From the Society

SHM Chapter innovations: A provider exchange program


The SHM Annual Conference is more than an educational event. It also provides an opportunity to collaborate, network and create innovative ideas to improve the quality of inpatient care.

Dr. Krystle D. Apodaca

During the 2019 Annual Conference (HM19) – the last “in-person” Annual Conference before the COVID pandemic – SHM chapter leaders from the New Mexico chapter (Krystle Apodaca) and the Wiregrass chapter (Amith Skandhan), which covers the counties of Southern Alabama and the Panhandle of Florida, met during a networking event.

As we talked, we realized the unique differences and similarities our practice settings shared. We debated the role of clinician wellbeing, quality of medical education, and faculty development on individual hospital medicine group (HMG) practice styles.

Clinician well-being is the prerequisite to the Triple Aim of improving the health of populations, enhancing the patient experience, and reducing the cost of care. Engagement in local SHM chapter activities promotes the efficiency of practice, a culture of wellness, and personal resilience. Each HMG faces similar challenges but approaches to solving them vary. Professional challenges can affect the well-being of individual clinicians. During our discussion we realized that an interinstitutional exchange programs could provide a platform to exchange ideas and establish mentors.

The quality of medical education is directly linked to the quality of faculty development. Improving the quality of medical education requires a multifaceted approach by highly developed faculty. The complex factors affecting medical education and faculty development are further complicated by geographic location, patient characteristics, and professional growth opportunities.

Overcoming these obstacles requires an innovative and collaborative approach. Although faculty exchanges are common in academic medicine, they are not commonly attempted with HMGs. Hospitalists are responsible for a significant part of inpatient training for residents, medical students, and nurse practitioners/physician assistants (NPs/PAs) but their faculty training can vary based on location.

As a young specialty, hospital medicine is still evolving and incorporating NPs/PAs and physician hospitalists in varied practice models. Each HMG addresses common obstacles differently based on their culture and practice styles. As chapter leaders we determined that an exchange program would afford the opportunity for visiting faculty members to experience these differences.

We shared the idea of a chapter-level exchange with SHM’s Chapter Development Committee and obtained chapter development funds to execute the event. We also requested that an SHM national board member visit during the exchange to provide insight and feedback. We researched the characteristics of individual academic HMGs and structured a faculty exchange involving physicians and NPs/PAs. During the exchange program planning, the visiting faculty itinerary was tailored to a well-planned agenda for one week, with separate tracks for physicians and NPs/PAs, giving increased access to their individual peer practice styles. Additionally, the visiting faculty had meetings and discussions with the HMG and hospital leadership, to specifically address the visiting faculty’s institutional challenges.

The overall goal of the exchange program was to promote cross-institutional collaboration, increase engagement, improve medical education through faculty development and improve the quality of care. The focus of the exchange program was to share ideas and innovation, and learn the approaches to unique challenges at each institution. Out of this also grew collaboration and mentoring opportunities.

Dr. Amith Skandhan

SHM’s New Mexico chapter is based in Albuquerque, a city in the desert Southwest with an ethnically diverse population of 545,000, The chapter leadership works at the University of New Mexico (UNM), a 553-bed medical center. UNM has a well-established internal medicine residency program, an academic hospitalist program, and an NP/PA fellowship program embedded within the hospital medicine department. At the time of the exchange, the HMG at UNM has 26 physicians and 9 NP/PA’s.

The SHM Wiregrass chapter is located in Dothan, Ala., a town of 80,000 near the Gulf of Mexico. Chapter leadership works at Southeast Health, a tertiary care facility with 420 beds, an affiliated medical school, and an internal medicine residency program. At the time of the exchange, the HMG at SEH has 28 physicians and 5 NP/PA’s.

These are two similarly sized hospital medicine programs, located in different geographic regions, and serving different populations. SHM board member Howard Epstein, MD, SFHM, vice president and chief medical officer of Presbyterian Healthcare Services in Albuquerque, participated on behalf of the Society when SEH faculty visited UNM. Kris Rehm, MD, SFHM, a pediatric hospitalist and the vice chair of outreach medicine at Vanderbilt University Medical Center, Nashville, came to Dothan during the faculty visit by UNM.

Two SEH faculty members, a physician and an NP, visited the University of New Mexico Hospital for one week. They participated as observers, rounding with the teams and meeting the UNM HMG leadership. The focus of the discussions included faculty education, a curriculum for quality improvement, and ways to address practice challenges. The SEH faculty also presented a QI project from their institution, and established collaborative relationships.

During the second part of the exchange, three UNM faculty members, including one physician and two NPs, visited SEH for one week. During the visit, they observed NP/PA hospitalist team models, discussed innovations, established mentoring relationships with leadership, and discussed QI projects at SEH. Additionally, the visiting UNM faculty participated in Women In Medicine events and participated as judges for a poster competition. They also had an opportunity to explore the rural landscape and visit the beach.

The evaluation process after the exchanges involved interviews, a survey, and the establishment of shared QI projects in mutual areas of challenge. The survey provided feedback, lessons learned from the exchange, and areas to be improved. Collaborative QI projects currently underway as a result of the exchange include paging etiquette, quality of sleep for hospitalized patients, and onboarding of NPs/PAs in HMGs.

This innovation changed our thinking as medical educators by addressing faculty development and medical education via clinician well-being. The physician and NP/PA Faculty Exchange program was an essential and meaningful innovation that resulted in increased SHM member engagement, crossinstitutional collaboration, networking, and mentorship.

This event created opportunities for faculty collaboration and expanded the professional network of participating institutions. The costs of the exchange were minimal given support from SHM. We believe that once the COVID pandemic has ended, this initiative has the potential to expand facilitated exchanges nationally and internationally, enhance faculty development, and improve medical education.

Dr. Apodaca is assistant professor and nurse practitioner hospitalist at the University of New Mexico. She serves as codirector of the UNM APP Hospital Medicine Fellowship and director of the APP Hospital Medicine Team. Dr. Skandhan is a hospitalist and member of the Core Faculty for the Internal Medicine Residency Program at Southeast Health (SEH), Dothan Ala., and an assistant professor at the Alabama College of Osteopathic Medicine. He serves as the medical director/physician liaison for the Clinical Documentation Program at SEH and also as the director for physician integration for Southeast Health Statera Network, an Accountable Care Organization.

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