March 21, 2022

HOMERuN Collaborative: Medical Education Focus Groups

The Hospital Medicine Reengineering Network (HOMERuN) is a national network of Hospital Medicine investigators at 12 academic medical centers (AMCs) and 50 affiliated sites.

Organizers and Facilitators: Matthew Sakumoto, Amit Pahwa, Marisha Burden, Nkemdilim Mgbojikwe, Jeffrey Schnipper, Andrew Auerbach Sites Participating in Focus Groups: Johns Hopkins Bayview Hopkins Medical Center, Oregon Health and Science University, Pennsylvania State University, UC Davis, University of Wisconsin, Johns Hopkins Hospital, Mount Sinai Health System, University of Colorado, University of Miami, UMass Medical School, University of Texas Austin, Denver Health, University of New Mexico, Cleveland Clinic, Beth Israel Deaconess Medical Center, Thomas Jefferson University Hospital, The Ohio State University College of Medicine, Brigham and Women's Hospital, UCSF

The Wards Rotation Multiple discussion on rounding styles What are the different rounding styles utilized? Teaching rounds, Discovery rounds, Direct care, Card flip, and more. How do you compare teaching styles within and across institutions? How do you compare the effectiveness of each of these styles, and what are appropriate metrics to carry out these assessments? How can we share rounding best practices throughout the HOMERuN Network?   Team structure and effect on educational goals At the attending level, what effect does a hospitalist versus a non-hospitalist medicine faculty have on the Wards experience? Is there an optimal number of residents, interns, and medical students? And what is the balance of teaching, supervision, workload, and autonomy? There was additional discussion of the effect of patient number and duty-hour caps, and effect of workload on the attending assuming direct care for additional patients.   Developing a framework for MedEd scholarly output For Quality Improvement, the EQUATOR Network has a number of frameworks and methods to structure operation QI work for scholarly presentation. HOMERuN could potentially develop something to guide MedEd efforts toward scholarly output.

"For the additional skills/knowledge, we want faculty to ask for help — they know who to go to, and are comfortable going to other attendings. If they have a question or disagree with a recommendation, we make sure they feel comfortable talking about it, and make sure they can handle challenging patients and communicate effectively."

Faculty Development Competency development for faculty While there are UME (medical student) and GME (resident) milestones and competencies, there is no specific set of competencies for physicians entering the hospitalist workforce. There is a possibility to develop and validate a template for guiding the early career academic hospitalist.   The “New Hospitalist” Handbook Logistics were identified as the main area of need. Answering questions like “Is MRI or echo available on weekends?” or “How do I contact the case manager?” are important in the first 90 days of working. Additional items like managing length of stay are often more difficult for the new hospitalist, and are often impacted by logistical questions like the ones above. Interpersonal communication skills were another area of focus. We recognized the importance of being comfortable asking other attendings and being comfortable with or knowing how to disagree with a recommendation from a colleague or consultant. Patient communication and handling challenging patients were also a focus of the interpersonal communication theme. Working with APPs (Advanced Practice Providers) is another skillset that is not always formally taught, and is becoming increasingly important in the hospitalist workflow and workforce.   Expansion of mentorship New faculty often onboard via the “buddy system” but compensation and clinical credit for the mentor is variable across institutions. How can we connect faculty to mentors across institutions, and possibly even use this as a way to accelerate dissemination of best practices from one institution to another?

Key Takeaways Ward Rounds are an area of high interest and high heterogeneity with many institutions looking to identify evidence-based best practices in rounding. As hospital medicine departments and divisions grow, faculty onboarding and faculty development have become a high priority at many HOMERuN institutions. Logistical information and Interpersonal communication are areas of high need for the early hospitalist.   Reach out to Matt Sakumoto or Amit Pahwa (matthew.sakumoto@ucsf.edu and pahwa@jhu.edu) if you're interested in joining the MedEd team. Or reach out to Tiffany (tiffany.lee@ucsf.edu) and she will connect you.

Studies Looking for Partners

The Reduce REVISITS Study: Reducing Respiratory Emergency Visits Using Implementation Science Interventions Tailored To Settings

Valerie Press, MD, MPH, of the University of Chicago is recruiting sites for the Reduce REVISITS Study (SUBMIT HERE). We are thrilled at the response we have gotten so far to our site recruitment efforts. However we are still looking for a few more sites. We have adjusted our timelines due to COVID surges, so see below for our extended deadline. Please reach out if you have any questions! We will collaborate with the Society of Hospital Medicine to harness their expertise with the Mentored Implementation Model (MIM) via their Mentor University to support sites to implement bundled transition of care interventions to reduce COPD revisits (ED visits and readmissions) after hospitalization for COPD exacerbations. All sites will participate in at least one virtual site visit followed by monthly mentoring meetings for one year. Half of sites will also receive expert co-design input. Participating sites will need to identify two site leads, obtain institutional support (letter of support), participate in data collection for planning and evaluation, and plan for sustained program implementation. Please submit if you are interested in participating by April 15, 2022. We will then follow-up with you with more information. Please contact Dr. Valerie Press with any questions (vpress@bsd.uchicago.edu).

Become a Site for the RELIANCE Study: Roflumilast or Azithromycin to Prevent COPD Exacerbations

Purpose of RELIANCE: Both roflumilast and azithromycin have been shown to reduce the risk of COPD exacerbations compared to placebo. However, there has not been a head-to-head comparison of these two FDA-approved medications. RELIANCE is intended to support hospital efforts to reduce the risk of all-cause hospitalization and premature deaths in individuals with COPD.  RELIANCE is Seeking Community-Based Hospitalists: Hospitalists are critical in the development of post-discharge care plans and medications used by people with COPD. We found from preliminary work that identification of people with COPD while they are hospitalized is an efficient recruitment method for RELIANCE. Benefits and Compensation: $500/year honorarium for being a community partner (paid after registration) plus $200 per patient enrolled. Option to participate in clinical roundtables with COPD thought leaders. Contribute topic ideas for future grant proposals or publications related to hospitalist care. Community Partners will not be investigators / authors, but will be acknowledged in the RELIANCE publication.  Please reach out to Tiffany.Lee@ucsf.edu if you are interested in participating and would like more information about RELIANCE.

Our next meeting will be on May 13, 2022.

Check out the HOMERuN COVID-19 Knowledge Base for more details. If you would like to join the HOMERuN Collaborative calls, please reach out to Tiffany.Lee@ucsf.edu.