarship. This takes many forms and our group has increasingly produced scholarly product in the form of posters, presentations and national quality improvement projects. The fellow will be expected to submit a scholarly product to a national conference at the conclusion of years 1 and 2. This product may emanate from the fellow’s work in the areas of Clinical Care, Education, Quality Improvement or Research; and the final product may be a continuation of the first year’s work, at the discretion of the program director. Scholarly mentorship will be arranged through local faculty depending on the project and needs of the individual.

Evaluation and Feedback

Feedback will be provided continuously throughout the fellowship in the process of faculty supervision and mentorship. It is expected that the fellow will define goals and objectives both longitudinally throughout the fellowship as well as for each defined block of clinical or non-clinical activities. These goals will provide a foundation on which to guide individualized curriculum development and subsequent evaluation. Intensive clinical time will be followed by formal evaluation with a paired faculty supervisor. Scholarly activities and improvement projects will be evaluated at the relative midpoint and conclusion of the projects.

Ongoing development in all of these areas will require consistent attention on the part of both the fellow and faculty mentors. The fellow is expected to demonstrate initiative and accountability with respect to the budgeting of time for learning in each of these domains and will have frequent discussions with the fellowship director regarding scheduling for each of these activities. The fellow will be surrounded by a diverse group of faculty with varying interests and mentoring styles. Mentoring relationships begin with communication and there is an expectation that both the fellow and the faculty will feel comfortable extending and accepting offers for assistance on a continual basis.

Fellows will also enjoy many of the benefits of attending faculty:

  • Credentialing: This should be thought of as a privilege that allows for autonomous work and clinical growth. The program will continue to provide clinical supervision based on a mutual and ongoing discussion of clinical readiness and competency. Expenses of credentialing will be reimbursed to include: Texas Medical License, Texas DPS, and DEA
  • Benefits: The Seton Family of Hospitals will provide employment and a link to benefit information will be provided after the interview or earlier upon request.
  • Professional Development Funds: Faculty receive  funding for conference attendance, professional organization fees and books.
  • Vacation/CME: Three weeks of vacation are provided per year.  In addition, ten days per year of CME time are supported by the program.

Successful completion of all expectations of the first year of fellowship, along with consensus agreement from faculty and program directors (based on feedback and evaluations), will be necessary for matriculation into the second year of fellowship.  In addition, consideration for faculty appointment following completion of the fellowship will be contingent upon a formal interview for a faculty position as well as performance and evaluations over the  course of the fellowship.