Leaders: Ped Hospitalist Strives to Improve Education, Quality

Dr. Erin Stucky Fisher has dedicated much of her career to educating pediatric hospitalists. Dr. Fisher, who is the vice chair of clinical affairs and a professor of clinical pediatrics at the University of California, San Diego, at Rady Children’s Hospital, helped establish UCSD’s pediatric hospital medicine fellowship program, one of the first in the nation.

Earlier this year, Dr. Fisher was chosen as a Master in Hospital Medicine by the Society of Hospital Medicine. The award is SHM’s highest honor and is presented to only a few hospitalists each year as a lifetime achievement award. In an interview with Hospitalist News, Dr. Fisher shared her thoughts on educating fellows, recognition for pediatric hospitalists, and her next project.

HN: How many pediatric hospitalist fellowship programs are there?

DR. FISHER: This academic year there will be 18 programs up and running. They vary in duration and in the number of trainees, but there will be about 30-35 trainees this next academic year and that number is growing. The number of programs has jumped in the past year, and it will probably jump by about 50% again a year from now. The number of trainees is likely to double over the next couple of years.

HN: How would you evaluate the state of fellowship training for pediatric hospitalists in the United States? Are trainees being prepared to handle the array of clinical problems and quality questions they will face?

DR. FISHER: The fellowship programs have taken a significant leap forward in the past 12-18 months in assuring specific content is covered during fellowship and also in creating guidelines for what can be expected of a fellow who has finished a 1-, 2-, or 3-year fellowship. We held a meeting of the fellowship directors last year and agreed on the expectations. At the core are systems issues such as quality and safety, as well as clinical excellence and a commitment to the other major domains of our pediatric hospital medicine core competencies. Physicians that are coming out of a 1-year fellowship are certainly much better prepared to address not only complex clinical management and related coordination of care issues, but also the systems practice issues than are those coming directly out of residency. Those fellows that complete 2- and 3-year fellowships have a focus on the research aspects of pediatric hospital medicine and/or greater emphasis on quality projects.

HN: Should pediatric hospitalists have their own type of formal certification?

DR. FISHER: I believe some type of certification is needed for pediatric hospitalists.

One reason to pursue certification is to let the community know we have an expectation of our performance and we hold ourselves accountable for this. The other reason is to create an identity so that we can present ourselves to an institution and its colleagues and they will know who we are.

To meet those goals, it doesn’t necessarily mean that a board has to certify you, although subcertification and a special maintenance of certification pathway are clearly options. There could be another process of recognition, such as through a society. Whether or not a particular certification model is pursued doesn’t matter as much as whether it is done correctly and in a way that meets the needs of the patient, community, and pediatric hospitalists. As we speak, the pediatric hospital medicine community is assessing all options, defining the weaknesses and strengths of each option, and discussing how we as a community should move forward.

HN: What’s next for you in terms of research and quality improvement?

DR. FISHER: One area I’m working on is how to help people deliver evidence-based medicine in the right way within electronic health care systems. Locally, we’ve had clinical pathways in place for a couple of decades. They have been embedded in our day-to-day work and they’ve been incredibly well-received and utilized. I worry that with an electronic system we might lose some of those gains. One of my goals is to make sure that the best practice models, order sets, algorithms, and references that help the physician to do the right thing for the patient in the paper world are moved forward to an electronic system.

Dr. Erin Stucky Fisher has dedicated much of her career to educating pediatric hospitalists. Dr. Fisher, who is the vice chair of clinical affairs and a professor of clinical pediatrics at the University of California, San Diego, at Rady Children’s Hospital, helped establish UCSD’s pediatric hospital medicine fellowship program, one of the first in the nation.

Earlier this year, Dr. Fisher was chosen as a Master in Hospital Medicine by the Society of Hospital Medicine. The award is SHM’s highest honor and is presented to only a few hospitalists each year as a lifetime achievement award. In an interview with Hospitalist News, Dr. Fisher shared her thoughts on educating fellows, recognition for pediatric hospitalists, and her next project.

HN: How many pediatric hospitalist fellowship programs are there?

DR. FISHER: This academic year there will be 18 programs up and running. They vary in duration and in the number of trainees, but there will be about 30-35 trainees this next academic year and that number is growing. The number of programs has jumped in the past year, and it will probably jump by about 50% again a year from now. The number of trainees is likely to double over the next couple of years.

HN: How would you evaluate the state of fellowship training for pediatric hospitalists in the United States? Are trainees being prepared to handle the array of clinical problems and quality questions they will face?

DR. FISHER: The fellowship programs have taken a significant leap forward in the past 12-18 months in assuring specific content is covered during fellowship and also in creating guidelines for what can be expected of a fellow who has finished a 1-, 2-, or 3-year fellowship. We held a meeting of the fellowship directors last year and agreed on the expectations. At the core are systems issues such as quality and safety, as well as clinical excellence and a commitment to the other major domains of our pediatric hospital medicine core competencies. Physicians that are coming out of a 1-year fellowship are certainly much better prepared to address not only complex clinical management and related coordination of care issues, but also the systems practice issues than are those coming directly out of residency. Those fellows that complete 2- and 3-year fellowships have a focus on the research aspects of pediatric hospital medicine and/or greater emphasis on quality projects.

HN: Should pediatric hospitalists have their own type of formal certification?

DR. FISHER: I believe some type of certification is needed for pediatric hospitalists.

One reason to pursue certification is to let the community know we have an expectation of our performance and we hold ourselves accountable for this. The other reason is to create an identity so that we can present ourselves to an institution and its colleagues and they will know who we are.

To meet those goals, it doesn’t necessarily mean that a board has to certify you, although subcertification and a special maintenance of certification pathway are clearly options. There could be another process of recognition, such as through a society. Whether or not a particular certification model is pursued doesn’t matter as much as whether it is done correctly and in a way that meets the needs of the patient, community, and pediatric hospitalists. As we speak, the pediatric hospital medicine community is assessing all options, defining the weaknesses and strengths of each option, and discussing how we as a community should move forward.

HN: What’s next for you in terms of research and quality improvement?

DR. FISHER: One area I’m working on is how to help people deliver evidence-based medicine in the right way within electronic health care systems. Locally, we’ve had clinical pathways in place for a couple of decades. They have been embedded in our day-to-day work and they’ve been incredibly well-received and utilized. I worry that with an electronic system we might lose some of those gains. One of my goals is to make sure that the best practice models, order sets, algorithms, and references that help the physician to do the right thing for the patient in the paper world are moved forward to an electronic system.

Dr. Erin Stucky Fisher has dedicated much of her career to educating pediatric hospitalists. Dr. Fisher, who is the vice chair of clinical affairs and a professor of clinical pediatrics at the University of California, San Diego, at Rady Children’s Hospital, helped establish UCSD’s pediatric hospital medicine fellowship program, one of the first in the nation.

Earlier this year, Dr. Fisher was chosen as a Master in Hospital Medicine by the Society of Hospital Medicine. The award is SHM’s highest honor and is presented to only a few hospitalists each year as a lifetime achievement award. In an interview with Hospitalist News, Dr. Fisher shared her thoughts on educating fellows, recognition for pediatric hospitalists, and her next project.

HN: How many pediatric hospitalist fellowship programs are there?

DR. FISHER: This academic year there will be 18 programs up and running. They vary in duration and in the number of trainees, but there will be about 30-35 trainees this next academic year and that number is growing. The number of programs has jumped in the past year, and it will probably jump by about 50% again a year from now. The number of trainees is likely to double over the next couple of years.

HN: How would you evaluate the state of fellowship training for pediatric hospitalists in the United States? Are trainees being prepared to handle the array of clinical problems and quality questions they will face?

DR. FISHER: The fellowship programs have taken a significant leap forward in the past 12-18 months in assuring specific content is covered during fellowship and also in creating guidelines for what can be expected of a fellow who has finished a 1-, 2-, or 3-year fellowship. We held a meeting of the fellowship directors last year and agreed on the expectations. At the core are systems issues such as quality and safety, as well as clinical excellence and a commitment to the other major domains of our pediatric hospital medicine core competencies. Physicians that are coming out of a 1-year fellowship are certainly much better prepared to address not only complex clinical management and related coordination of care issues, but also the systems practice issues than are those coming directly out of residency. Those fellows that complete 2- and 3-year fellowships have a focus on the research aspects of pediatric hospital medicine and/or greater emphasis on quality projects.

HN: Should pediatric hospitalists have their own type of formal certification?

DR. FISHER: I believe some type of certification is needed for pediatric hospitalists.

One reason to pursue certification is to let the community know we have an expectation of our performance and we hold ourselves accountable for this. The other reason is to create an identity so that we can present ourselves to an institution and its colleagues and they will know who we are.

To meet those goals, it doesn’t necessarily mean that a board has to certify you, although subcertification and a special maintenance of certification pathway are clearly options. There could be another process of recognition, such as through a society. Whether or not a particular certification model is pursued doesn’t matter as much as whether it is done correctly and in a way that meets the needs of the patient, community, and pediatric hospitalists. As we speak, the pediatric hospital medicine community is assessing all options, defining the weaknesses and strengths of each option, and discussing how we as a community should move forward.

HN: What’s next for you in terms of research and quality improvement?

DR. FISHER: One area I’m working on is how to help people deliver evidence-based medicine in the right way within electronic health care systems. Locally, we’ve had clinical pathways in place for a couple of decades. They have been embedded in our day-to-day work and they’ve been incredibly well-received and utilized. I worry that with an electronic system we might lose some of those gains. One of my goals is to make sure that the best practice models, order sets, algorithms, and references that help the physician to do the right thing for the patient in the paper world are moved forward to an electronic system.