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To keep its physicians sharp, one group is trying new ways to educate hospitalists
Sound Inpatient Physicians in Tacoma has reinvented its journal club meeting to serve a large—and growing—practice
by Michael Mena, MD



Published in the March 2006 issue of Today's Hospitalist

Sound Inpatient Physicians is a hospitalist group that employs nearly 80 physicians in Washington, Oregon and Montana. We aim to provide superior patient care, in part by recognizing that our physicians are central to the achievement of this goal.

A key strategy to meet that goal revolves around our efforts to educate the hospitalists who work for our group. In our view, because the education of hospitalists should not take place solely in the clinical practice of medicine, our physicians need additional resources.

Whether hospitalists are fresh out of residency or veterans of private
“To encourage collegiality, we invite area primary care providers and hospitalists from other groups, along with specialists, ER physicians and internal medicine residents.”

Michael Mena, MD
Sound Inpatient Physicians
practice, they all can benefit from information on a wide range of topics, from clinical medicine to risk management and the business of medicine.

As the educational director of Sound Inpatient Physicians, I am responsible for creating the group’s curriculum and organizing the events that support it. In this article, I’d like to give an overview of our educational efforts.

Orientation for new hospitalists

To help bring hospitalists new to our group up to speed, we have created an orientation that explains our systems and processes.

New hospitalists spend one to two days at our main office in Tacoma, where they learn about billing and coding. We’ve found that particularly for hospitalists who are just out of training who may have little experience with billing, spending a little up-front time learning the basics of coding and documentation helps eliminate problems with coding and documentation down the road.

During that initial orientation period, we also teach new physicians to use our Web-based coding and billing software. This system, which was developed exclusively for our group, lets our hospitalists tap into not only billing and coding information, but create checkout lists for their patients. Physicians can enter information like patient history, medication lists and issues for follow-up on our Web-based software, then print it out and round with the list.

Once this orientation is complete, new hospitalists undergo a second orientation that takes place at the location where they will be practicing. An experienced hospitalist guides our new physicians through their initial period of practice for two or three days, teaching them the ins and outs of the system of their new hospital.

CME for hospitalists

Just because a physician’s orientation period is over doesn’t mean that educational efforts come to a halt. Sound Inpatient Physicians holds CME meetings about once a month to keep physicians up to date on a variety of issues.

Our meetings originally began as journal clubs, where we brought together hospitalists to discuss interesting articles that had been published in major journals. As our group grew and these meetings evolved, we began to invite local specialists from the hospitals where we work to give presentations on their areas of expertise.

In 2005, our CME meetings covered a variety of topics that included community-acquired MRSA infections, stroke and CHF management. We also addressed more topical issues such as medical malpractice and avian influenza.

In 2006, we are creating a more structured curriculum. We will hold 10 meetings that focus on our 10 most frequently encountered DRGs: congestive heart failure, pneumonia, GI bleeds, stroke, COPD, diabetes-related issues, acute coronary syndrome, infectious issues/sepsis, delirium, and co-management of hip fracture.

We are inviting specialists and hospitalists from academic medical centers to discuss evidence-based approaches for each of these conditions. After a one-hour presentation on the main topic, we’ll open up the discussion to questions. As I write this article, we’re planning conferences on clostridium difficile, GI bleeding and antimicrobial resistance.

Reaching out to non-hospitalists

On topics for which there is not much new evidence, we may focus on a slightly different issue within that specialty. For our meeting on GI bleeding, for example, we’re planning to invite a gastroenterologist to discuss issues surrounding the diagnosis and treatment of hepatitis C. As a wrap-up to that discussion, we’ll review new data—and answer hospitalists’ questions—about GI bleeds.

At the end of the meetings, we’ll also address concerns members of the audience have about topics like quality improvement.

It’s important to note that we invite non-hospitalists to attend these CME meetings. To encourage collegiality, in fact, we invite area primary care providers and hospitalists from other groups, along with specialists, ER physicians and internal medicine residents.

Our recent meeting on avian infl uenza, for example, attracted a number of ER physicians, pulmonologists, infectious disease physicians, and several internal medicine residents from the University of Washington.

These meetings give our hospitalists an excellent opportunity to interact with their colleagues who work outside the hospital environment. I often have a chance to meet primary care physicians who work with our group, but who I rarely have a chance to meet.

Keeping things interesting

As Sound Inpatient Physicians has grown, one of the challenges in holding these CME meetings has been maintaining interest among a large group of hospitalists. We are working hard not only to create a venue that’s convenient for a large number of physicians, but to motivate them to attend a one- or two-hour meeting in the middle of their very busy schedules.

We tend to hold these meetings at popular restaurants in the middle of the week. We also raffle off items such as the latest edition of “Harrison’s Principles of Internal Medicine” with online access, iPod Shuffles and tickets to Seattle Sonics games.

Another challenge we face is reaching a geographically dispersed audience. While most of our hospitalists work in the Seattle/Tacoma area, a number of our physicians work in Oregon and Montana, and they can’t easily attend our CME meetings.

To reach these physicians, we will soon begin putting PDF files of our CME meetings on our group’s Web site. These summaries will provide an overview of the material and a short quiz to make sure that each physician has had a chance to review the lecture’s main messages. In addition, hospitalists who complete the quiz will earn CME credit.

Boosting performance through education

Our Web site will help us disseminate the content of our CME meetings, a strategy that will not only facilitate learning among hospitalists at all our practice sites, but also encourage our physicians to regularly communicate with us.

We plan to circulate information from our core curriculum and our CME meetings to address best practices on an ongoing basis. Our educational staff will update this information regularly.

For any group of physicians, the desire to learn and continually provide superior care is of paramount importance. We believe that through our educational efforts, we can help our physicians perform better than they would alone.

Realizing these objectives will allow our physicians to grow both as hospitalists and as members of their hospitals’ medical staff. By continuing to develop and refine our educational programs, we can help our physicians provide a superior level of service to every patient, hospital and community where our practice has a presence.

Michael Mena, MD, is educational director with Sound Inpatient Physicians, which operates hospitalist programs in Washington, Oregon and Montana.

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