Table 1.

Underemphasized Areas of Training for Hospitalists*

Clinical areas	Examples of training needs
Perioperative medicine	Surgical risk assessment and patient optimization
	Perioperative pain and symptom management
	Perioperative venous thromboprophylaxis
	Perioperative diabetes management
	Rapid assessment of the surgical abdomen
Consultative medicine	Effective medical consultation
	Understanding the consultant versus co-management role
Orthopedics	Management of acute hip fracture and joint arthroplasty
	Basics of acute rehabilitation medicine
Neurology/neurosurgery	Management of blood pressure and diabetes in acute stroke
	Indications and contraindications to thrombolytic use in acute stroke
	Risk assessment in transient ischemic attack
	Management of acute seizure and status epilepticus
	Acute medical management of intracranial, subarachnoid and subdural hemorrhage
Geriatrics	Rational medication withdrawal in the acute care setting
	Delirium, fall and pressure ulcer recognition, prevention and treatment
	Preventing in-hospital functional and nutritional decline
Palliative care	Acute pain and symptom management
	Understanding the Medicare hospice benefit
	Feeding tube use at the end of life
Non-clinical areas examples of training needs
Health-care economics	Understanding the stakeholders whose decisions drive hospital policy
	Understanding hospital reimbursement as a driver of hospitalist compensation and performance
	Understanding hospital utilization review
Patient safety and quality improvement	Common inpatient safety problems and methods for analysis (e.g., root cause analysis)
	Role of human factors and hospital systems in adverse events
	Developing and leading systemic QI and patient safety initiatives
	Practice guideline/protocol development and use
	Hospital information systems development, implementation and management
Practice management	Understanding hospitalist employment contracts, terms and conditions
	Inpatient billing and coding
	Risk management and malpractice for the hospitalist
Continuums of care	Transitions of care between patient settings
	Key elements of an effective patient hand-off
	Prescribing the appropriate level and type of post-discharge care
Leadership skills	Methods to effect organizational change
	Negotiation and conflict resolution skills
	Importance of personal influence as a management tool to achieve goals
	Demonstrating the value of QI and patient safety work
Communication	Appropriate and timely communication with referring practioners
	Key elements of an effective patient hand off
	Facilitating family meetings
	Delivering bad news effectively
	Leading and participating in a multidisciplinary team approach to care
	Disclosure of medical errors to patients
	Determining patient competence and capacity for medical decision making

*Some of these underemphasized competencies would be appropriately taught to all trainees