The Core Competencies in Hospital Medicine: A Framework
for Curriculum Development published in the January/February
2006 Supplement of the Journal of Hospital Medicine, is a blueprint to
develop standardized curricula for teaching Hospital Medicine in medical
school, post-graduate (i.e., residency, fellowship), and continuing
medical education programs. The competencies standardize expected
learning outcomes, but leave it to the curriculum developers and content
experts to select instructional strategies, provide relevancy of
context, and select the most relevant and up to date medical
content.
The publication contains 51 chapters, divided into three sections:
Clinical Conditions, Healthcare Systems, and Procedures. Each chapter
has an introduction followed by learning objectives categorized into
knowledge, skills or attitudes. Some chapters have a fourth section,
“system improvement” that lists specific activities of a
Hospitalist to improve the system of care. Statements in this fourth
section allow for a range of expectations and proficiencies.
SHM will use the core competencies to drive education programs. SHM
is currently engaged in an analysis to identify gaps in our educational
efforts relative to the core competencies, with a focus on healthcare
system topics such as quality improvement, transitions of care, patient
education, palliative care, and information management. Educational
modalities are being explored including POD Casts, webinars,
conferences, and CME modules and physician preferences for the
modalities are being analyzed.
We hope educators will utilize these competencies to revise and/or
develop curricula; and assess their current programs. Further, we hope
review of these competencies by the larger medical community will lead
to educational reform that better prepares physicians to become
Hospitalists. The Core Competencies were developed with the following
audiences in mind:
Directors of Continuing Medical Education
Hospitalist fellowship directors
Residency program directors
Medical School Internal Medicine Clerkship directors
Hospital administrators/leaders
The Core Competencies offer residency Program Directors an
opportunity to help meet the goals outlined by the ACGME Outcomes
Project. The Core Competencies addresses all six of the ACGME
competencies, especially communication skills, medical knowledge,
systems-based practice, and practice-based learning and improvement. By
incorporating the Core Competencies in Hospital Medicine into residency
curricula, a Program Director can meet the ACGME requirements and teach
resident physicians many of the issues that often fall outside
traditional medical curricula.
The Core Competencies should provide the framework of professional
development for and evaluation of hospitalists. Any hospitalist-specific
CME should be developed around the Core Competencies. For example, a
program on community-acquired pneumonia (CAP) should not only focus on
the common etiologic agents of CAP, but also on how hospitalists can
assist in ensuring hospital-wide adherence to The
Joint Commission standards. Similarly, if one is leading a
hospitalist program, the Core Competencies can provide the 'common
language' for evaluation of physicians in that program.
What methodology was used to develop the core competencies?
A Task Force representing academic and community Hospitalists from
varying U.S. regions was formed following SHM's Education Summit in
2002. The Task Force developed an initial table of contents and
structure for the Core Competencies which was vetted through SHM's
various regional chapters and councils, as well as the Education
Committee and Executive Committee. Contributors were selected based on a
nomination and panel review process. When appropriate, authors were
paired with non-hospitalist experts. Once submitted, chapters underwent
an extensive editing process for accuracy, level of detail, formatting
and adherence to established educational principles. The final document
underwent internal and external review. Once all review comments were
received, the TF editorial board reviewed each comment and made changes
to the Competencies when necessary.
Who contributed to the development of the core competencies?
The Core Competencies are a result of the contributions of over 100
hospitalists and other content experts, under the guidance and
leadership of the SHM Core Curriculum Task Force and Editorial Board.
Task Force members were chosen from university and community hospitals,
teaching and non-teaching programs, for- and not-for-profit programs,
and from all geographic regions of the United States to ensure broad
representation of practicing Hospitalists and SHM membership. The
editors are Michael Pistoria, DO; Alpesh Amin, MD, MBA; Daniel Dressler,
MD, MSc; Sylvia McKean, MD; and Tina Budnitz, MPH.
How are the core competencies different from other competency
guidelines?
The Core Competencies integrates the six competencies of ACGME into
the four sections of each chapter. Besides the traditional knowledge
(cognitive domain), skills (affective domain), attitudes (psychomotor
domain) sections, a fourth section on systems-based practice was
included to highlight the role of Hospitalists in improving the systems
(hospital) in which they work.
Other published competencies often use vague terms like "understand"
that give little or no insight into the level of proficiency that is
expected. The Core Competencies are carefully crafted to place the
concept at the correct level of proficiency.
Why aren't all clinical conditions addressed?
The Core Competencies in Hospital Medicine is meant to guide
educators to develop curricula that incorporates the competencies into
the training and evaluation of students, clinicians-in-training, and
practicing hospitalists. It is not meant to contain a complete
compilation of all inpatient clinical topics or recreate what many
residency training programs in adult inpatient care already provide. It
should not limit and does not define every aspect of hospitalist
practice. It includes the most common and fundamental elements of
inpatient care without an exhaustive listing of every clinical entity
that may be encountered by a hospitalist. Some of the more common
clinical topics encountered by inpatient physicians are included, with
an emphasis on subject areas that stress the systems-based approach to
healthcare, which is central to the practice of Hospital Medicine. The
Core Competencies also focuses on potential areas that could enhance the
training of physicians to reflect the current practice of
hospitalists.
What changes can be expected in future editions?
The Society of Hospital will analyze feedback from residency
directors, curriculum developers and other medical educators and
practicing Hospitalists to determine how future editions of the Core
Competencies can best meet the needs of its audience. Already underway
are the development of chapters for additional clinical topics and a
pediatric hospital medicine supplement.
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