AS ACADEMIC HOSPITALIST PROGRAMS continue to expand, growing numbers of early career hospitalists—those out of residency five years or less—are being hired to work on non-teaching services. Most of those junior faculty have little teaching or research time, and they struggle to find mentors who could help them score such opportunities.
“After a few years,” says hospitalist Elizabeth Murphy, MD, assistant professor at the University of Chicago, “some do find a niche in academic medicine in teaching or leadership or quality roles.” But early career physicians often lack any kind of roadmap to help them “access the wealth of institutional knowledge” or identify opportunities to advance their careers. As a result, “some just leave academia.”
To help young hospitalists develop solid, long-term academic careers, Dr. Murphy and her colleague Shannon Martin, MD, MS, developed and launched in 2020 what they call The Passport to Clinical Teaching Program. As described in a perspective published this January in the Journal of Hospital Medicine, the two-year program is structured around activities in eight domains that focus on developing medical education, scholarship and teaching skills.
“We need to find a way for people to do a small amount of academia while staying very clinically active.”
Elizabeth Murphy, MD
University of Chicago
Participating hospitalists pick and choose among those activities, then check off those they complete, getting feedback on their performance in the program twice a year from Drs. Martin and Murphy. (In fact, the biannual review is one of the eight passport domains.) In return for completing activities, they receive prioritized scheduling for teaching slots.
“Academic centers need to help clinically active hospitalists have rewarding careers,” Dr. Murphy says. While not everyone will end up being “a bigtime researcher or medical education leader, we need to find a way for people to do a small amount of academia while staying very clinically active.”
Structure and flexibility
According to Dr. Murphy, she and her colleagues borrowed the “passport” concept from undergraduate and graduate medical education. The idea is to have a visual tool of requirements that learners work through on their own time, “stamping” different ones they complete.
In her program’s first iteration, Dr. Murphy says the “passport” was an Excel spreadsheet that participants updated as they finished activities. She has since received a grant so that successive programs—and enrollment is ongoing, with a new two-year program started every year for new hires—can create an electronic tool where each participant receives his or her own passport dashboard.
Each of the various domains typically contains up to six different activities, each with its own anticipated time commitment and a suggested timeframe for finishing.
Physicians in the program are expected to do at least one activity in each domain over the course of two years. But “there’s a great deal of flexibility,” says Dr. Murphy. “If people are already participating in something that we didn’t think of, that can certainly count toward fulfilling the requirements in one of the domains.”
As for engaging in scholarship, which along with teaching is a key program focus, “people really surpassed our expectations,” she points out. Over the course of the first two-year program, for instance, while 20% reported active new scholarship after participating for six months, that percentage at 12 months had risen to 90%.
In terms of teaching shifts, passport participants reported that 17.6% of their shifts were teaching shifts vs. only 9.5% of shifts among early career hospitalists at the University of Chicago who were not enrolled in the program.
A hybrid mentorship model
Mentorship is another key aspect of the program— and a real challenge in hospital medicine. “Because the field is relatively new, we don’t have many people in the top rungs of academia as a full or even associate professor,” Dr. Murphy points out. “It’s not realistic to think that the limited number of very senior people can mentor all the junior faculty.”
Through their biannual reviews, she and Dr. Martin—and “we’re both mid-career”—stepped into that mentor role for program participants through what she calls “a hybrid mentorship arrangement.” They are also pursuing innovative ways of offering mentorship, working with the Society of Hospital Medicine, the Society of General Internal Medicine and HOMERuN (the Hospital Medicine Re-Engineering Network) to encourage academic centers to pool their resources and create a national network of potential mentors.
Colleagues in her academic center, led by Matt Cerasale, MD, MPH, director of quality improvement for hospital medicine, have used the passport model to create a similar program for early career physicians interested in quality improvement.
As for building such a program from scratch, “the initial development obviously takes time to put resources together,” Dr. Murphy says—but that might not be too onerous if program leaders “are highly knowledgeable of what’s available.” As the passport program has continued, she and her colleagues have also put together a user’s guide that collates all the information for each activity, with contact and cost information.
And when it comes to the mentorship piece, “that is a time commitment,” Dr. Murphy admits. “But for someone like me whose work is faculty development, it’s something we should probably be doing anyway. A program like this at least provides structure and focus.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.
Published in the March/April 2023 issue of Today’s Hospitalist