Developing a Hospital Medicine Elective for a Family Medicine Residency
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Publication Date
2025
Keywords
oregon, oaa 2025
Disciplines
Family Medicine | Medical Education
Abstract
Background: Inpatient medicine is a key area of family medicine training, providing experiences in both triage and management of decompensated illness and building skills in safe transitions back to outpatient care. There is a growing trend of FM-trained physicians providing inpatient care (3-7% growth in some studies), but the training in many FM programs lacks the volume of hospital medicine that is needed for comfort with independent hospital work. Despite our FM residency including more hospital medicine training than many FM programs, and more than required of FM residencies per ACGME guidelines, there were still deficits in our volume of inpatient day coverage and critical care training when compared to two local IM residencies. Purpose: We aimed to design a hospital medicine elective experience that FM residents could take in the PGY2 or PGY3 years to augment the inpatient medicine experiences and help residents gain further proficiency in acute and critical patient care. Design: The elective was designed as a 4-week experience. The residents taking any elective rotations were surveyed in July of the 2024-2025 academic year, and again in February. Setting & Participants: Participants were PGY3 family medicine residents at a small, academic community hospital. Intervention: The 4-week elective implemented during the 2024-2025 academic year included 2 weeks of critical care time, a one-week rotation with a community hospitalist training residents to manage a higher volume of hospitalized patients, and one week focused on training in hospital-based procedures and POCUS. Main outcome measures: Residents evaluated their level of confidence with management of critical care cases, a high hospital census, and selected hospital procedures and POCUS skills at the beginning of the 2024-2025 academic year and in February 2025. Residents taking the hospital medicine elective also completed qualitative evaluations on the elective experience. Results: While the N of this study is underpowered for meaningful quantitative analysis (only two PGY3 residents chose to take this elective in the 2024-2025 academic year), key stakeholder interviews show success with POCUS training in the ED with 1:1 precepting, working directly with hospitalists, and gaining intubation experience with anesthesia providers. Areas for improvement included the ability to rotate at larger medical centers for medical ICU training, timing of hospital rotations to be during high-census seasons, and improvement in procedure training opportunities. Administrative staff gave feedback that the rotation was challenging to schedule given many preceptors and locations. Conclusions: Key learning points in the development of this elective were the challenges of coordinating complex elective experiences with multiple subspecialty partners and ensuring that residents are having high-value learning experiences. Key lessons from the post-elective stakeholder interviews include a need for a simplified schedule structure, improved procedural and ICU experiences, and ensuring residents can rotate in high hospital census seasons (although, this is unpredictable). Next steps are to discuss options for ICU and procedural experiences with program administration and work to develop ties with high-value learning opportunities.
Specialty/Research Institute
Family Medicine
Specialty/Research Institute
Graduate Medical Education
