Healthcare expenditures in the United States (totaling almost 18% of the gross domestic product on an annual basis) continue to rise, with hospital spending accounting for the largest portion.¹ According to the Congressional Budget Office, up to 5% of the gross domestic product each year ($700 billion) is spent on tests and procedures that do not improve health outcomes.²Efficient and equitable distribution of healthcare resources is critical for overall population health, as the uninsured and underinsured, the poor, and members of certain minority groups often have inadequate healthcare access and substandard health outcomes.^3,4 Hospitals are under constant pressure to provide more efficient care with limited resources, with hospitalists acting as coordinators of care and resource use. In addition, hospitalists are positioned to identify healthcare disparities, optimize care for all patients, and advocate for equitable and cost-effective allocation of hospital resources. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the concepts of equity and cost-effectiveness.

• Identify patient populations at risk for healthcare disparities.

• Identify health resources that are prone to inequitable allocations.

• Differentiate among decision analysis, cost-effectiveness analysis, and cost-benefit analysis.

• Explain how cost-effectiveness may conflict with equity in healthcare policies.

• Describe patient factors that affect the allocation of healthcare resources.

• Explain how equity in healthcare is cost effective.

• Explain the relationship between healthcare disparities and healthcare quality.

Hospitalists should be able to:

• Measure patient access to healthcare resources.

• Incorporate equity concerns into cost-effectiveness analysis.

• Triage patients to appropriate hospital resources.

• Construct cost-effective care pathways that allocate resources equitably.

• Practice evidence-based, cost-effective care for all patients.

• Use cost-effectiveness analysis, cost-benefit analysis, evidence-based medicine, and measurements of healthcare equity to shape hospital policy on the allocation of its resources.

• Lead, coordinate, and/or participate in multidisciplinary teams, which may include radiology, pharmacy, nursing, and social services, to decrease hospital costs and provide evidence-based, cost-effective care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve resource allocation.

• Lead, coordinate, and/or participate in multidisciplinary hospital and community efforts to ensure proper access to care for all individuals. 

Hospitalists should be able to:

• Actively listen to the concerns of all patients.

• Advocate for every patient’s healthcare needs.

• Recognize that overuse of resources, including excessive test ordering, may not improve patient safety, patient satisfaction, or quality of care.

• Engage collaboratively with information technologists and healthcare economists to track resource use and outcomes.

• Advocate for cross-cultural education and interpreter services in hospital systems to decrease barriers to equitable healthcare allocation.

Healthcare expenditures in the United States (totaling almost 18% of the gross domestic product on an annual basis) continue to rise, with hospital spending accounting for the largest portion.¹ According to the Congressional Budget Office, up to 5% of the gross domestic product each year ($700 billion) is spent on tests and procedures that do not improve health outcomes.²Efficient and equitable distribution of healthcare resources is critical for overall population health, as the uninsured and underinsured, the poor, and members of certain minority groups often have inadequate healthcare access and substandard health outcomes.^3,4 Hospitals are under constant pressure to provide more efficient care with limited resources, with hospitalists acting as coordinators of care and resource use. In addition, hospitalists are positioned to identify healthcare disparities, optimize care for all patients, and advocate for equitable and cost-effective allocation of hospital resources. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the concepts of equity and cost-effectiveness.

• Identify patient populations at risk for healthcare disparities.

• Identify health resources that are prone to inequitable allocations.

• Differentiate among decision analysis, cost-effectiveness analysis, and cost-benefit analysis.

• Explain how cost-effectiveness may conflict with equity in healthcare policies.

• Describe patient factors that affect the allocation of healthcare resources.

• Explain how equity in healthcare is cost effective.

• Explain the relationship between healthcare disparities and healthcare quality.

Hospitalists should be able to:

• Measure patient access to healthcare resources.

• Incorporate equity concerns into cost-effectiveness analysis.

• Triage patients to appropriate hospital resources.

• Construct cost-effective care pathways that allocate resources equitably.

• Practice evidence-based, cost-effective care for all patients.

• Use cost-effectiveness analysis, cost-benefit analysis, evidence-based medicine, and measurements of healthcare equity to shape hospital policy on the allocation of its resources.

• Lead, coordinate, and/or participate in multidisciplinary teams, which may include radiology, pharmacy, nursing, and social services, to decrease hospital costs and provide evidence-based, cost-effective care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve resource allocation.

• Lead, coordinate, and/or participate in multidisciplinary hospital and community efforts to ensure proper access to care for all individuals. 

Hospitalists should be able to:

• Actively listen to the concerns of all patients.

• Advocate for every patient’s healthcare needs.

• Recognize that overuse of resources, including excessive test ordering, may not improve patient safety, patient satisfaction, or quality of care.

• Engage collaboratively with information technologists and healthcare economists to track resource use and outcomes.

• Advocate for cross-cultural education and interpreter services in hospital systems to decrease barriers to equitable healthcare allocation.

Healthcare expenditures in the United States (totaling almost 18% of the gross domestic product on an annual basis) continue to rise, with hospital spending accounting for the largest portion.¹ According to the Congressional Budget Office, up to 5% of the gross domestic product each year ($700 billion) is spent on tests and procedures that do not improve health outcomes.²Efficient and equitable distribution of healthcare resources is critical for overall population health, as the uninsured and underinsured, the poor, and members of certain minority groups often have inadequate healthcare access and substandard health outcomes.^3,4 Hospitals are under constant pressure to provide more efficient care with limited resources, with hospitalists acting as coordinators of care and resource use. In addition, hospitalists are positioned to identify healthcare disparities, optimize care for all patients, and advocate for equitable and cost-effective allocation of hospital resources. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the concepts of equity and cost-effectiveness.

• Identify patient populations at risk for healthcare disparities.

• Identify health resources that are prone to inequitable allocations.

• Differentiate among decision analysis, cost-effectiveness analysis, and cost-benefit analysis.

• Explain how cost-effectiveness may conflict with equity in healthcare policies.

• Describe patient factors that affect the allocation of healthcare resources.

• Explain how equity in healthcare is cost effective.

• Explain the relationship between healthcare disparities and healthcare quality.

Hospitalists should be able to:

• Measure patient access to healthcare resources.

• Incorporate equity concerns into cost-effectiveness analysis.

• Triage patients to appropriate hospital resources.

• Construct cost-effective care pathways that allocate resources equitably.

• Practice evidence-based, cost-effective care for all patients.

• Use cost-effectiveness analysis, cost-benefit analysis, evidence-based medicine, and measurements of healthcare equity to shape hospital policy on the allocation of its resources.

• Lead, coordinate, and/or participate in multidisciplinary teams, which may include radiology, pharmacy, nursing, and social services, to decrease hospital costs and provide evidence-based, cost-effective care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve resource allocation.

• Lead, coordinate, and/or participate in multidisciplinary hospital and community efforts to ensure proper access to care for all individuals. 

Hospitalists should be able to:

• Actively listen to the concerns of all patients.

• Advocate for every patient’s healthcare needs.

• Recognize that overuse of resources, including excessive test ordering, may not improve patient safety, patient satisfaction, or quality of care.

• Engage collaboratively with information technologists and healthcare economists to track resource use and outcomes.

• Advocate for cross-cultural education and interpreter services in hospital systems to decrease barriers to equitable healthcare allocation.

Evidence-based medicine (EBM) uses a systematic approach to medical decision-making and patient care, combining the highest available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, using an EBM approach helps them collaborate with patients to make the best possible individualized decisions. In the current environment, in which hospitalists have immediate access to vast amounts of information, knowledge management skills are critical so hospitalists can find, synthesize, and organize the best available information. Hospitalists also use their EBM skills to find current scientific evidence to develop quality improvement projects, including protocols and clinical pathways that improve the efficiency and quality of care within their organizations. Additionally, hospitalists lead and participate in educational efforts that foster the adoption of a rigorous evidence-based approach among medical trainees, hospital staff, and physician colleagues. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Identify peer-reviewed databases and other resources to search for scientific evidence to answer clinical and systems questions.

• Distinguish between filtered and nonfiltered resources by providing examples and describing their advantages and disadvantages.

• Describe major study types, including therapy, diagnosis, prognosis, harm, meta-analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the salient features of the following study designs: randomized controlled trials, meta-analyses, cohort studies, case-control studies, case series, cost-effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and intention-to-treat analysis.

• Explain the core components and core statistical concepts used in diagnosis studies, including Bayes’ theorem, sensitivity, specificity, and likelihood ratios.

Hospitalists should be able to:

• Formulate a well-designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Identify the most appropriate study design(s) for any given clinical- or systems-based question.

• Search filtered and nonfiltered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Lead, coordinate, and/or participate in educational initiatives aimed at teaching and practicing EBM.

• Lead, coordinate, and/or participate in evidence-based systems interventions to improve care quality and efficiency. 

Hospitalists should be able to:

• Reflect upon individual practice patterns to identify new questions.

• Serve as a role model for evidence-based point-of-care practice.

• Advocate for institutional access to high-quality point-of-care EBM information resources.

Evidence-based medicine (EBM) uses a systematic approach to medical decision-making and patient care, combining the highest available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, using an EBM approach helps them collaborate with patients to make the best possible individualized decisions. In the current environment, in which hospitalists have immediate access to vast amounts of information, knowledge management skills are critical so hospitalists can find, synthesize, and organize the best available information. Hospitalists also use their EBM skills to find current scientific evidence to develop quality improvement projects, including protocols and clinical pathways that improve the efficiency and quality of care within their organizations. Additionally, hospitalists lead and participate in educational efforts that foster the adoption of a rigorous evidence-based approach among medical trainees, hospital staff, and physician colleagues. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Identify peer-reviewed databases and other resources to search for scientific evidence to answer clinical and systems questions.

• Distinguish between filtered and nonfiltered resources by providing examples and describing their advantages and disadvantages.

• Describe major study types, including therapy, diagnosis, prognosis, harm, meta-analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the salient features of the following study designs: randomized controlled trials, meta-analyses, cohort studies, case-control studies, case series, cost-effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and intention-to-treat analysis.

• Explain the core components and core statistical concepts used in diagnosis studies, including Bayes’ theorem, sensitivity, specificity, and likelihood ratios.

Hospitalists should be able to:

• Formulate a well-designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Identify the most appropriate study design(s) for any given clinical- or systems-based question.

• Search filtered and nonfiltered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Lead, coordinate, and/or participate in educational initiatives aimed at teaching and practicing EBM.

• Lead, coordinate, and/or participate in evidence-based systems interventions to improve care quality and efficiency. 

Hospitalists should be able to:

• Reflect upon individual practice patterns to identify new questions.

• Serve as a role model for evidence-based point-of-care practice.

• Advocate for institutional access to high-quality point-of-care EBM information resources.

Evidence-based medicine (EBM) uses a systematic approach to medical decision-making and patient care, combining the highest available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, using an EBM approach helps them collaborate with patients to make the best possible individualized decisions. In the current environment, in which hospitalists have immediate access to vast amounts of information, knowledge management skills are critical so hospitalists can find, synthesize, and organize the best available information. Hospitalists also use their EBM skills to find current scientific evidence to develop quality improvement projects, including protocols and clinical pathways that improve the efficiency and quality of care within their organizations. Additionally, hospitalists lead and participate in educational efforts that foster the adoption of a rigorous evidence-based approach among medical trainees, hospital staff, and physician colleagues. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Identify peer-reviewed databases and other resources to search for scientific evidence to answer clinical and systems questions.

• Distinguish between filtered and nonfiltered resources by providing examples and describing their advantages and disadvantages.

• Describe major study types, including therapy, diagnosis, prognosis, harm, meta-analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the salient features of the following study designs: randomized controlled trials, meta-analyses, cohort studies, case-control studies, case series, cost-effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and intention-to-treat analysis.

• Explain the core components and core statistical concepts used in diagnosis studies, including Bayes’ theorem, sensitivity, specificity, and likelihood ratios.

Hospitalists should be able to:

• Formulate a well-designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Identify the most appropriate study design(s) for any given clinical- or systems-based question.

• Search filtered and nonfiltered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Lead, coordinate, and/or participate in educational initiatives aimed at teaching and practicing EBM.

• Lead, coordinate, and/or participate in evidence-based systems interventions to improve care quality and efficiency. 

Hospitalists should be able to:

• Reflect upon individual practice patterns to identify new questions.

• Serve as a role model for evidence-based point-of-care practice.

• Advocate for institutional access to high-quality point-of-care EBM information resources.

Hospitalists serve as educators and role models for all members of the multidisciplinary care team, including student learners, fellow physicians, allied health professionals, and hospital administrators. “Hospitalist as educator” refers to specific interactions with these team members to educate them about a wide range of knowledge and clinical skills such as patient care plans, treatment protocols, aspects of patient safety, and evidence-based problem-solving exercises. In this role as educators, hospitalists facilitate team building. They instruct students in an optimal learning environment, provide feedback, and promote independent thinking. They model efficient clinical decision-making and communication skills during physician-patient encounters. Hospitalists must attend to the learning needs of a generation of medical trainees that has an affinity for technology, interaction, and group-based learning, while also operating in an environment of restricted resident work hours. The hospitalist as educator core competency is essential to effecting organizational excellence. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the role of the hospitalist as an educator.

• Describe adult education principles.

• Explain factors that may facilitate or inhibit learning.

• Define the concept of a teachable moment.

• Describe the benefits and limitations of various teaching modalities.

• Identify resources for training materials.

• Describe the process of developing a formal educational session, including performing a needs assessment, determining teaching goals and objectives, developing teaching materials and activities, and evaluating a learner’s comprehension of the target material.

• Describe practical steps for delivering dynamic presentations for multiple venues, including bedside teaching to trainees, small group discussions with coworkers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.

• Describe models for clinical teaching (eg, the “microskills” model).

• Explain the process of applying competencies to curricular development.

Hospitalists should be able to:

• Establish a comfortable and safe learning environment.

• Establish expectations for each teaching session and clearly articulate the objectives.

• Determine the information needs of the intended recipient and tailor messages to the needs, abilities, and preferences of the intended recipient.

• Effectively assess learners’ progress towards the goals of the teaching session.

• Frame educational interventions in a manner that sets up trainees for success.

• Provide prompt, explicit, and action-oriented feedback in a manner conducive to self-improvement.

• Facilitate learners’ self-assessment of comprehension of target information and development of plans for further self-education.

• Promote evaluation standards that are fair and facilitate personal and professional development.

• Instruct at the level of learners’ experience and knowledge and accommodate for learners at different levels.

• Seek feedback on the effectiveness of instruction methods, modalities, and materials.

• Encourage and provide tools for lifelong, self-directed learning and clinical problem-solving.

• Structure the timing and delivery of information and learning experiences to maximize comprehension.

• Use adult learning principles in the development or selection of educational programs, methods, and materials.

• Promote the effective use of the “teachable moment” in the education of patients, students, and healthcare professionals.

• Use explicit and accessible language to explain clinical decision-making to learners.

• Make the clinical reasoning process understandable, explicit, and relevant to learners.

• Promote efficient, up-to-date clinical problem-solving during every patient encounter.

• Model the integration of quality initiatives and patient feedback into clinical decision-making.

• Provide bedside teaching that is informative and comfortable for patients, trainees, and members of the multidisciplinary care team.

• Demonstrate effective mentoring, including role modeling and active feedback techniques.

• Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the performance of the procedure, and necessary follow-up.

• Lead, coordinate, and/or participate in efforts to formulate a needs assessment program for hospitalists’ continued professional development.

• Lead, coordinate, and/or participate in educational scholarship. 

Hospitalists should be able to:

• Project enthusiasm for the teaching role.

• Respect learners from all backgrounds, knowledge, and skill levels.

• Promote an atmosphere of cooperation among patients, trainees, and multidisciplinary team members.

• Advocate the importance of lifelong learning and mentorship.

• Advocate the dual role of all healthcare professionals as simultaneous educators and students.

• Balance patient care and teaching regarding relevant time constraints.

• Promote an organizational environment in which knowledge deficiencies are identified and targeted.

• Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.

• Admit the limitations of one’s knowledge and respond appropriately to mistakes.

• Reflect on teaching moments to identify opportunities for improvement.

• Promote evidence-based information acquisition and clinical decision-making.

• Use the role of the “hospitalist as educator” to lead, coordinate, and/or participate in performance improvement initiatives.

Hospitalists serve as educators and role models for all members of the multidisciplinary care team, including student learners, fellow physicians, allied health professionals, and hospital administrators. “Hospitalist as educator” refers to specific interactions with these team members to educate them about a wide range of knowledge and clinical skills such as patient care plans, treatment protocols, aspects of patient safety, and evidence-based problem-solving exercises. In this role as educators, hospitalists facilitate team building. They instruct students in an optimal learning environment, provide feedback, and promote independent thinking. They model efficient clinical decision-making and communication skills during physician-patient encounters. Hospitalists must attend to the learning needs of a generation of medical trainees that has an affinity for technology, interaction, and group-based learning, while also operating in an environment of restricted resident work hours. The hospitalist as educator core competency is essential to effecting organizational excellence. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the role of the hospitalist as an educator.

• Describe adult education principles.

• Explain factors that may facilitate or inhibit learning.

• Define the concept of a teachable moment.

• Describe the benefits and limitations of various teaching modalities.

• Identify resources for training materials.

• Describe the process of developing a formal educational session, including performing a needs assessment, determining teaching goals and objectives, developing teaching materials and activities, and evaluating a learner’s comprehension of the target material.

• Describe practical steps for delivering dynamic presentations for multiple venues, including bedside teaching to trainees, small group discussions with coworkers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.

• Describe models for clinical teaching (eg, the “microskills” model).

• Explain the process of applying competencies to curricular development.

Hospitalists should be able to:

• Establish a comfortable and safe learning environment.

• Establish expectations for each teaching session and clearly articulate the objectives.

• Determine the information needs of the intended recipient and tailor messages to the needs, abilities, and preferences of the intended recipient.

• Effectively assess learners’ progress towards the goals of the teaching session.

• Frame educational interventions in a manner that sets up trainees for success.

• Provide prompt, explicit, and action-oriented feedback in a manner conducive to self-improvement.

• Facilitate learners’ self-assessment of comprehension of target information and development of plans for further self-education.

• Promote evaluation standards that are fair and facilitate personal and professional development.

• Instruct at the level of learners’ experience and knowledge and accommodate for learners at different levels.

• Seek feedback on the effectiveness of instruction methods, modalities, and materials.

• Encourage and provide tools for lifelong, self-directed learning and clinical problem-solving.

• Structure the timing and delivery of information and learning experiences to maximize comprehension.

• Use adult learning principles in the development or selection of educational programs, methods, and materials.

• Promote the effective use of the “teachable moment” in the education of patients, students, and healthcare professionals.

• Use explicit and accessible language to explain clinical decision-making to learners.

• Make the clinical reasoning process understandable, explicit, and relevant to learners.

• Promote efficient, up-to-date clinical problem-solving during every patient encounter.

• Model the integration of quality initiatives and patient feedback into clinical decision-making.

• Provide bedside teaching that is informative and comfortable for patients, trainees, and members of the multidisciplinary care team.

• Demonstrate effective mentoring, including role modeling and active feedback techniques.

• Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the performance of the procedure, and necessary follow-up.

• Lead, coordinate, and/or participate in efforts to formulate a needs assessment program for hospitalists’ continued professional development.

• Lead, coordinate, and/or participate in educational scholarship. 

Hospitalists should be able to:

• Project enthusiasm for the teaching role.

• Respect learners from all backgrounds, knowledge, and skill levels.

• Promote an atmosphere of cooperation among patients, trainees, and multidisciplinary team members.

• Advocate the importance of lifelong learning and mentorship.

• Advocate the dual role of all healthcare professionals as simultaneous educators and students.

• Balance patient care and teaching regarding relevant time constraints.

• Promote an organizational environment in which knowledge deficiencies are identified and targeted.

• Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.

• Admit the limitations of one’s knowledge and respond appropriately to mistakes.

• Reflect on teaching moments to identify opportunities for improvement.

• Promote evidence-based information acquisition and clinical decision-making.

• Use the role of the “hospitalist as educator” to lead, coordinate, and/or participate in performance improvement initiatives.

Hospitalists serve as educators and role models for all members of the multidisciplinary care team, including student learners, fellow physicians, allied health professionals, and hospital administrators. “Hospitalist as educator” refers to specific interactions with these team members to educate them about a wide range of knowledge and clinical skills such as patient care plans, treatment protocols, aspects of patient safety, and evidence-based problem-solving exercises. In this role as educators, hospitalists facilitate team building. They instruct students in an optimal learning environment, provide feedback, and promote independent thinking. They model efficient clinical decision-making and communication skills during physician-patient encounters. Hospitalists must attend to the learning needs of a generation of medical trainees that has an affinity for technology, interaction, and group-based learning, while also operating in an environment of restricted resident work hours. The hospitalist as educator core competency is essential to effecting organizational excellence. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the role of the hospitalist as an educator.

• Describe adult education principles.

• Explain factors that may facilitate or inhibit learning.

• Define the concept of a teachable moment.

• Describe the benefits and limitations of various teaching modalities.

• Identify resources for training materials.

• Describe the process of developing a formal educational session, including performing a needs assessment, determining teaching goals and objectives, developing teaching materials and activities, and evaluating a learner’s comprehension of the target material.

• Describe practical steps for delivering dynamic presentations for multiple venues, including bedside teaching to trainees, small group discussions with coworkers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.

• Describe models for clinical teaching (eg, the “microskills” model).

• Explain the process of applying competencies to curricular development.

Hospitalists should be able to:

• Establish a comfortable and safe learning environment.

• Establish expectations for each teaching session and clearly articulate the objectives.

• Determine the information needs of the intended recipient and tailor messages to the needs, abilities, and preferences of the intended recipient.

• Effectively assess learners’ progress towards the goals of the teaching session.

• Frame educational interventions in a manner that sets up trainees for success.

• Provide prompt, explicit, and action-oriented feedback in a manner conducive to self-improvement.

• Facilitate learners’ self-assessment of comprehension of target information and development of plans for further self-education.

• Promote evaluation standards that are fair and facilitate personal and professional development.

• Instruct at the level of learners’ experience and knowledge and accommodate for learners at different levels.

• Seek feedback on the effectiveness of instruction methods, modalities, and materials.

• Encourage and provide tools for lifelong, self-directed learning and clinical problem-solving.

• Structure the timing and delivery of information and learning experiences to maximize comprehension.

• Use adult learning principles in the development or selection of educational programs, methods, and materials.

• Promote the effective use of the “teachable moment” in the education of patients, students, and healthcare professionals.

• Use explicit and accessible language to explain clinical decision-making to learners.

• Make the clinical reasoning process understandable, explicit, and relevant to learners.

• Promote efficient, up-to-date clinical problem-solving during every patient encounter.

• Model the integration of quality initiatives and patient feedback into clinical decision-making.

• Provide bedside teaching that is informative and comfortable for patients, trainees, and members of the multidisciplinary care team.

• Demonstrate effective mentoring, including role modeling and active feedback techniques.

• Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the performance of the procedure, and necessary follow-up.

• Lead, coordinate, and/or participate in efforts to formulate a needs assessment program for hospitalists’ continued professional development.

• Lead, coordinate, and/or participate in educational scholarship. 

Hospitalists should be able to:

• Project enthusiasm for the teaching role.

• Respect learners from all backgrounds, knowledge, and skill levels.

• Promote an atmosphere of cooperation among patients, trainees, and multidisciplinary team members.

• Advocate the importance of lifelong learning and mentorship.

• Advocate the dual role of all healthcare professionals as simultaneous educators and students.

• Balance patient care and teaching regarding relevant time constraints.

• Promote an organizational environment in which knowledge deficiencies are identified and targeted.

• Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.

• Admit the limitations of one’s knowledge and respond appropriately to mistakes.

• Reflect on teaching moments to identify opportunities for improvement.

• Promote evidence-based information acquisition and clinical decision-making.

• Use the role of the “hospitalist as educator” to lead, coordinate, and/or participate in performance improvement initiatives.

Information management refers to the acquisition and use of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal workflow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computerized provider order entry (CPOE), event monitoring, electronic charting, and bar coding. Successful information management may have positive effects on quality of care, including patient safety, effectiveness, and efficiency. For example, CPOE has been shown to reduce prescribing errors by 48%, and an electronic health record combined with clinical decision support tools reduces the ordering of redundant tests.^1-4 Hospitalists use local systems to acquire data and information that support optimal medical decision-making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, use, and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the use of hospital information systems by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe the process to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators, and practice guidelines to support optimal patient care.

• Describe information systems that can facilitate the practice of evidence-based medical decision-making.

• Explain the impact of CPOE with decision support on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include cardiac or bedside monitors, glucometers, and pulse oximeters.

• Access and interpret information from internet-based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

• Recognize the limitations of acquisition devices or equipment and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework. 

Hospitalists should be able to:

• Adhere to principles of data integrity, security, and confidentiality.

• Adhere to principles of professionalism and avoid “cut and paste” plagiarism within one’s own electronic medical documentation.

• Advocate for information decision support to facilitate efficient and optimal medical management.

Information management refers to the acquisition and use of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal workflow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computerized provider order entry (CPOE), event monitoring, electronic charting, and bar coding. Successful information management may have positive effects on quality of care, including patient safety, effectiveness, and efficiency. For example, CPOE has been shown to reduce prescribing errors by 48%, and an electronic health record combined with clinical decision support tools reduces the ordering of redundant tests.^1-4 Hospitalists use local systems to acquire data and information that support optimal medical decision-making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, use, and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers. 

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Hospitalists should be able to:

• Describe the use of hospital information systems by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe the process to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators, and practice guidelines to support optimal patient care.

• Describe information systems that can facilitate the practice of evidence-based medical decision-making.

• Explain the impact of CPOE with decision support on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include cardiac or bedside monitors, glucometers, and pulse oximeters.

• Access and interpret information from internet-based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

• Recognize the limitations of acquisition devices or equipment and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework. 

Hospitalists should be able to:

• Adhere to principles of data integrity, security, and confidentiality.

• Adhere to principles of professionalism and avoid “cut and paste” plagiarism within one’s own electronic medical documentation.

• Advocate for information decision support to facilitate efficient and optimal medical management.

Information management refers to the acquisition and use of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal workflow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computerized provider order entry (CPOE), event monitoring, electronic charting, and bar coding. Successful information management may have positive effects on quality of care, including patient safety, effectiveness, and efficiency. For example, CPOE has been shown to reduce prescribing errors by 48%, and an electronic health record combined with clinical decision support tools reduces the ordering of redundant tests.^1-4 Hospitalists use local systems to acquire data and information that support optimal medical decision-making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, use, and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the use of hospital information systems by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe the process to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators, and practice guidelines to support optimal patient care.

• Describe information systems that can facilitate the practice of evidence-based medical decision-making.

• Explain the impact of CPOE with decision support on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include cardiac or bedside monitors, glucometers, and pulse oximeters.

• Access and interpret information from internet-based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

• Recognize the limitations of acquisition devices or equipment and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework. 

Hospitalists should be able to:

• Adhere to principles of data integrity, security, and confidentiality.

• Adhere to principles of professionalism and avoid “cut and paste” plagiarism within one’s own electronic medical documentation.

• Advocate for information decision support to facilitate efficient and optimal medical management.

Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare. 

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Hospitalists should be able to:

• Distinguish between management and leadership.

• Describe hospitalist responsibilities and opportunities to provide active leadership.

• Explain the attributes and effects of modeling positive and negative behaviors.

• Explain the importance of finding mentor(s) and serving as a mentor.

• Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.

• Describe the key elements of a message.

• Name the key elements of strategic planning processes.

• Explain factors that predict the success or failure of strategic plans.

• Describe styles of leadership.

• Explain the attributes of effective leadership.

• Articulate the business and financial motivators that affect decision-making.

• Explain the specific factors that effect positive change.

• Explain effective negotiation and conflict resolution techniques.b.

Hospitalists should be able to:

• Tailor messages to specific target audiences.

• Develop effective communication skills using multiple modalities.

• Plan and conduct an effective meeting.

• Construct program mission and vision statements.

• Develop personal, team, and program goals and identify indicators of achievement.

• Establish, measure, and report key performance metrics.

• Use established metrics to assess progress and set new goals for performance and outcomes.

• Analyze personal leadership style.

• Demonstrate the ability to effectively work with colleagues who have various leadership styles.

• Develop budgets to support goals using accepted financial principles.

• Translate performance into measurable financial outcomes.

• Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.

• Demonstrate effective and creative problem-solving techniques.

• Resolve conflicts with specific negotiation techniques.

• Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.

• Advocate for financial and other resources needed to support goals and initiatives. 

Hospitalists should be able to:

• Lead by example.

• Practice active listening techniques.

• Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.

• Recognize the importance and influence of positive role modeling.

• Assess and address personal leadership strengths and weaknesses.

• Seek and participate in opportunities for professional development.

• Exemplify professionalism.

• Accept responsibility and accountability for management decisions.

• Build consensus in support of key decisions.

Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Distinguish between management and leadership.

• Describe hospitalist responsibilities and opportunities to provide active leadership.

• Explain the attributes and effects of modeling positive and negative behaviors.

• Explain the importance of finding mentor(s) and serving as a mentor.

• Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.

• Describe the key elements of a message.

• Name the key elements of strategic planning processes.

• Explain factors that predict the success or failure of strategic plans.

• Describe styles of leadership.

• Explain the attributes of effective leadership.

• Articulate the business and financial motivators that affect decision-making.

• Explain the specific factors that effect positive change.

• Explain effective negotiation and conflict resolution techniques.b.

Hospitalists should be able to:

• Tailor messages to specific target audiences.

• Develop effective communication skills using multiple modalities.

• Plan and conduct an effective meeting.

• Construct program mission and vision statements.

• Develop personal, team, and program goals and identify indicators of achievement.

• Establish, measure, and report key performance metrics.

• Use established metrics to assess progress and set new goals for performance and outcomes.

• Analyze personal leadership style.

• Demonstrate the ability to effectively work with colleagues who have various leadership styles.

• Develop budgets to support goals using accepted financial principles.

• Translate performance into measurable financial outcomes.

• Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.

• Demonstrate effective and creative problem-solving techniques.

• Resolve conflicts with specific negotiation techniques.

• Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.

• Advocate for financial and other resources needed to support goals and initiatives. 

Hospitalists should be able to:

• Lead by example.

• Practice active listening techniques.

• Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.

• Recognize the importance and influence of positive role modeling.

• Assess and address personal leadership strengths and weaknesses.

• Seek and participate in opportunities for professional development.

• Exemplify professionalism.

• Accept responsibility and accountability for management decisions.

• Build consensus in support of key decisions.

Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Distinguish between management and leadership.

• Describe hospitalist responsibilities and opportunities to provide active leadership.

• Explain the attributes and effects of modeling positive and negative behaviors.

• Explain the importance of finding mentor(s) and serving as a mentor.

• Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.

• Describe the key elements of a message.

• Name the key elements of strategic planning processes.

• Explain factors that predict the success or failure of strategic plans.

• Describe styles of leadership.

• Explain the attributes of effective leadership.

• Articulate the business and financial motivators that affect decision-making.

• Explain the specific factors that effect positive change.

• Explain effective negotiation and conflict resolution techniques.b.

Hospitalists should be able to:

• Tailor messages to specific target audiences.

• Develop effective communication skills using multiple modalities.

• Plan and conduct an effective meeting.

• Construct program mission and vision statements.

• Develop personal, team, and program goals and identify indicators of achievement.

• Establish, measure, and report key performance metrics.

• Use established metrics to assess progress and set new goals for performance and outcomes.

• Analyze personal leadership style.

• Demonstrate the ability to effectively work with colleagues who have various leadership styles.

• Develop budgets to support goals using accepted financial principles.

• Translate performance into measurable financial outcomes.

• Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.

• Demonstrate effective and creative problem-solving techniques.

• Resolve conflicts with specific negotiation techniques.

• Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.

• Advocate for financial and other resources needed to support goals and initiatives. 

Hospitalists should be able to:

• Lead by example.

• Practice active listening techniques.

• Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.

• Recognize the importance and influence of positive role modeling.

• Assess and address personal leadership strengths and weaknesses.

• Seek and participate in opportunities for professional development.

• Exemplify professionalism.

• Accept responsibility and accountability for management decisions.

• Build consensus in support of key decisions.

Management practice in hospital medicine refers to program/medical group development and growth, contract negotiation, performance measurement, and financial analysis. Hospitalists require fundamental management skills to enhance their individual success and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe different models of physician compensation and incentives.

• Explain the impact of third-party payer contracts on hospital reimbursement.

• Describe key features of healthcare reform and discuss the potential effect of high-impact areas such as value-based purchasing, care transitions, and hospital-acquired conditions on patient care and expectations for individual hospitalists and hospital medicine groups.

• Describe the impact of medication formularies, utilization review requirements, third-party payer contracts, and other policies affecting patient care.

• Describe required system improvements needed to meet new healthcare legislation or public health guidelines.

• Describe the basics of human resource management, particularly regarding managing diversity, basic employment law, recruitment and retention, and the tools used to manage personnel.

• Describe federal statutory restrictions on physicians contracting with hospitals, third-party payers, and group practices.

• Define the role and value of hospitalists and hospital medicine programs.

• Explain advantages and disadvantages of using physician extenders in a hospital medicine practice.

• Describe the necessary elements for effective and compliant billing, coding, and revenue capture.

• Define commonly used hospital financial terminology, including, but not limited to, procedure codes, relative value units, direct and indirect costs, average length of stay, and case mix index.

• Define the components of a useful financial report.

Hospitalists should be able to:

• Apply basic accounting practices to track financial performance and develop a practice budget.

• Implement financially sustainable changes in staffing, skill mix, and care delivery models to optimize performance.

• Develop effective strategies to market the hospital medicine program.

• Develop job descriptions for physician and nonphysician employees to facilitate accountability and professional development.

• Develop effective strategies for recruiting and retaining hospitalists.

• Conduct or participate in performance reviews for physician and nonphysician staff.

• Negotiate effectively with physicians, medical practices, hospitals, and third-party payers.

• Interpret hospital-generated reports on individual and group performance.

• Assess satisfaction of community physicians, patients, nurses, and other user groups.

• Develop strategic planning processes to meet individual and group goals and establish accountability.

• Develop effective strategies for aligning hospitalist incentives with organization- and system-level goals.

• Develop business plans to facilitate growth of the practice.

• Prepare an annual review of program performance for the hospital executive team.

• Demonstrate teamwork, organization, and leadership skills.

• Achieve greater clinical integration between hospitalists and other healthcare providers across the care continuum. 

Hospitalists should be able to:

• Lead by example.

• Value the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality, and effectiveness.

• Prioritize meeting or exceeding customer and colleague expectations.

• Value the importance of best management practice.

• Value the importance of marketing and public relations to foster sustainable practice growth.

Management practice in hospital medicine refers to program/medical group development and growth, contract negotiation, performance measurement, and financial analysis. Hospitalists require fundamental management skills to enhance their individual success and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe different models of physician compensation and incentives.

• Explain the impact of third-party payer contracts on hospital reimbursement.

• Describe key features of healthcare reform and discuss the potential effect of high-impact areas such as value-based purchasing, care transitions, and hospital-acquired conditions on patient care and expectations for individual hospitalists and hospital medicine groups.

• Describe the impact of medication formularies, utilization review requirements, third-party payer contracts, and other policies affecting patient care.

• Describe required system improvements needed to meet new healthcare legislation or public health guidelines.

• Describe the basics of human resource management, particularly regarding managing diversity, basic employment law, recruitment and retention, and the tools used to manage personnel.

• Describe federal statutory restrictions on physicians contracting with hospitals, third-party payers, and group practices.

• Define the role and value of hospitalists and hospital medicine programs.

• Explain advantages and disadvantages of using physician extenders in a hospital medicine practice.

• Describe the necessary elements for effective and compliant billing, coding, and revenue capture.

• Define commonly used hospital financial terminology, including, but not limited to, procedure codes, relative value units, direct and indirect costs, average length of stay, and case mix index.

• Define the components of a useful financial report.

Hospitalists should be able to:

• Apply basic accounting practices to track financial performance and develop a practice budget.

• Implement financially sustainable changes in staffing, skill mix, and care delivery models to optimize performance.

• Develop effective strategies to market the hospital medicine program.

• Develop job descriptions for physician and nonphysician employees to facilitate accountability and professional development.

• Develop effective strategies for recruiting and retaining hospitalists.

• Conduct or participate in performance reviews for physician and nonphysician staff.

• Negotiate effectively with physicians, medical practices, hospitals, and third-party payers.

• Interpret hospital-generated reports on individual and group performance.

• Assess satisfaction of community physicians, patients, nurses, and other user groups.

• Develop strategic planning processes to meet individual and group goals and establish accountability.

• Develop effective strategies for aligning hospitalist incentives with organization- and system-level goals.

• Develop business plans to facilitate growth of the practice.

• Prepare an annual review of program performance for the hospital executive team.

• Demonstrate teamwork, organization, and leadership skills.

• Achieve greater clinical integration between hospitalists and other healthcare providers across the care continuum. 

Hospitalists should be able to:

• Lead by example.

• Value the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality, and effectiveness.

• Prioritize meeting or exceeding customer and colleague expectations.

• Value the importance of best management practice.

• Value the importance of marketing and public relations to foster sustainable practice growth.

Management practice in hospital medicine refers to program/medical group development and growth, contract negotiation, performance measurement, and financial analysis. Hospitalists require fundamental management skills to enhance their individual success and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe different models of physician compensation and incentives.

• Explain the impact of third-party payer contracts on hospital reimbursement.

• Describe key features of healthcare reform and discuss the potential effect of high-impact areas such as value-based purchasing, care transitions, and hospital-acquired conditions on patient care and expectations for individual hospitalists and hospital medicine groups.

• Describe the impact of medication formularies, utilization review requirements, third-party payer contracts, and other policies affecting patient care.

• Describe required system improvements needed to meet new healthcare legislation or public health guidelines.

• Describe the basics of human resource management, particularly regarding managing diversity, basic employment law, recruitment and retention, and the tools used to manage personnel.

• Describe federal statutory restrictions on physicians contracting with hospitals, third-party payers, and group practices.

• Define the role and value of hospitalists and hospital medicine programs.

• Explain advantages and disadvantages of using physician extenders in a hospital medicine practice.

• Describe the necessary elements for effective and compliant billing, coding, and revenue capture.

• Define commonly used hospital financial terminology, including, but not limited to, procedure codes, relative value units, direct and indirect costs, average length of stay, and case mix index.

• Define the components of a useful financial report.

Hospitalists should be able to:

• Apply basic accounting practices to track financial performance and develop a practice budget.

• Implement financially sustainable changes in staffing, skill mix, and care delivery models to optimize performance.

• Develop effective strategies to market the hospital medicine program.

• Develop job descriptions for physician and nonphysician employees to facilitate accountability and professional development.

• Develop effective strategies for recruiting and retaining hospitalists.

• Conduct or participate in performance reviews for physician and nonphysician staff.

• Negotiate effectively with physicians, medical practices, hospitals, and third-party payers.

• Interpret hospital-generated reports on individual and group performance.

• Assess satisfaction of community physicians, patients, nurses, and other user groups.

• Develop strategic planning processes to meet individual and group goals and establish accountability.

• Develop effective strategies for aligning hospitalist incentives with organization- and system-level goals.

• Develop business plans to facilitate growth of the practice.

• Prepare an annual review of program performance for the hospital executive team.

• Demonstrate teamwork, organization, and leadership skills.

• Achieve greater clinical integration between hospitalists and other healthcare providers across the care continuum. 

Hospitalists should be able to:

• Lead by example.

• Value the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality, and effectiveness.

• Prioritize meeting or exceeding customer and colleague expectations.

• Value the importance of best management practice.

• Value the importance of marketing and public relations to foster sustainable practice growth.

As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.¹ Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the role of a consultant.

• Describe the principles of effective consultation.

• Describe factors influencing compliance with consultant recommendations.

• Recognize the importance of arranging appropriate follow-up.

Hospitalists should be able to:

• Determine their scope as a consultant or a partner participating in comanagement.

• Assess the urgency of the consultation and the nature of the question posed by the requesting physician.

• Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.

• Provide concise and specific evidence-based recommendations for risk assessment and management.

• Use a patient-centered approach when making recommendations.

• Communicate recommendations in an expedient and efficient manner.

• Transmit written communication legibly and include contact information.

• Communicate effectively with patients and families to convey recommendations and treatment plans.

• Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.

• Anticipate potential complications and provide recommendations to prevent complications.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients. 

Hospitalists should be able to:

• Respond promptly to the requesting physician’s need for consultation.

• Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.

• Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.

As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.¹ Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the role of a consultant.

• Describe the principles of effective consultation.

• Describe factors influencing compliance with consultant recommendations.

• Recognize the importance of arranging appropriate follow-up.

Hospitalists should be able to:

• Determine their scope as a consultant or a partner participating in comanagement.

• Assess the urgency of the consultation and the nature of the question posed by the requesting physician.

• Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.

• Provide concise and specific evidence-based recommendations for risk assessment and management.

• Use a patient-centered approach when making recommendations.

• Communicate recommendations in an expedient and efficient manner.

• Transmit written communication legibly and include contact information.

• Communicate effectively with patients and families to convey recommendations and treatment plans.

• Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.

• Anticipate potential complications and provide recommendations to prevent complications.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients. 

Hospitalists should be able to:

• Respond promptly to the requesting physician’s need for consultation.

• Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.

• Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.

As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.¹ Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define the role of a consultant.

• Describe the principles of effective consultation.

• Describe factors influencing compliance with consultant recommendations.

• Recognize the importance of arranging appropriate follow-up.

Hospitalists should be able to:

• Determine their scope as a consultant or a partner participating in comanagement.

• Assess the urgency of the consultation and the nature of the question posed by the requesting physician.

• Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.

• Provide concise and specific evidence-based recommendations for risk assessment and management.

• Use a patient-centered approach when making recommendations.

• Communicate recommendations in an expedient and efficient manner.

• Transmit written communication legibly and include contact information.

• Communicate effectively with patients and families to convey recommendations and treatment plans.

• Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.

• Anticipate potential complications and provide recommendations to prevent complications.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients. 

Hospitalists should be able to:

• Respond promptly to the requesting physician’s need for consultation.

• Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.

• Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.

Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, increased risk of readmission, and overall increased morbidity and mortality.^1,2 Malnutrition is reported in up to 50% of hospitalized patients. Although early screening for nutritional risk allows for appropriate intervention in the hospital setting as well as planning for appropriate home services and follow-up for outpatient nutritional care, malnutrition is underrecognized and undertreated.³In malnourished patients, nutritional intervention has been shown to reduce clinical complications, length of stay, readmission rates, and mortality.⁴ Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate, or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients. 

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Hospitalists should be able to:

• Describe methods of screening for malnutrition.

• Describe the consequences of malnutrition on bodily function, illness, and outcomes.

• Explain when a nutrition evaluation by a registered dietitian is required.

• Differentiate among various modified diets and nutritional supplements and explain the indications for each.

• Explain the indications and contraindications for enteral nutrition.

• Describe the indications for parenteral nutrition.

• Describe potential complications associated with enteral and parenteral nutrition.

• Recognize that specialized nutritional supplementation may be required in certain patient populations, which include patients with extensive wounds or increased catabolic needs.

• Explain the risk factors for and the clinical features of the refeeding syndrome.

Hospitalists should be able to:

• Use objective criteria, including history, physical examination findings, and laboratory results, to diagnose and categorize the severity of malnutrition and identify patients who are at increased risk.

• Identify the symptoms or signs of medical conditions that are associated with or secondary to malnutrition and formulate an evidence-based treatment plan.

• Implement individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, on the basis of the patient’s medical condition.

• Treat electrolyte abnormalities associated with the refeeding syndrome.

• Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.

• Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.

• Coordinate follow-up nutrition care as part of discharge plans for those patients requiring nutritional support.

• Lead, coordinate, and/or participate in initiatives to improve awareness and documentation efforts that appropriately categorize the patient with malnutrition and determine the impact this may have on risk-adjusted mortality and value-based purchasing.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to optimize resource use.

• Lead, coordinate, and/or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.

• Lead, coordinate, and/or participate in efforts to develop strategies to minimize institution complication rates. 

Hospitalists should be able to:

• Recognize the importance of adequate nutrition in hospitalized patients.

• Work collaboratively with clinical nutrition staff, which may include nursing, pharmacists, and dieticians, to implement the nutrition care plan.

• Engage in a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.

Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, increased risk of readmission, and overall increased morbidity and mortality.^1,2 Malnutrition is reported in up to 50% of hospitalized patients. Although early screening for nutritional risk allows for appropriate intervention in the hospital setting as well as planning for appropriate home services and follow-up for outpatient nutritional care, malnutrition is underrecognized and undertreated.³In malnourished patients, nutritional intervention has been shown to reduce clinical complications, length of stay, readmission rates, and mortality.⁴ Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate, or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe methods of screening for malnutrition.

• Describe the consequences of malnutrition on bodily function, illness, and outcomes.

• Explain when a nutrition evaluation by a registered dietitian is required.

• Differentiate among various modified diets and nutritional supplements and explain the indications for each.

• Explain the indications and contraindications for enteral nutrition.

• Describe the indications for parenteral nutrition.

• Describe potential complications associated with enteral and parenteral nutrition.

• Recognize that specialized nutritional supplementation may be required in certain patient populations, which include patients with extensive wounds or increased catabolic needs.

• Explain the risk factors for and the clinical features of the refeeding syndrome.

Hospitalists should be able to:

• Use objective criteria, including history, physical examination findings, and laboratory results, to diagnose and categorize the severity of malnutrition and identify patients who are at increased risk.

• Identify the symptoms or signs of medical conditions that are associated with or secondary to malnutrition and formulate an evidence-based treatment plan.

• Implement individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, on the basis of the patient’s medical condition.

• Treat electrolyte abnormalities associated with the refeeding syndrome.

• Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.

• Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.

• Coordinate follow-up nutrition care as part of discharge plans for those patients requiring nutritional support.

• Lead, coordinate, and/or participate in initiatives to improve awareness and documentation efforts that appropriately categorize the patient with malnutrition and determine the impact this may have on risk-adjusted mortality and value-based purchasing.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to optimize resource use.

• Lead, coordinate, and/or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.

• Lead, coordinate, and/or participate in efforts to develop strategies to minimize institution complication rates. 

Hospitalists should be able to:

• Recognize the importance of adequate nutrition in hospitalized patients.

• Work collaboratively with clinical nutrition staff, which may include nursing, pharmacists, and dieticians, to implement the nutrition care plan.

• Engage in a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.

Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, increased risk of readmission, and overall increased morbidity and mortality.^1,2 Malnutrition is reported in up to 50% of hospitalized patients. Although early screening for nutritional risk allows for appropriate intervention in the hospital setting as well as planning for appropriate home services and follow-up for outpatient nutritional care, malnutrition is underrecognized and undertreated.³In malnourished patients, nutritional intervention has been shown to reduce clinical complications, length of stay, readmission rates, and mortality.⁴ Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate, or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe methods of screening for malnutrition.

• Describe the consequences of malnutrition on bodily function, illness, and outcomes.

• Explain when a nutrition evaluation by a registered dietitian is required.

• Differentiate among various modified diets and nutritional supplements and explain the indications for each.

• Explain the indications and contraindications for enteral nutrition.

• Describe the indications for parenteral nutrition.

• Describe potential complications associated with enteral and parenteral nutrition.

• Recognize that specialized nutritional supplementation may be required in certain patient populations, which include patients with extensive wounds or increased catabolic needs.

• Explain the risk factors for and the clinical features of the refeeding syndrome.

Hospitalists should be able to:

• Use objective criteria, including history, physical examination findings, and laboratory results, to diagnose and categorize the severity of malnutrition and identify patients who are at increased risk.

• Identify the symptoms or signs of medical conditions that are associated with or secondary to malnutrition and formulate an evidence-based treatment plan.

• Implement individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, on the basis of the patient’s medical condition.

• Treat electrolyte abnormalities associated with the refeeding syndrome.

• Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.

• Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.

• Coordinate follow-up nutrition care as part of discharge plans for those patients requiring nutritional support.

• Lead, coordinate, and/or participate in initiatives to improve awareness and documentation efforts that appropriately categorize the patient with malnutrition and determine the impact this may have on risk-adjusted mortality and value-based purchasing.

• Lead, coordinate, and/or participate in multidisciplinary initiatives to optimize resource use.

• Lead, coordinate, and/or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.

• Lead, coordinate, and/or participate in efforts to develop strategies to minimize institution complication rates. 

Hospitalists should be able to:

• Recognize the importance of adequate nutrition in hospitalized patients.

• Work collaboratively with clinical nutrition staff, which may include nursing, pharmacists, and dieticians, to implement the nutrition care plan.

• Engage in a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.

Palliative care refers to the comprehensive care of patients and families who are living with serious illness. It focuses on providing patients with relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any stage of illness and should be provided simultaneously with other medical treatments, including disease-modifying and life-prolonging therapies. Palliative care is provided by interprofessional teams, including physicians, nurse practitioners, physician assistants, nurses, social workers, case managers, and chaplains.

Seriously ill patients are frequently hospitalized, and thus all hospitalists—as frontline physicians who coordinate care for these patients—are key members of the interprofessional team who provide primary or generalist palliative care. In addition, in hospitals where palliative care consultation services are available, hospitalists are optimally positioned to refer to and collaborate with these specialty palliative care consultants. In hospitals where no or limited specialty palliative care services are available, hospitalists have an even more central role in providing palliative care. Hospitalists also have a key role in leading and contributing to systems and quality improvement efforts related to palliative care.

Key roles for hospitalists involved in palliative care are (1) leading discussions of goals of care and advance care planning, including completing appropriate documentation of patients’ wishes; (2) screening and implementing treatment for common physical symptoms, including pain, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation; and (3) referring patients to community services to provide support around serious illness after hospital discharge, including hospice and community palliative care services when available. A complete list of core competencies for hospitalists in palliative care follows. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define palliative care, including primary (or generalist) and specialty palliative care, and explain effective strategies for describing the benefits of palliative care to colleagues, specialists, patients, and families.

• Explain the role of palliative care throughout the course of illness, how it can be provided alongside all other appropriate medical treatments, and appropriate referral to local resources that provide palliative care in the hospital and community.

• Recognize when specialty palliative care consultation, when it is available, should be sought for refractory or complex patient or family palliative care needs.

• Identify the factors that contribute to prognosis in common serious illnesses (eg, cancer, congestive heart failure, chronic obstructive pulmonary disease, end stage renal disease, dementia, and multimorbidity), including how to identify patients who may benefit from palliative care and how to broadly estimate prognosis (eg, months to years, weeks to months, days to weeks, hours to days).

• Describe signs and symptoms of the last 24 hours of life and how to discuss these observations with families.

• Describe data on efficacy and burdens of life support interventions in seriously ill patients, such as tube feeding in advanced dementia and cardiopulmonary resuscitation.

• Explain the ethical principles involved with caring for patients at the end of life, including the right of competent patients or their surrogates to refuse medical treatments, including life-sustaining therapies, and the principle of “double effect.”

• Describe specific legal considerations related to surrogate decision-making and advance planning in the state in which the hospitalist practices.

• Describe the purpose and mechanics of advance directives, including physician or medical orders for life-sustaining treatment (POLST/MOLST) forms available in the state in which the hospitalist practices, durable medical power of attorney forms, and other declarations of patient wishes and treatment preferences.

• Describe the basic tenets of hospice care and the Medicare hospice benefit and explain the process of initiating direct referrals to these programs in various settings (ie, home, skilled nursing facility, inpatient).

• Describe the role of the hospitalist after a patient dies in the hospital, including pronouncing of death, completing the death certificate, requesting an autopsy, notifying the family and primary care physician, contacting the organ donor network, and providing the family with hospital contact information for questions and bereavement resources.

Hospitalists should be able to:

• Perform a comprehensive patient assessment to screen patients for palliative care needs, including (1) pain and other common symptoms (eg, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, constipation); (2) psychosocial and spiritual support of the patient and family; (3) advance care planning communication about prognosis and goals of care; and (4) needs for support on hospital discharge or bereavement.

• Work in interdisciplinary teams, including nursing, social work, case management, therapy, and spiritual care, to formulate specific patient-centered palliative care plans to address identified patient and family needs.

• Build therapeutic relationships with seriously ill patients and their families as a basis of support for coping and creating collaborative patient- and family-centered care plans.

• In seriously ill and/or actively dying patients, provide first-line treatment for common symptoms such as nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation.

• Provide counseling on advance care planning, advance care directives, POLST/MOLST forms, and code status, including the outcomes of cardiopulmonary resusitation and other life-sustaining interventions in seriously ill patients.

• Lead culturally sensitive communications about prognosis and goals of care among patients, families, and other members of the healthcare team, including family meetings and discussions in urgent situations to ensure that patients receive treatments that match their goals.

• Coordinate goals of care and treatment plan among the treatment team, including primary care physicians and inpatient and outpatient specialty consultants.

• Consult specialty palliative care and/or hospital ethics service when there is conflict among patients, families, and/or healthcare providers regarding the appropriate healthcare agent for decision-making and provision of life-sustaining interventions.

• Identify when hospice may be the appropriate care model given a patient’s prognosis and goals of care, and describe the hospice care philosophy and care model to a patient and family.

• Implement protocols and multidisciplinary care plans to ensure patient comfort and adequate family support when life-prolonging measures such as mechanical ventilation, vasopressor support, or other intensive care measures are withdrawn or withheld.

• Ensure that the hospital palliative care plan is honored upon discharge, including communicating this plan with primary care and other outpatient providers and establishing home supportive services if needed.

• Implement best practices for self-care and coping with the stress of caring for the seriously ill. 

Hospitalists should be able to:

• Appreciate that palliative care is appropriate at any stage of a serious illness and that it should be provided to all seriously ill patients.

• Appreciate that hospitalists have a key role in ensuring that the palliative care needs of seriously ill patients are addressed.

• Recognize the importance of empathic communication, building a therapeutic relationship with patients and families, and developing patient- and family-centered treatment plans.

• Recognize the impact that social, cultural, and spiritual factors have on preferences for care in the setting of serious illness.

• Appreciate the roles of, and collaboration with, other members of the healthcare team, including nursing and social services, pharmacy, psychology, and spiritual care, in providing palliative care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve the care of seriously ill patients, such as symptom identification and management systems and improved advance care planning and goals of care approaches.

• Lead, coordinate, and/or participate in efforts to establish or support existing multidisciplinary palliative care teams.

Palliative care refers to the comprehensive care of patients and families who are living with serious illness. It focuses on providing patients with relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any stage of illness and should be provided simultaneously with other medical treatments, including disease-modifying and life-prolonging therapies. Palliative care is provided by interprofessional teams, including physicians, nurse practitioners, physician assistants, nurses, social workers, case managers, and chaplains.

Seriously ill patients are frequently hospitalized, and thus all hospitalists—as frontline physicians who coordinate care for these patients—are key members of the interprofessional team who provide primary or generalist palliative care. In addition, in hospitals where palliative care consultation services are available, hospitalists are optimally positioned to refer to and collaborate with these specialty palliative care consultants. In hospitals where no or limited specialty palliative care services are available, hospitalists have an even more central role in providing palliative care. Hospitalists also have a key role in leading and contributing to systems and quality improvement efforts related to palliative care.

Key roles for hospitalists involved in palliative care are (1) leading discussions of goals of care and advance care planning, including completing appropriate documentation of patients’ wishes; (2) screening and implementing treatment for common physical symptoms, including pain, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation; and (3) referring patients to community services to provide support around serious illness after hospital discharge, including hospice and community palliative care services when available. A complete list of core competencies for hospitalists in palliative care follows. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define palliative care, including primary (or generalist) and specialty palliative care, and explain effective strategies for describing the benefits of palliative care to colleagues, specialists, patients, and families.

• Explain the role of palliative care throughout the course of illness, how it can be provided alongside all other appropriate medical treatments, and appropriate referral to local resources that provide palliative care in the hospital and community.

• Recognize when specialty palliative care consultation, when it is available, should be sought for refractory or complex patient or family palliative care needs.

• Identify the factors that contribute to prognosis in common serious illnesses (eg, cancer, congestive heart failure, chronic obstructive pulmonary disease, end stage renal disease, dementia, and multimorbidity), including how to identify patients who may benefit from palliative care and how to broadly estimate prognosis (eg, months to years, weeks to months, days to weeks, hours to days).

• Describe signs and symptoms of the last 24 hours of life and how to discuss these observations with families.

• Describe data on efficacy and burdens of life support interventions in seriously ill patients, such as tube feeding in advanced dementia and cardiopulmonary resuscitation.

• Explain the ethical principles involved with caring for patients at the end of life, including the right of competent patients or their surrogates to refuse medical treatments, including life-sustaining therapies, and the principle of “double effect.”

• Describe specific legal considerations related to surrogate decision-making and advance planning in the state in which the hospitalist practices.

• Describe the purpose and mechanics of advance directives, including physician or medical orders for life-sustaining treatment (POLST/MOLST) forms available in the state in which the hospitalist practices, durable medical power of attorney forms, and other declarations of patient wishes and treatment preferences.

• Describe the basic tenets of hospice care and the Medicare hospice benefit and explain the process of initiating direct referrals to these programs in various settings (ie, home, skilled nursing facility, inpatient).

• Describe the role of the hospitalist after a patient dies in the hospital, including pronouncing of death, completing the death certificate, requesting an autopsy, notifying the family and primary care physician, contacting the organ donor network, and providing the family with hospital contact information for questions and bereavement resources.

Hospitalists should be able to:

• Perform a comprehensive patient assessment to screen patients for palliative care needs, including (1) pain and other common symptoms (eg, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, constipation); (2) psychosocial and spiritual support of the patient and family; (3) advance care planning communication about prognosis and goals of care; and (4) needs for support on hospital discharge or bereavement.

• Work in interdisciplinary teams, including nursing, social work, case management, therapy, and spiritual care, to formulate specific patient-centered palliative care plans to address identified patient and family needs.

• Build therapeutic relationships with seriously ill patients and their families as a basis of support for coping and creating collaborative patient- and family-centered care plans.

• In seriously ill and/or actively dying patients, provide first-line treatment for common symptoms such as nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation.

• Provide counseling on advance care planning, advance care directives, POLST/MOLST forms, and code status, including the outcomes of cardiopulmonary resusitation and other life-sustaining interventions in seriously ill patients.

• Lead culturally sensitive communications about prognosis and goals of care among patients, families, and other members of the healthcare team, including family meetings and discussions in urgent situations to ensure that patients receive treatments that match their goals.

• Coordinate goals of care and treatment plan among the treatment team, including primary care physicians and inpatient and outpatient specialty consultants.

• Consult specialty palliative care and/or hospital ethics service when there is conflict among patients, families, and/or healthcare providers regarding the appropriate healthcare agent for decision-making and provision of life-sustaining interventions.

• Identify when hospice may be the appropriate care model given a patient’s prognosis and goals of care, and describe the hospice care philosophy and care model to a patient and family.

• Implement protocols and multidisciplinary care plans to ensure patient comfort and adequate family support when life-prolonging measures such as mechanical ventilation, vasopressor support, or other intensive care measures are withdrawn or withheld.

• Ensure that the hospital palliative care plan is honored upon discharge, including communicating this plan with primary care and other outpatient providers and establishing home supportive services if needed.

• Implement best practices for self-care and coping with the stress of caring for the seriously ill. 

Hospitalists should be able to:

• Appreciate that palliative care is appropriate at any stage of a serious illness and that it should be provided to all seriously ill patients.

• Appreciate that hospitalists have a key role in ensuring that the palliative care needs of seriously ill patients are addressed.

• Recognize the importance of empathic communication, building a therapeutic relationship with patients and families, and developing patient- and family-centered treatment plans.

• Recognize the impact that social, cultural, and spiritual factors have on preferences for care in the setting of serious illness.

• Appreciate the roles of, and collaboration with, other members of the healthcare team, including nursing and social services, pharmacy, psychology, and spiritual care, in providing palliative care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve the care of seriously ill patients, such as symptom identification and management systems and improved advance care planning and goals of care approaches.

• Lead, coordinate, and/or participate in efforts to establish or support existing multidisciplinary palliative care teams.

Palliative care refers to the comprehensive care of patients and families who are living with serious illness. It focuses on providing patients with relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any stage of illness and should be provided simultaneously with other medical treatments, including disease-modifying and life-prolonging therapies. Palliative care is provided by interprofessional teams, including physicians, nurse practitioners, physician assistants, nurses, social workers, case managers, and chaplains.

Seriously ill patients are frequently hospitalized, and thus all hospitalists—as frontline physicians who coordinate care for these patients—are key members of the interprofessional team who provide primary or generalist palliative care. In addition, in hospitals where palliative care consultation services are available, hospitalists are optimally positioned to refer to and collaborate with these specialty palliative care consultants. In hospitals where no or limited specialty palliative care services are available, hospitalists have an even more central role in providing palliative care. Hospitalists also have a key role in leading and contributing to systems and quality improvement efforts related to palliative care.

Key roles for hospitalists involved in palliative care are (1) leading discussions of goals of care and advance care planning, including completing appropriate documentation of patients’ wishes; (2) screening and implementing treatment for common physical symptoms, including pain, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation; and (3) referring patients to community services to provide support around serious illness after hospital discharge, including hospice and community palliative care services when available. A complete list of core competencies for hospitalists in palliative care follows. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Define palliative care, including primary (or generalist) and specialty palliative care, and explain effective strategies for describing the benefits of palliative care to colleagues, specialists, patients, and families.

• Explain the role of palliative care throughout the course of illness, how it can be provided alongside all other appropriate medical treatments, and appropriate referral to local resources that provide palliative care in the hospital and community.

• Recognize when specialty palliative care consultation, when it is available, should be sought for refractory or complex patient or family palliative care needs.

• Identify the factors that contribute to prognosis in common serious illnesses (eg, cancer, congestive heart failure, chronic obstructive pulmonary disease, end stage renal disease, dementia, and multimorbidity), including how to identify patients who may benefit from palliative care and how to broadly estimate prognosis (eg, months to years, weeks to months, days to weeks, hours to days).

• Describe signs and symptoms of the last 24 hours of life and how to discuss these observations with families.

• Describe data on efficacy and burdens of life support interventions in seriously ill patients, such as tube feeding in advanced dementia and cardiopulmonary resuscitation.

• Explain the ethical principles involved with caring for patients at the end of life, including the right of competent patients or their surrogates to refuse medical treatments, including life-sustaining therapies, and the principle of “double effect.”

• Describe specific legal considerations related to surrogate decision-making and advance planning in the state in which the hospitalist practices.

• Describe the purpose and mechanics of advance directives, including physician or medical orders for life-sustaining treatment (POLST/MOLST) forms available in the state in which the hospitalist practices, durable medical power of attorney forms, and other declarations of patient wishes and treatment preferences.

• Describe the basic tenets of hospice care and the Medicare hospice benefit and explain the process of initiating direct referrals to these programs in various settings (ie, home, skilled nursing facility, inpatient).

• Describe the role of the hospitalist after a patient dies in the hospital, including pronouncing of death, completing the death certificate, requesting an autopsy, notifying the family and primary care physician, contacting the organ donor network, and providing the family with hospital contact information for questions and bereavement resources.

Hospitalists should be able to:

• Perform a comprehensive patient assessment to screen patients for palliative care needs, including (1) pain and other common symptoms (eg, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, constipation); (2) psychosocial and spiritual support of the patient and family; (3) advance care planning communication about prognosis and goals of care; and (4) needs for support on hospital discharge or bereavement.

• Work in interdisciplinary teams, including nursing, social work, case management, therapy, and spiritual care, to formulate specific patient-centered palliative care plans to address identified patient and family needs.

• Build therapeutic relationships with seriously ill patients and their families as a basis of support for coping and creating collaborative patient- and family-centered care plans.

• In seriously ill and/or actively dying patients, provide first-line treatment for common symptoms such as nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation.

• Provide counseling on advance care planning, advance care directives, POLST/MOLST forms, and code status, including the outcomes of cardiopulmonary resusitation and other life-sustaining interventions in seriously ill patients.

• Lead culturally sensitive communications about prognosis and goals of care among patients, families, and other members of the healthcare team, including family meetings and discussions in urgent situations to ensure that patients receive treatments that match their goals.

• Coordinate goals of care and treatment plan among the treatment team, including primary care physicians and inpatient and outpatient specialty consultants.

• Consult specialty palliative care and/or hospital ethics service when there is conflict among patients, families, and/or healthcare providers regarding the appropriate healthcare agent for decision-making and provision of life-sustaining interventions.

• Identify when hospice may be the appropriate care model given a patient’s prognosis and goals of care, and describe the hospice care philosophy and care model to a patient and family.

• Implement protocols and multidisciplinary care plans to ensure patient comfort and adequate family support when life-prolonging measures such as mechanical ventilation, vasopressor support, or other intensive care measures are withdrawn or withheld.

• Ensure that the hospital palliative care plan is honored upon discharge, including communicating this plan with primary care and other outpatient providers and establishing home supportive services if needed.

• Implement best practices for self-care and coping with the stress of caring for the seriously ill. 

Hospitalists should be able to:

• Appreciate that palliative care is appropriate at any stage of a serious illness and that it should be provided to all seriously ill patients.

• Appreciate that hospitalists have a key role in ensuring that the palliative care needs of seriously ill patients are addressed.

• Recognize the importance of empathic communication, building a therapeutic relationship with patients and families, and developing patient- and family-centered treatment plans.

• Recognize the impact that social, cultural, and spiritual factors have on preferences for care in the setting of serious illness.

• Appreciate the roles of, and collaboration with, other members of the healthcare team, including nursing and social services, pharmacy, psychology, and spiritual care, in providing palliative care.

• Lead, coordinate, and/or participate in quality improvement initiatives to improve the care of seriously ill patients, such as symptom identification and management systems and improved advance care planning and goals of care approaches.

• Lead, coordinate, and/or participate in efforts to establish or support existing multidisciplinary palliative care teams.

The Institute of Medicine has defined patient-centered care as 1 of the 6 aims for healthcare improvements in the 21st century. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Self-management education has been shown to improve patient outcomes in chronic disease. For example, disease-specific patient education improves Health-Related Quality of Life scores in patients with chronic obstructive pulmonary disease, reduces glycosylated hemoglobin levels and blood pressure in patients with diabetes mellitus, and decreases the number of attacks in patients with asthma.^1,2 Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in healthcare decisions and management. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the guiding principles for patient education.

• Identify institutional resources for patient education materials and programs.

• Summarize the evidence for the primacy of patient education as a means to improve the quality of healthcare.

• Discuss the contextual factors that influence a patient’s readiness to learn new information.

• Describe the role of patient education in the management of chronic diseases, which may include diabetes mellitus, congestive heart failure, and asthma.

• Explain the effect of the patient’s sociocultural background on his or her health beliefs and behavior.

• Describe different methods of delivering patient education.

• Describe patient characteristics that influence the utility and appropriateness of patient education materials, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.

• Recognize the importance of early identification of barriers to patient education such as low health literacy and language fluency.

Hospitalists should be able to:

• Deliver effective patient education in a manner best suited to the patient’s level of literacy and understanding.

• Identify and assist patients and families who require additional education about their medical illnesses.

• Use and/or develop methods and materials to fully inform patients and families.

• Communicate effectively with patients from diverse backgrounds.

• Determine patient and family understanding of illness severity, prognosis, and goals of care.

• Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow-up.

• Ensure that patients understand anticipated therapies, procedures, and/or surgery.

• Use methods that confirm the comprehension and retention of new information by patients and families, such as “Teach Back” and “Show Back.”

• Advocate for the incorporation of patient wishes into care plans.

• Lead, coordinate, and/or participate in the development of team-based approaches to patient education.

• Lead, coordinate, and/or participate in the development of effective quality measures sensitive to the effects of patient education. 

Hospitalists should be able to:

• Value the potential for patient education to improve the quality of healthcare.

• Encourage patients to ask questions, keep accurate medication lists, and obtain test results.

• Convey diagnosis, prognosis, treatment, and support options available for patients and families in a clear, concise, compassionate, culturally sensitive, and timely manner.

• Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.

The Institute of Medicine has defined patient-centered care as 1 of the 6 aims for healthcare improvements in the 21st century. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Self-management education has been shown to improve patient outcomes in chronic disease. For example, disease-specific patient education improves Health-Related Quality of Life scores in patients with chronic obstructive pulmonary disease, reduces glycosylated hemoglobin levels and blood pressure in patients with diabetes mellitus, and decreases the number of attacks in patients with asthma.^1,2 Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in healthcare decisions and management. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the guiding principles for patient education.

• Identify institutional resources for patient education materials and programs.

• Summarize the evidence for the primacy of patient education as a means to improve the quality of healthcare.

• Discuss the contextual factors that influence a patient’s readiness to learn new information.

• Describe the role of patient education in the management of chronic diseases, which may include diabetes mellitus, congestive heart failure, and asthma.

• Explain the effect of the patient’s sociocultural background on his or her health beliefs and behavior.

• Describe different methods of delivering patient education.

• Describe patient characteristics that influence the utility and appropriateness of patient education materials, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.

• Recognize the importance of early identification of barriers to patient education such as low health literacy and language fluency.

Hospitalists should be able to:

• Deliver effective patient education in a manner best suited to the patient’s level of literacy and understanding.

• Identify and assist patients and families who require additional education about their medical illnesses.

• Use and/or develop methods and materials to fully inform patients and families.

• Communicate effectively with patients from diverse backgrounds.

• Determine patient and family understanding of illness severity, prognosis, and goals of care.

• Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow-up.

• Ensure that patients understand anticipated therapies, procedures, and/or surgery.

• Use methods that confirm the comprehension and retention of new information by patients and families, such as “Teach Back” and “Show Back.”

• Advocate for the incorporation of patient wishes into care plans.

• Lead, coordinate, and/or participate in the development of team-based approaches to patient education.

• Lead, coordinate, and/or participate in the development of effective quality measures sensitive to the effects of patient education. 

Hospitalists should be able to:

• Value the potential for patient education to improve the quality of healthcare.

• Encourage patients to ask questions, keep accurate medication lists, and obtain test results.

• Convey diagnosis, prognosis, treatment, and support options available for patients and families in a clear, concise, compassionate, culturally sensitive, and timely manner.

• Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.

The Institute of Medicine has defined patient-centered care as 1 of the 6 aims for healthcare improvements in the 21st century. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Self-management education has been shown to improve patient outcomes in chronic disease. For example, disease-specific patient education improves Health-Related Quality of Life scores in patients with chronic obstructive pulmonary disease, reduces glycosylated hemoglobin levels and blood pressure in patients with diabetes mellitus, and decreases the number of attacks in patients with asthma.^1,2 Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in healthcare decisions and management. 

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Hospitalists should be able to:

• Describe the guiding principles for patient education.

• Identify institutional resources for patient education materials and programs.

• Summarize the evidence for the primacy of patient education as a means to improve the quality of healthcare.

• Discuss the contextual factors that influence a patient’s readiness to learn new information.

• Describe the role of patient education in the management of chronic diseases, which may include diabetes mellitus, congestive heart failure, and asthma.

• Explain the effect of the patient’s sociocultural background on his or her health beliefs and behavior.

• Describe different methods of delivering patient education.

• Describe patient characteristics that influence the utility and appropriateness of patient education materials, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.

• Recognize the importance of early identification of barriers to patient education such as low health literacy and language fluency.

Hospitalists should be able to:

• Deliver effective patient education in a manner best suited to the patient’s level of literacy and understanding.

• Identify and assist patients and families who require additional education about their medical illnesses.

• Use and/or develop methods and materials to fully inform patients and families.

• Communicate effectively with patients from diverse backgrounds.

• Determine patient and family understanding of illness severity, prognosis, and goals of care.

• Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow-up.

• Ensure that patients understand anticipated therapies, procedures, and/or surgery.

• Use methods that confirm the comprehension and retention of new information by patients and families, such as “Teach Back” and “Show Back.”

• Advocate for the incorporation of patient wishes into care plans.

• Lead, coordinate, and/or participate in the development of team-based approaches to patient education.

• Lead, coordinate, and/or participate in the development of effective quality measures sensitive to the effects of patient education. 

Hospitalists should be able to:

• Value the potential for patient education to improve the quality of healthcare.

• Encourage patients to ask questions, keep accurate medication lists, and obtain test results.

• Convey diagnosis, prognosis, treatment, and support options available for patients and families in a clear, concise, compassionate, culturally sensitive, and timely manner.

• Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.