The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.
Pediatric Hospital Medicine (PHM) is the fastest-growing subspecialty in pediatrics, with 1 of every 12 residency graduates entering the field.1–5 Fellowship programs in PHM have existed since the late 1990s, rapidly growing and evolving over time to meet the needs of the trainees and the field.6–9 In recognition of the specific skill set required for its practice, PHM was designated a subspecialty by the American Board of Medical Specialties with a 2-year fellowship program in 2016.10 Concurrent with PHM subspecialty recognition, hospitals have seen major changes in the organization, delivery, and financing of health care, signaling the need to provide better care with better value.11,12 Our young field, like others before, faces the challenge of developing academic scholars to drive innovation in research, including advances in the safety and efficiency of health care delivery, the identification and mitigation of health care disparities, and the discovery, implementation, and dissemination of best practices. A strong core curriculum in scholarly activities for fellows is critical for the field of PHM to expand academically, which, in turn, will propel us forward in providing the highest quality of care for hospitalized children.
There are several major challenges to training PHM fellows in scholarly activities. First, a 2-year fellowship provides less time for research training than traditional 3-year fellowships in other pediatric subspecialties. In the 2-year curricular framework, just one-third of the time is dedicated to scholarly pursuits.7,9 In addition, PHM fellowship program graduates had an identified need for further research skill training.13–15 A standardized and efficient training approach is thus necessary to ensure fellows gain relevant and meaningful research skills. Second, PHM is a new subspecialty and one that, in contrast to other pediatric subspecialties, includes fellowship training programs at both community hospitals and University and Children’s Hospitals. Thus, some fellowship programs, particularly those in community settings, have limited program, division, or even institutional infrastructure and mentorship to conduct scholarly activities and are led by program directors with limited formal research training. Finally, fellowship programs lack objectives for a comprehensive curriculum in scholarly activities and thus struggle to ensure fellows gain the necessary skills to conduct scholarly projects.
To address these concerns, the Council of PHM Fellowship Directors partnered with researchers from the Pediatric Research in Inpatient Settings (PRIS) Network (www.prisnetwork.org) to create core competencies for PHM fellow scholarship. The purpose of this article is to describe the development of fellowship goals and objectives for scholarly activities in PHM and to further delineate advanced skills for fellows pursuing careers as physician-scientists.
Methods
A 2-day conference was held in April 2019 in Cincinnati, Ohio. The conference was developed and implemented by a planning group composed of fellowship directors with experience in educational theory and scholarship and researchers with diverse expertise in methods and applications of clinical, health services, and translational research, as well as implementation science. The members of this planning group included representatives of the PRIS Network, the Council on Pediatric Subspecialties, the Association of Pediatric Program Directors, the American Board of Pediatrics (ABP) sub-board for PHM, and the Executive Council of the PHM Fellowship Directors.
All existing PHM fellowships were invited to send 1 representative to the conference. PHM fellowship leaders from 40 fellowship programs participated in the conference, representing 83% of actively recruiting programs at the time. Participants also included nationally recognized and grant-funded PHM researchers. In addition, representatives of the 3 major medical societies in our field attended, including the American Academy of Pediatrics Section of Hospital Medicine, the Academic Pediatric Association Hospital Medicine Special Interest Group, and the Society of Hospital Medicine Pediatrics Special Interest Group, as well as representatives from the ABP sub-board, the Association of Pediatric Program Directors, the Council on Pediatric Subspecialties, Children’s Hospital Association, and the PRIS Network. Participants are listed in Supplemental Table 3.
In preparation for the conference, the planning group reviewed and compiled the national standards for scholarship from the ABP, the Accreditation Council for Graduate Medical Education (ACGME), and the Clinical and Translation Science Awards Program.16–19 Additional scholarly activity requirements from pediatric critical care, pediatric emergency medicine, and the Federation of Pediatric Organizations Policy Statement on Pediatric Fellowship Training were reviewed.20–22 This review of national standards resulted in a comprehensive list that was edited to remove duplicate topics. Next, the planning group completed iterative edits to reach a consensus draft of PHM-specific scholarship goals and objectives. Before the conference, the objectives were arranged into 6 domains: research design, data management, statistical analysis, clinical epidemiology, scientific communications, and responsible conduct of research.
At the conference, the planning group presented an orientation to the 6 domains and a review of educational processes for the development of competencies, goals, and objectives. This review included specific knowledge sharing related to the differences between goals and objectives, the key components of writing effective objectives, and the relationship between competencies, milestones, and entrustable professional activities. Participants were then divided into 6 small groups with at least 1 experienced PHM physician-scientist faculty and at least 1 PHM fellowship program director with advanced education knowledge per group. Each group was assigned a primary and secondary domain from the 6 domains. For the primary domain, the group reviewed the draft goals and objectives and suggested the addition, subtraction, and revision of goals and objectives to align with the expected competencies of PHM fellowship graduates. After this initial review and editing, groups were asked to review and edit a second domain. Ultimately, this configuration allowed for a double review of each domain to reconcile diverging viewpoints and ensure the development of rigorous and comprehensive training goals and objectives. At the conclusion of this small group work, the larger group was reconvened. Each small group then reported on their domains, and facilitators led a large-group discussion to address points of controversy and reach a final consensus around the goals and objectives for each of the 6 domains.
After the conference, the planning group incorporated feedback provided by the conference participants. The 6 initial domains were refined into 7 final domains, each with a specific goal. To account for the many areas of scholarship within PHM and, consequently, the need for broad as well as discrete methodologic knowledge, specific objectives for each goal were further organized into 3 levels. Level 1 objectives indicate core skills expected of all PHM fellows, level 2 objectives represent specialized skills specific to the focus of a fellow’s scholarly work, and level 3 objectives are more advanced objectives specific to fellows interested in a physician-scientist path. Of note, many level 3 objectives are anticipated to require additional time beyond the standard 2-year PHM ACGME fellowship. A final, expert review by the PRIS Network leadership and PHM fellowship program directors then occurred to reconcile any remaining uncertainties. Figure 1 provides an overview of the entire process of developing these scholarship core competencies.
Process diagram detailing the steps in the development of scholarship core competencies for pediatric hospital medicine fellowship programs.
Process diagram detailing the steps in the development of scholarship core competencies for pediatric hospital medicine fellowship programs.
Results
Based on expert review, iterative feedback, and refinement, the initial 6 domains yielded 7 final domains and corresponding goals representing the comprehensive scholarship core competencies expected of PHM fellowship graduates: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership (Tables 1 and 2). Each goal is presented with corresponding objectives, including levels 1, 2, and 3 objectives to represent the core objectives expected of all PHM fellows (1), specialized objectives specific to the focus of the fellow’s scholarly work (2), and more advanced objectives for fellows pursuing a physician-scientist path (3).
Scholarship Core Competency Areas and Goals
| Initial Focus Areas | Final Focus Areas | Goal |
|---|---|---|
| Research design | Study design and execution | Construct a research project that reveals the selection of the appropriate study design, methods, and analysis plan to address the research question. |
| Clinical epidemiology | ||
| Data management | Data management | Apply the basic principles of data management to organize and prepare data for analysis, ensuring accuracy, completeness, secure storage, and appropriate sharing. |
| Statistical analysis | Principles of analytics | Demonstrate knowledge of common biostatistics principles required for the interpretation of scholarly work in pediatric hospital medicine. |
| Critical appraisal of the medical literature | Evaluate the literature to determine validity, reliability, applicability, and generalizability as it relates to the care of hospitalized children. | |
| Responsible conduct of research | Ethics and responsible conduct of research | Understand the ethics and the responsible conduct of research to ensure investigations and research-related activities respect the rights, privacy, and interests of human subjects and provide special protections for children and other vulnerable populations. |
| Professionalism and leadership in research | Demonstrate professionalism and leadership in the design, implementation, and dissemination of scholarly work. | |
| Scientific communications | Dissemination of research | Participate in the review and dissemination of scholarship to advance the field of pediatric hospital medicine. |
| Initial Focus Areas | Final Focus Areas | Goal |
|---|---|---|
| Research design | Study design and execution | Construct a research project that reveals the selection of the appropriate study design, methods, and analysis plan to address the research question. |
| Clinical epidemiology | ||
| Data management | Data management | Apply the basic principles of data management to organize and prepare data for analysis, ensuring accuracy, completeness, secure storage, and appropriate sharing. |
| Statistical analysis | Principles of analytics | Demonstrate knowledge of common biostatistics principles required for the interpretation of scholarly work in pediatric hospital medicine. |
| Critical appraisal of the medical literature | Evaluate the literature to determine validity, reliability, applicability, and generalizability as it relates to the care of hospitalized children. | |
| Responsible conduct of research | Ethics and responsible conduct of research | Understand the ethics and the responsible conduct of research to ensure investigations and research-related activities respect the rights, privacy, and interests of human subjects and provide special protections for children and other vulnerable populations. |
| Professionalism and leadership in research | Demonstrate professionalism and leadership in the design, implementation, and dissemination of scholarly work. | |
| Scientific communications | Dissemination of research | Participate in the review and dissemination of scholarship to advance the field of pediatric hospital medicine. |
Scholarship Core Competency Goals and Objectives for PHM Fellowship
| Study design and execution |
|---|
| Goal: Construct a research project that reveals the selection of the appropriate study design, methods, and analysis plan to address the research question. |
| Basic objectives |
| 1. Use a comprehensive and systematic approach to define gaps in knowledge by identifying and evaluating the relevant literature, employing sound search strategies, a literature matrix, and reference management. (1) |
| 2. Develop a focused research question based on gaps in current literature. (1) |
| a. For qualitative studies, identify methodologic and sampling approaches that align with the research question, including ethnography, phenomenology, and grounded theory. (2) |
| b. For QI studies, identify an improvement opportunity, determine an improvement aim, identify outcome, process, and balancing measures, and plan appropriate interventions using QI tools. (2) |
| 3. Derive specific aims and, if relevant, hypotheses from a research question. (1) |
| 4. Identify the most appropriate study design to evaluate the specific aims, with consideration of inherent strengths, limitations, feasibility, and resource needs of study design options. (1) |
| 5. Distinguish indications for when to use a meta-analysis versus a systematic review versus a scoping review. (1) |
| 6. Choose measurable outcomes for study aims, optimizing reliability and validity while decreasing bias and confounding. (1) |
| 7. Design a study protocol that defines the target population with inclusion or exclusion criteria, recruitment plans, proposed outcome measures, and sampling strategy. (1) |
| 8. Execute a research project, including obtaining IRB approval, implementing recruitment and data collection plans, and maintaining a record of study procedures. (1) |
| Advanced objectives specific to quantitative research |
| 1. Describe the role of pilot testing and quality control in the implementation of research protocols. (2) |
| 2. Define variables for each aim and identify those variables as independent, dependent, confounders, or effect modifiers. (2) |
| 3. Discuss the uses and limitations of secondary databases in research. (2) |
| Principles of analysis |
| Goal: Demonstrate knowledge of the common biostatistics principles required for the interpretation of scholarly work in pediatric hospital medicine. |
| Basic objectives |
| 1. Distinguish the different types of variables (eg, continuous, ordinal) and how they affect choice of statistical tests. (1) |
| 2. Define ways to describe the distribution of data. (1) |
| 3. Interpret the results of hypothesis testing. (1) |
| 4. Differentiate type 1 from type 2 errors. (1) |
| 5. Recognize the difference between association and causation. (1) |
| 6. Interpret the results of a meta-analysis. (1) |
| 7. Describe differences between validity and reliability. (1) |
| 8. Discuss how bias and confounding affect the validity of results and describe methods to account for bias and confounding. (1) |
| 9. Identify factors that contribute to or limit generalizability. (1) |
| 10. Outline the difference between incidence and prevalence. (1) |
| 11. Interpret sensitivity, specificity, likelihood ratios, and positive and negative predictive values. (1) |
| 12. Describe how disease prevalence affects the positive and negative predictive value of a test. (1) |
| 13. Define the significance of study results, generalizability, and the likelihood that study results represent the truth. (1) |
| 14. Interpret an ROC curve. (1) |
| 15. Determine appropriate situations for use of different tests of association (eg, χ2, paired and non-paired t test, Wilcoxon rank, ANOVA). (1) |
| 16. Differentiate cost-benefit from cost-effectiveness analyses. (1) |
| 17. Describe the components of a successful quality improvement charter (eg, model for improvement, aims, key drivers, tools, PDSA cycles). (1) |
| 18. Interpret common quality improvement analytic tools, such as Pareto charts, run charts, and statistical process control charts. (1) |
| Advanced objectives specific to quantitative research |
| 1. Collaborate with biostatistician for conduct of advanced analytics. (2) |
| 2. Calculate statistical power analysis. (2) |
| 3. Use and interpret linear and logistic regression. (2) |
| 4. Use and interpret survival analyses. (3) |
| 5. Calculate confidence intervals and P values. (2) |
| 6. Calculate and interpret relative risk, hazard ratios, odds ratios, and/or correlation coefficients. (2) |
| 7. Conduct post-hoc and subgroup analyses, as appropriate. (2) |
| 8. Describe how to maximize validity and reliability in research studies. (2) |
| 9. Identify when data exist in clusters and understand what the implications are for study design, analysis, and power. (3) |
| 10. Identify when to consider use of more advanced analytics (eg, multilevel modeling, propensity scores). (3) |
| 11. Describe quality adjusted life years and the relationship to cost analyses. (3) |
| 12. Describe methods to increase the quality of publication using a reporting guideline (eg, CONSORT, STROBE, PRISMA). (3) |
| Advanced objectives specific to scholarly quality improvement |
| 1. Define measures involved in quality improvement (eg, structure, process, outcome, balancing measures). (2) |
| 2. Use tools to model processes, drivers, or causes of outcomes of interest (eg, process maps, key drivers, fishbone diagrams). (2) |
| 3. Identify special and common cause variation. (2) |
| 4. Design, implement, and perform analysis using advanced QI methods, including interrupted time series, stepped-wedge designs, factorial designs, advanced control charts, and segmentation of data. (3) |
| 5. Understand the differences in Sigma6, Lean, and Model for Improvement methodologies. (3) |
| 6. Describe methods to increase quality of scholarly QI publication using SQUIRE reporting guideline. (3) |
| Advanced objectives specific to qualitative research |
| 1. Apply qualitative interview skills in the conduct of interviews. (2) |
| 2. Understand the differences between inductive and deductive coding approach. (2) |
| 3. Conduct coding and analysis on the basis of a qualitative methodological or theoretical approach to generate categories, themes, or a framework or model. (2) |
| 4. Recognize the importance of reflexivity in qualitative research. (2) |
| 5. Identify research paradigms for qualitative analysis, including constructivism, positivism, and post-positivism. (3) |
| 6. Describe methods to increase quality of qualitative research publication using reporting guidelines (eg, SRQR, COREQ, O’Brien et al). (3) |
| Data management |
| Goal: Apply the basic principles of data management to organize and prepare data for analysis, ensuring accuracy, completeness, secure storage, and appropriate sharing. |
| Basic objectives |
| 1. Maintain the security of data in collection, storage, and sharing by selecting the appropriate location to collect, protect, and securely store data, completing data sharing agreements, and ensuring privacy and rights for study participants. (1) |
| 2. Select appropriate data management tools for collecting and managing data. (1) |
| 3. Recognize the steps necessary to prepare data for analysis to ensure data accuracy and completeness. (1) |
| Advanced objectives specific to quantitative research |
| 1. Manage a clinical database or perform analyses with a secondary data set. (3) |
| Critical appraisal of the medical literature |
| Goal: Evaluate the literature to determine validity, reliability, applicability, and generalizability as it relates to the care of hospitalized children. |
| Basic objectives |
| 1. Search the medical literature using steps outlined by the Centre for Evidence Based Medicine. (1) |
| 2. Apply acquired knowledge in epidemiology and statistical analyses to appraise medical literature for validity, reliability, generalizability, and applicability to clinical situations. (1) |
| 3. Interpret and apply findings from evidence on the basis of hierarchy of evidence. (1) |
| 4. Summarize the process of clinical practice guideline development, including the assessment of benefits and harms of alternative care options. (1) |
| Ethics and responsible conduct of research |
| Goal: Understand the ethics and the responsible conduct of research to ensure investigations and research-related activities respect the rights, privacy, and interests of human subjects and provide special protections for children and other vulnerable populations. |
| Basic objectives |
| 1. Define the principles of respect for person, beneficence, and justice as defined by the Belmont Report. (1) |
| 2. Describe the role of risk-benefit analysis. (1) |
| 3. Summarize the ethical importance of study design and conduct. (eg, placebo, harm of intervention, deception, or flawed design). (1) |
| 4. Identify conflicts of interest and the appropriate disclosure of conflicts required for ethical conduct of research. (1) |
| 5. Define research misconduct and describe principal investigator, institution, and federal agency responsibility with respect to research misconduct. (1) |
| 6. Define persons considered to be part of a vulnerable population and the types of protections that should be afforded to vulnerable populations. (1) |
| 7. Discuss how to mitigate implicit bias and inequity in research. (1) |
| 8. Explain informed consent in research and the effect of undue influence and coercion. (1) |
| 9. Recognize the principles of assent and permission in children. (1) |
| 10. Demonstrate high standards of professionalism and an ethical approach to conducting research by evaluating conflicts of interest and adhering to the IRB-approved protocol during the research study. (1) |
| 11. Apply federal laws for privacy to research data and ensure high standards for confidentiality. (1) |
| Advanced objectives |
| 1. Complete the National Institutes of Health requirements for Responsible Conduct of Research training. (3) |
| Dissemination of research |
| Goal: Participate in the review and dissemination of scholarship to advance the field of pediatric hospital medicine. |
| Basic objectives |
| 1. Describe the importance of peer review in research. (1) |
| 2. Select an appropriate venue for the dissemination of a scholarly project, including opportunities for presentation and publication. (1) |
| 3. Share research findings responsibly, assuring that presented work is accurate and complete. (1) |
| 4. Prepare a scholarly work product for submission to the American Board of Pediatrics. (1) |
| Advanced objectives |
| 1. Perform a mentored peer review of a scientific abstract or manuscript, including providing constructive feedback in a diplomatic and timely manner and maintaining confidentiality of materials under review. (3) |
| 2. Present scholarly work at a professional meeting via poster, platform, workshop, or another appropriate format. (3) |
| 3. Publish a first author manuscript. (3) |
| 4. Understand when to use and how to identify funding sources, including both federal and nonfederal grant mechanisms, appropriate for an individual project. (3) |
| 5. Submit a grant application. (3) |
| Professionalism and leadership |
| Goal: Demonstrate professionalism and leadership in the design, implementation, and dissemination of scholarly work. |
| Basic objectives |
| 1. Recognize how your leadership style impacts interactions with others. (1) |
| 2. Demonstrate respect and accountability in mentoring relationships by scheduling regular meetings, preparing for meetings, and responding to communications in a timely manner. (1) |
| 3. Effectively communicate with team members to establish expectations and roles. (1) |
| 4. Discuss authorship criteria with project team members early in the process, ensuring all authors commit to expectations for involvement in the project completion and dissemination. (1) |
| 5. Communicate clearly and respectfully with multidisciplinary team members in the research project, managing conflict and disagreement as it may arise. (1) |
| 6. Develop a timeline and establish goals for the advancement of the scholarly project. (1) |
| 7. Give, receive, and incorporate feedback to improve scholarly work products. (1) |
| 8. Effectively use project management skills and strategies to efficiently manage a research project and team. (1) |
| Advanced objectives |
| 1. Train research personnel in study specific procedures. (3) |
| 2. Create a budget for a research grant. (3) |
| Study design and execution |
|---|
| Goal: Construct a research project that reveals the selection of the appropriate study design, methods, and analysis plan to address the research question. |
| Basic objectives |
| 1. Use a comprehensive and systematic approach to define gaps in knowledge by identifying and evaluating the relevant literature, employing sound search strategies, a literature matrix, and reference management. (1) |
| 2. Develop a focused research question based on gaps in current literature. (1) |
| a. For qualitative studies, identify methodologic and sampling approaches that align with the research question, including ethnography, phenomenology, and grounded theory. (2) |
| b. For QI studies, identify an improvement opportunity, determine an improvement aim, identify outcome, process, and balancing measures, and plan appropriate interventions using QI tools. (2) |
| 3. Derive specific aims and, if relevant, hypotheses from a research question. (1) |
| 4. Identify the most appropriate study design to evaluate the specific aims, with consideration of inherent strengths, limitations, feasibility, and resource needs of study design options. (1) |
| 5. Distinguish indications for when to use a meta-analysis versus a systematic review versus a scoping review. (1) |
| 6. Choose measurable outcomes for study aims, optimizing reliability and validity while decreasing bias and confounding. (1) |
| 7. Design a study protocol that defines the target population with inclusion or exclusion criteria, recruitment plans, proposed outcome measures, and sampling strategy. (1) |
| 8. Execute a research project, including obtaining IRB approval, implementing recruitment and data collection plans, and maintaining a record of study procedures. (1) |
| Advanced objectives specific to quantitative research |
| 1. Describe the role of pilot testing and quality control in the implementation of research protocols. (2) |
| 2. Define variables for each aim and identify those variables as independent, dependent, confounders, or effect modifiers. (2) |
| 3. Discuss the uses and limitations of secondary databases in research. (2) |
| Principles of analysis |
| Goal: Demonstrate knowledge of the common biostatistics principles required for the interpretation of scholarly work in pediatric hospital medicine. |
| Basic objectives |
| 1. Distinguish the different types of variables (eg, continuous, ordinal) and how they affect choice of statistical tests. (1) |
| 2. Define ways to describe the distribution of data. (1) |
| 3. Interpret the results of hypothesis testing. (1) |
| 4. Differentiate type 1 from type 2 errors. (1) |
| 5. Recognize the difference between association and causation. (1) |
| 6. Interpret the results of a meta-analysis. (1) |
| 7. Describe differences between validity and reliability. (1) |
| 8. Discuss how bias and confounding affect the validity of results and describe methods to account for bias and confounding. (1) |
| 9. Identify factors that contribute to or limit generalizability. (1) |
| 10. Outline the difference between incidence and prevalence. (1) |
| 11. Interpret sensitivity, specificity, likelihood ratios, and positive and negative predictive values. (1) |
| 12. Describe how disease prevalence affects the positive and negative predictive value of a test. (1) |
| 13. Define the significance of study results, generalizability, and the likelihood that study results represent the truth. (1) |
| 14. Interpret an ROC curve. (1) |
| 15. Determine appropriate situations for use of different tests of association (eg, χ2, paired and non-paired t test, Wilcoxon rank, ANOVA). (1) |
| 16. Differentiate cost-benefit from cost-effectiveness analyses. (1) |
| 17. Describe the components of a successful quality improvement charter (eg, model for improvement, aims, key drivers, tools, PDSA cycles). (1) |
| 18. Interpret common quality improvement analytic tools, such as Pareto charts, run charts, and statistical process control charts. (1) |
| Advanced objectives specific to quantitative research |
| 1. Collaborate with biostatistician for conduct of advanced analytics. (2) |
| 2. Calculate statistical power analysis. (2) |
| 3. Use and interpret linear and logistic regression. (2) |
| 4. Use and interpret survival analyses. (3) |
| 5. Calculate confidence intervals and P values. (2) |
| 6. Calculate and interpret relative risk, hazard ratios, odds ratios, and/or correlation coefficients. (2) |
| 7. Conduct post-hoc and subgroup analyses, as appropriate. (2) |
| 8. Describe how to maximize validity and reliability in research studies. (2) |
| 9. Identify when data exist in clusters and understand what the implications are for study design, analysis, and power. (3) |
| 10. Identify when to consider use of more advanced analytics (eg, multilevel modeling, propensity scores). (3) |
| 11. Describe quality adjusted life years and the relationship to cost analyses. (3) |
| 12. Describe methods to increase the quality of publication using a reporting guideline (eg, CONSORT, STROBE, PRISMA). (3) |
| Advanced objectives specific to scholarly quality improvement |
| 1. Define measures involved in quality improvement (eg, structure, process, outcome, balancing measures). (2) |
| 2. Use tools to model processes, drivers, or causes of outcomes of interest (eg, process maps, key drivers, fishbone diagrams). (2) |
| 3. Identify special and common cause variation. (2) |
| 4. Design, implement, and perform analysis using advanced QI methods, including interrupted time series, stepped-wedge designs, factorial designs, advanced control charts, and segmentation of data. (3) |
| 5. Understand the differences in Sigma6, Lean, and Model for Improvement methodologies. (3) |
| 6. Describe methods to increase quality of scholarly QI publication using SQUIRE reporting guideline. (3) |
| Advanced objectives specific to qualitative research |
| 1. Apply qualitative interview skills in the conduct of interviews. (2) |
| 2. Understand the differences between inductive and deductive coding approach. (2) |
| 3. Conduct coding and analysis on the basis of a qualitative methodological or theoretical approach to generate categories, themes, or a framework or model. (2) |
| 4. Recognize the importance of reflexivity in qualitative research. (2) |
| 5. Identify research paradigms for qualitative analysis, including constructivism, positivism, and post-positivism. (3) |
| 6. Describe methods to increase quality of qualitative research publication using reporting guidelines (eg, SRQR, COREQ, O’Brien et al). (3) |
| Data management |
| Goal: Apply the basic principles of data management to organize and prepare data for analysis, ensuring accuracy, completeness, secure storage, and appropriate sharing. |
| Basic objectives |
| 1. Maintain the security of data in collection, storage, and sharing by selecting the appropriate location to collect, protect, and securely store data, completing data sharing agreements, and ensuring privacy and rights for study participants. (1) |
| 2. Select appropriate data management tools for collecting and managing data. (1) |
| 3. Recognize the steps necessary to prepare data for analysis to ensure data accuracy and completeness. (1) |
| Advanced objectives specific to quantitative research |
| 1. Manage a clinical database or perform analyses with a secondary data set. (3) |
| Critical appraisal of the medical literature |
| Goal: Evaluate the literature to determine validity, reliability, applicability, and generalizability as it relates to the care of hospitalized children. |
| Basic objectives |
| 1. Search the medical literature using steps outlined by the Centre for Evidence Based Medicine. (1) |
| 2. Apply acquired knowledge in epidemiology and statistical analyses to appraise medical literature for validity, reliability, generalizability, and applicability to clinical situations. (1) |
| 3. Interpret and apply findings from evidence on the basis of hierarchy of evidence. (1) |
| 4. Summarize the process of clinical practice guideline development, including the assessment of benefits and harms of alternative care options. (1) |
| Ethics and responsible conduct of research |
| Goal: Understand the ethics and the responsible conduct of research to ensure investigations and research-related activities respect the rights, privacy, and interests of human subjects and provide special protections for children and other vulnerable populations. |
| Basic objectives |
| 1. Define the principles of respect for person, beneficence, and justice as defined by the Belmont Report. (1) |
| 2. Describe the role of risk-benefit analysis. (1) |
| 3. Summarize the ethical importance of study design and conduct. (eg, placebo, harm of intervention, deception, or flawed design). (1) |
| 4. Identify conflicts of interest and the appropriate disclosure of conflicts required for ethical conduct of research. (1) |
| 5. Define research misconduct and describe principal investigator, institution, and federal agency responsibility with respect to research misconduct. (1) |
| 6. Define persons considered to be part of a vulnerable population and the types of protections that should be afforded to vulnerable populations. (1) |
| 7. Discuss how to mitigate implicit bias and inequity in research. (1) |
| 8. Explain informed consent in research and the effect of undue influence and coercion. (1) |
| 9. Recognize the principles of assent and permission in children. (1) |
| 10. Demonstrate high standards of professionalism and an ethical approach to conducting research by evaluating conflicts of interest and adhering to the IRB-approved protocol during the research study. (1) |
| 11. Apply federal laws for privacy to research data and ensure high standards for confidentiality. (1) |
| Advanced objectives |
| 1. Complete the National Institutes of Health requirements for Responsible Conduct of Research training. (3) |
| Dissemination of research |
| Goal: Participate in the review and dissemination of scholarship to advance the field of pediatric hospital medicine. |
| Basic objectives |
| 1. Describe the importance of peer review in research. (1) |
| 2. Select an appropriate venue for the dissemination of a scholarly project, including opportunities for presentation and publication. (1) |
| 3. Share research findings responsibly, assuring that presented work is accurate and complete. (1) |
| 4. Prepare a scholarly work product for submission to the American Board of Pediatrics. (1) |
| Advanced objectives |
| 1. Perform a mentored peer review of a scientific abstract or manuscript, including providing constructive feedback in a diplomatic and timely manner and maintaining confidentiality of materials under review. (3) |
| 2. Present scholarly work at a professional meeting via poster, platform, workshop, or another appropriate format. (3) |
| 3. Publish a first author manuscript. (3) |
| 4. Understand when to use and how to identify funding sources, including both federal and nonfederal grant mechanisms, appropriate for an individual project. (3) |
| 5. Submit a grant application. (3) |
| Professionalism and leadership |
| Goal: Demonstrate professionalism and leadership in the design, implementation, and dissemination of scholarly work. |
| Basic objectives |
| 1. Recognize how your leadership style impacts interactions with others. (1) |
| 2. Demonstrate respect and accountability in mentoring relationships by scheduling regular meetings, preparing for meetings, and responding to communications in a timely manner. (1) |
| 3. Effectively communicate with team members to establish expectations and roles. (1) |
| 4. Discuss authorship criteria with project team members early in the process, ensuring all authors commit to expectations for involvement in the project completion and dissemination. (1) |
| 5. Communicate clearly and respectfully with multidisciplinary team members in the research project, managing conflict and disagreement as it may arise. (1) |
| 6. Develop a timeline and establish goals for the advancement of the scholarly project. (1) |
| 7. Give, receive, and incorporate feedback to improve scholarly work products. (1) |
| 8. Effectively use project management skills and strategies to efficiently manage a research project and team. (1) |
| Advanced objectives |
| 1. Train research personnel in study specific procedures. (3) |
| 2. Create a budget for a research grant. (3) |
ANOVA, analysis of variance; CONSORT, Consolidated Standards of Reporting Trials; IRB, institutional review board; PDSA, Plan Do Study Act; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QI, quality improvement; ROC, receiver operator characteristic; SQUIRE, Standards for QUality Improvement Reporting Excellence; SPQR, Standards for Reporting Qualitative Research; STROBE, Strengthening the Reporting of Observational studies in Epidemiology.
Discussion
We present scholarship core competencies for PHM fellows as a tool to advance our training programs and the field of PHM and to complement the clinical core competencies that already exist. We gathered PHM experts from research and education to define the essential scholarship skills that all fellowship graduates should have to conduct scholarship, which will improve outcomes for hospitalized children. Because of the uniquely shorter training period for PHM, we further delineated advanced research competencies trainees interested in physician-scientist careers would need.
We expect the creation and implementation of these scholarship core competencies to serve as the basis for the development of curricula. We anticipate that these competencies will additionally assist programs and fellows in identifying the scholarship knowledge and skills that trainees can expect to accrue during fellowship. Many PHM fellowship programs are located within small-to-medium hospital systems. Such programs may not have the resources of a large academic institution, or their faculty may lack the time and experience needed to mentor fellows in scholarly activities. Content areas frequently lacking from individual program curricula could benefit from national or regional curricula, to provide support to overcome local research and resource infrastructure gaps. Many resources have been in evolution to provide this support over the last decade in our growing field, including content at the annual PHM Conference and PHM Fellows Conference. The development of these competencies provides a framework for program directors to link resources and activities with discrete outcomes and identify continued gaps. With this in mind, the Research Subcommittee of the Council of PHM Fellowship Directors took the objectives that were most challenging for all programs to meet individually and created a recurring webinar series that not only addresses the content gaps but also provides fellows with exposure to researchers in the field. This series has included 4 to 6 topics per year open to all PHM fellows, allowing programs to consistently provide access to education in core scholarly areas, regardless of individual institutional resources. Topics covered have included survey design, quality improvement, qualitative research, databases for research, scientific meeting abstract writing, manuscript writing, and responding to peer reviews. The series has been well received by fellows and program directors and will continue to be enhanced to meet the needs of our fellows nationally. This approach to sharing educational materials nationally has been notably helpful in our young field, in which many fellowship directors and faculty did not complete the fellowship themselves yet are charged with supervising fellow scholarly activity. The Council of PHM Fellowship Directors has also started developing a faculty development curriculum around scholarship mentorship.
In addition to fostering curriculum development, the use of standard goals and objectives provides an opportunity for more consistent evaluation of individual fellows. Programs may benefit from utilizing the standardized research goals and objectives to create evaluation methods to assess fellow competency in scholarly activities. The goals and objectives can also serve as a tool for fellow self-assessment and can aid Scholarship Oversight Committee members in the evaluation of fellows’ scholarly progress.
During the development of the goals and objectives, it was clear that there were core research skills that all fellows should be expected to gain, and that there were additional skills those seeking careers as physician-scientists would require. This recognition led to the creation of tiered objectives in which level 3 objectives represent advanced methods and skills. The training necessary to meet these advanced objectives may require individualized curriculum and time beyond the standard 2-year PHM fellowship, such as the addition of a third year or a master’s degree program.
Although we focused on defining scholarship core competencies for PHM fellows with the goal of improving the health of children, we also believe these standardized goals and objectives can serve as a model for many other medical and surgical specialties and subspecialties. Our rigorous approach began with a review of the literature and the existing resources, most of which were from general medical organizations. We then added to and refined these compiled standards using real-life experiences from a wide variety of research and fellowship training experts who have recognized knowledge in research and research mentorship. Based on the rigor with which we developed these scholarship core competencies, we believe other specialties and subspecialties can feel confident utilizing them within their own programs.
We have presented our collaborative approach to developing scholarship core competencies for PHM fellows in partnership with a variety of national stakeholders. We present goals and objectives to serve as the standard for scholarship in PHM programs nationally while also allowing for curricular content development that can ideally be accessed by all fellows. Our focus was largely on research skills outside of medical education and quality improvement given PHM fellowship program director identified gaps in providing core knowledge in more traditional research skills. Additionally, there has been ongoing work by the Council of PHM Fellowship Directors to develop specific educational and quality improvement goals and objectives. However, there is an overlap in skills presented within these goals and objectives that fellows can apply to educational or quality improvement projects. Future work could endeavor to create a scholarship timeline to aid fellows and fellowship leaders in developing and implementing scholarly projects during a 2-year fellowship. Lastly, these standard goals and objectives will allow for the creation and validation of more objective- and competency-based assessments of fellows and evaluation of scholarship curricula. Of course, because training environments and requirements are constantly in evolution, in particular, because the ACGME is currently revising Pediatric Residency training requirements that may impact PHM fellowship training, these competencies should be revisited and revised as necessary.
The scholarship goals and objectives emphasize the need for research training in several areas of focus, including epidemiology, health services research, clinical trials in complex health systems, and improvement research, among others. We expect research training in PHM fellowships to produce the next generation of expert scholars and physician-scientists who will be equipped to meet new challenges in pediatric hospital medicine and improve the care and outcomes of hospitalized children.
Acknowledgments
The authors wish to acknowledge the following individuals for their critical feedback throughout the process: Katherine Auger, MD, MSc, William Basco, MD, MS, Jessica Bettenhausen, MD, Patrick Brady, MD, MSc, Mark Brittan, MD, Stephanie Doupnik, MD, MSHP, Alisa Khan, MD, MPH, Mary Ottolini, MD, MPH, Med, Christopher Russell, MD, MS, Hadley Sauers-Ford, MPH, Michael Tchou, MD, MSc, Lynn Thorensen, DO, Ashlie Tseng, MD, Derek Williams, MD, MPH, and Jeffrey Winer, MD, MA, MSHS.
COMPANION PAPER: A companion to this article can be found online at www.hosppeds.org/cgi/doi/10.1542/hpeds.2023-007534.
Dr Thomson contributed to design of study, co-led the conference and post-conference activities, and drafted the initial manuscript; Drs Rassbach, N. Shah, and Walker contributed to design of study and planned and co-led the conference and post-conference activities; Dr Wilson conceptualized and designed the study and participated in the conference and post-conference activities; Drs S.S. Shah and Jerardi conceptualized and designed the study and supervised the planning of and execution of the conference and all post-conference activities; and all authors critically reviewed and revised the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.
FUNDING: This work was supported by the Agency for Health Care Research and Quality (AHRQ) R13-HS026356 (SSS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. The funder did not participate in the work.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.
Comments