Inpatient staffing within pediatric residency programs: work hour restrictions and the evolving role of the pediatric hospitalist.

In October 2010, the Accreditation Council for Graduate Medical Education (ACGME) mandated new standards that will further restrict resident work hours. There is growing concern surrounding the impact these restrictions will have on the staffing of inpatient services. The objective of this study was to survey the landscape of pediatric resident coverage of noncritical care inpatient teaching services prior to the implementation of these guidelines. In addition, we sought to explore how changes in work hour restrictions might affect the role of pediatric hospitalists in training programs. In January 2010, an institutional review board (IRB)-approved electronic survey was sent to 196 US residency training programs via the Association of Pediatric Program Directors (APPD) listserve. One hundred twenty responses were received representing 5201 pediatric residents. Of the programs that responded, 84% have hospitalists. At programs with hospitalists (n = 97), 24% have pediatric hospitalist attendings in-house at night. Nearly a quarter of responding programs (22%) reported having no attending physicians in-house at night. At the time of our survey, 31% of programs anticipated the addition of 24-hour in-house hospitalist coverage within the next 5 years. When the additional work hour restrictions are implemented, 70% of programs anticipated the need to add additional hospitalist coverage at night. Significant variation exists in how pediatric teaching services provide overnight coverage. While hospitalists are prevalent in pediatric training programs (84% overall, 67% day only), their role in direct patient care during the overnight hours has been limited thus far. New work hour restrictions will promote the need for more hospitalists.

Oshimura J ，Sperring J ，Bauer BD ，Rauch DA ... -  《-》

Changes in inpatient staffing following implementation of new residency work hours.

In 2011, the Accreditation Council for Graduate Medical Education added additional resident work-hour restrictions that limited the number of hours residents could work, with increased emphasis on attending supervision. Our objective was to determine how residency programs have responded to residency work hours, specifically assessing residency night float systems and in-house attending physicians. In May 2012, an electronic survey was sent to all US pediatric residency training programs via the Association of Pediatric Program Directors listserv with e-mail reminders to nonresponding programs. We analyzed data to assess the use of resident night float systems, admission caps, and attending physicians in-house at night. Out of 198 programs contacted, 152 programs responded (77% response rate). Residency programs utilizing a night float system increased from 43% to 71% after new work hours were implemented. Overall use of resident admission caps did not change significantly. Twenty-three percent of programs increased the number of attending physicians in-house at night; 57% of those programs increased the number of pediatric hospitalist attendings, whereas 37% increased the number of pediatric intensivists. There is a trend toward increased pediatric hospitalist attending in-house 24/7 coverage. Of programs without 24/7 coverage, 26% plan to add coverage within 5 years. Only 12% of programs have no in-house attending coverage at night. Although programs vary in their response to changes in residency work restrictions, they most commonly utilize night float systems and increased the amount of in-house attending coverage at night, especially pediatric hospitalist attendings. Many programs plan to add 24/7 pediatric hospitalist coverage within 5 years.

Oshimura JM ，Sperring J ，Bauer BD ，Carroll AE ，Rauch DA ... -  《-》

Survey of academic pediatric hospitalist programs in the US: organizational, administrative, and financial factors.

Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure. To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM). This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV. The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site). PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development.

Gosdin C ，Simmons J ，Yau C ，Sucharew H ，Carlson D ，Paciorkowski N ... -  《-》

Hospitalists' involvement in pediatrics training: perspectives from pediatric residency program and clerkship directors.

Freed GL ，Dunham KM ，Lamarand KE ，Research Advisory Committee of the American Board of Pediatrics ... -  《-》

Hospitalist involvement in internal medicine residencies.

The ways hospitalists interact with and contribute to internal medicine residencies in the United States have been described locally, but have not been documented on a national level. To describe the penetration of hospitalists into medicine residency faculty nationally, and document their contributions to teaching activities. Survey of all 386 internal medicine residency directors in the United States in 2005 (272 respondents) and 2007 (236 respondents). Number of teaching hospitals utilizing hospitalists, number of programs utilizing hospitalists to teach, hospitalist teaching duties, and number with hospitalist tracks. In 2005, program directors recalled 54% of teaching hospitals employed hospitalists before and 73% after implementation of work-hour limitations. Of those employing hospitalists, 92% of programs in the Northeast and West used them to teach. Two years later, the Midwest (78%) and South (76%) continued to lag behind in the proportion of teaching hospitalists. Specific teaching activities of hospitalists included: attending on teaching service (92%), conducting rounds (81%), observation of clinical skills (67%), lectures (68%), and morning report (52%). Seven percent of program directors reported other duties of hospitalists, including: supervising procedures, reviewing night float patients, serving as associate program directors, and writing curricula. Eleven percent of training programs had hospitalist tracks. As hospitalists have become prevalent and have become efficient clinicians in community and university hospitals, the majority of internal medicine residencies have enlisted them to provide rounds, lectures, and bedside teaching. A small number of residencies are beginning to develop tracks to facilitate this new career option for graduates.

Beasley BW ，McBride J ，McDonald FS 《-》