Introduction
The primary purpose of the fellowship is to provide trainees with an opportunity to experience inpatient care as provided through a Hospital Medicine Service, an approach that is becoming increasingly common in hospitals across Canada. The specific educational goals and objectives, classified by CanMEDS roles, include:
Medical Expert:
- Appreciate and understand the structure, organization and operation of a Hospital Medicine Service and the critical role of Hospitalists in the Ontario health care system.
- Enhance knowledge, skills and experience in performing the central clinical roles routinely carried out by Hospitalists including:
- Triaging medical admission from the ED, ICU and CCU
- Completing focused but comprehensive admission histories, physical examinations and management plans for complex medical patients
- Mastering comprehensive, discharge planning to ensure patients with complex medical problems have safe and efficient transitions from the inpatient wards to the community or Rehabilitation/LTC/Convalescent Care Site.
- Demonstrating awareness of the risk factors predicting patient readmissions, and strategies to reduce unplanned re-admissions
- Improve their knowledge, skills and performance in managing complex medical problems commonly encountered by Hospitalists, including using the best available evidence, clinical guidelines, and standard protocols. Common medical conditions include, but are not limited to:
- Acute Coronary Syndrome
- Acute Renal Failure
- Alcohol and Drug Withdrawal
- Asthma
- Cancer and Treatment-Associated Conditions
- Cardiac Arrhythmia
- Cellulitis
- Chronic Obstructive Pulmonary Disease
- Cirrhosis
- Community-Acquired Pneumonia
- Congestive Heart Failure
- Delirium and Dementia
- Diabetes Mellitus
- Gastrointestinal Bleed
- Hospital-Acquired Pneumonia
- Pain Management
- Perioperative Medicine and Co-management
- Sepsis Syndrome
- Stroke
- Urinary Tract Infection
- Venous Thromboembolism
- Diagnostic and Therapeutic Procedures Commonly used by Hospitalists
- Arthrocentesis
- Thoracentesis
- Paracentesis
- Lumbar puncture
- Point of Care Ultrasound
Communicator:
- Acquire enhanced skills in effective communication with patient and their families, to promote shared decision-making.
- Develop conflict management skills to manage to emotionally-charged conversations with other Health Care Providers (HCPs), consultants, patients and family members
- Document clinical encounters in an accurate, complete, timely and accessible manner, in compliance with legal and regulatory requirements
- Effectively communicate to Primary Care Providers (PCPs) using the electronic Discharge Summary
Collaborator:
- Understand the roles and responsibilities of the various members of the other HCPs on the Interprofessional (IP) Teams
- Demonstrate expertise in collaborating with other HCPs, consulting physicians and collaborating trainees
- Acquire a greater appreciation of the central role of effective communication in improving interprofessional patient care including:
- written and verbal case presentations
- problem-based progress notes
- strategies to improve clinical “handover” during the rotation
- discharge summaries and effective communication with physicians in the community
- Demonstrate effective, evidence-based handover of patient care through both electronic sign-out tools and face-to-face verbal handover with covering physicians/residents at the end of the day
Leader/Health Advocate:
- Become familiar with strategies routinely used by Hospitalists to assess performance including:
- Utilization statistics, Benchmarks, Performance Measurements
- Understand the basic methods and approaches used for Quality Improvement and Patient Safety initiatives
- Apply evidence and management processes to achieve cost-appropriate care
- Demonstrate consistent advocacy for patients, irrespective of socioeconomic status, cultural background, sexual identity, religious affiliation
- Contribute to a culture that promotes patient safety
- Informed by principles of health equity, address the unique health needs and barriers to access to appropriate health and social services of medically underserved populations
Scholar:
- Opportunity to participate in quality improvement activities (e.g., through OpenLab/CEEP at UHN or other ongoing unit and hospital-specific QI initiatives) looking at related innovations in health services, medical education or both
- Demonstrate effective bedside and small-group teaching during formal and informal case rounds
Specific Educational Activities
During the rotation,
most learning occurs directly in association with patient care activities, including reviewing case presentations, discussing investigation and management strategies, and discharge planning, in conjunction with the attending physician and the rest of the team. All residents and fellows are also encouraged to attend Morning Report, IC/DC (Bullet) Rounds, Noon Rounds, and Medical Grand Rounds. When patient care responsibilities permit, they are encouraged to participate in scheduled educational sessions organized for the General Medicine Teams. While didactic educational sessions provide value, the education emphasis of this
clinical fellowship will be found in the daily assessment and management of patients. This is a competency-based learning fellowship, which means that the learning is “by doing”, including bedside teaching and patient care reviews. Classroom-based learning is de-emphasized. The Hospital Medicine attending will provide a minimum of 2 structured Team teaching sessions per week, at 3:00 pm on Tuesdays and Thursdays (or other agreed-upon days) on topics related to Hospital Medicine.
Evaluation
All residents and fellows will have a formal evaluation at the completion of each block using standard U of T in-training evaluation forms. Informal feedback is provided by the Attending Physician at the midpoint of the rotation, as well as on an ongoing regular basis.
