Changing the Paradigm of Research in Pediatric Hospital Medicine

The breadth of clinical care provided by pediatric hospitalists affords numerous opportunities for conducting basic science and translational research. The PHM patient population allows for investigations into understanding the differential pathophysiology of the minority of patients who do not follow the expected illness trajectory. One recent example is the use of transcriptome profiling of patients with Kawasaki disease and its potential to reduce unnecessary treatments with immunoglobulin.⁷  Others include the role of “multiomics” to predict bronchiolitis severity,^8,9  pathogen physiology in patients with tracheostomy-associated infections,^10,11  and identification of patients with asthma who will respond to corticosteroids.¹²  Indeed, given the variety of patients seen by hospitalists, as well as PHM’s focus on high-value care, hospitalists are uniquely positioned to translate basic science discoveries into clinical care using a variety of approaches.

Incorporation of basic and translational research into PHM requires engagement at multiple levels, from individual hospitalists to professional societies (Table 1). The factors necessary to expand the academic focus of PHM to include basic and translational science center around support, training, and mentorship (Fig 1).

Divisional and institutional support is necessary for the success of any research program. The PHM division leader can be a powerful advocate for the hospitalist pursuing translational research, especially with regard to institutional support. Support from the institution comes in many forms, including protected time for research, pilot funds, laboratory or bench space, support to attend conferences and workshops, and biostatistical and research coordinator assistance. However, this degree of support requires institutional leadership to adopt the view of hospitalists as physician scientists, which is another area in which the PHM divisional leader can advocate on behalf of researchers.

Protected time is arguably 1 of the most important resources that can be provided by the institution. Institutional allotment of protected time between funded opportunities is especially important. This includes providing bridging support at critical times, such as between completion of fellowship training and the receipt of a career-development award, as well as after the completion of a career-development award and before a successful application for independent funding (eg, R01 or the equivalent). Intellectual support is also essential for the development of PHM physician scientists. In addition to mentorship, as discussed below, intellectual support includes providing opportunities for feedback on research ideas, such as formalized faculty crosstalks or data-blitz sessions, and creating a network of researchers who are willing to review each other’s grants. Additionally, joint appointments with another division already invested in basic science or translational research infrastructure (eg, pharmacology and microbiology) can provide necessary support for the faculty member. Finally, project funds, either in the form of a start-up package or competitive pilot awards, are critical to the development of a successful research program. The institutional provision of both protected time and intellectual support is key to the success of the hospitalist physician scientist.

Training hospitalists to become translational researchers should focus on attaining the relevant research skills and mentorship. These recommendations are different for hospitalists who want to become independent investigators versus recommendations for those who are interested in participating in translational research as part of a multidisciplinary team. Here, we speak to those hospitalists interested in a career as an independent investigator, although the recommendations can be modified for hospitalists who are interested in participating, but not leading, such studies.

It is important to ensure that interested hospitalists have the opportunity for training and experience. Because PHM fellowships are currently becoming standardized, inclusion of translational research methodologies into education curricula would address this need for trainees. A career-development award (eg, K award or the equivalent) can be an invaluable source of protected time and additional research training necessary for a career as an independent investigator, such as a master’s degree. Outside of fellowship or a career-development award, hospitalists can seek research training through various professional societies, several of which offer opportunities for research training or exposure. Institutions frequently host other venues that can be helpful to junior researchers, such as K clubs, which allow for an opportunity to both network and become exposed to other areas of research at an institutional level. An additional way is through hands-on experience. Although fully immersing oneself into this field of research is invaluable, it is rarely realistic. Experiential learning by spending a few months in a basic science laboratory to learn techniques or by contributing to an ongoing translational study can be critical in the decision to pursue a basic science career. However, because many PHM physicians do not have this amount of protected time, attending weekly laboratory meetings in which methodology and data are discussed can address this gap.

Many subspecialties have thriving basic science and translational research programs, such as pediatric emergency medicine and pediatric critical care medicine; thus, it is important for PHM physician scientists to consider mentorship from R01-funded researchers outside their divisions. PHM division directors can also seek mentorship from pediatric emergency medicine and pediatric critical care medicine division directors in fostering growth of these researchers within their own divisions. As interest in these areas grows, we encourage PHM physician scientists to identify peer mentors within PHM with this shared interest to create a culture that supports this new frontier. This approach can be done through networking at conferences (eg, speed networking) or leveraging Listservs. Finally, support from the larger PHM community is needed to aid in the acceptance and promotion of hospitalist researchers engaging in basic science and translational research. PHM leadership on a national level can support these efforts through inclusion of basic science– or translational science–related content at national meetings, providing a network or peer-mentorship opportunities and encouraging hospitalists to consider engaging in translational research. PHM physician scientists should consider attending additional non-PHM conferences that incorporate more basic science and translational research conferences.

As the PHM field continues to grow, it is important to consider the broad realm of research that will be undertaken to improve all facets of the management of care among hospitalized children. There are several areas in which hospitalists can advance the science of diseases using basic science and translational research. Although there are already various examples of basic science research for chronic and infectious diseases conditions that are managed by hospitalists, additional conditions such as failure to thrive, brief resolved unexplained events, chronic pain, fever of unknown source, and many others are ripe for investigation. An increase in human capital is needed to grow this type of research within PHM. Therefore, it is imperative to support residents, fellows, and hospitalists who are interested in the field of basic science and translational research by supplementing existing PHM programs and by protecting their time to conduct research in this field. It is time for PHM to be on the forefront of basic and translational research that will directly improve the care of hospitalized children.