Preparing resident physicians for careers in pediatric hospital medicine (PHM) has increasingly become a topic of conversation since becoming its own subspecialty several years ago. In the upcoming issue of Hospital Pediatrics, the article “Preparation for PHM: Considerations for Pediatric Residency Programs” by Schord et al. (10.1542/hpeds.2024-007845) advocates for the implementation of a PHM training track incorporated into residency training, similar to primary care tracks or emergency medicine tracks seen in other specialties such as internal medicine and family medicine, respectively.
The authors propose an interesting process on how to promote the field and ensure residents receive adequate exposure and training, regardless of the decision to enter fellowship or community PHM. This is in response to the possibility of insufficient supply of PHM physicians that are needed for the high demand. It also was created due to surveys of senior residents suggesting there is not enough inpatient training, as well as feeling unprepared for becoming an attending. Additionally, these tracks may better introduce residents to fellowship training and what it entails. I have found myself explaining that PHM fellowship is not for more clinical training. Many recent resident graduates feel they get an adequate amount as it is during residency, though ACGME changes may threaten this. It is more for the academic component: research, QI, medical education, etc.
The proposed rotations seem attractive in that one is able to practice hospital medicine without the tedious or mundane tasks (e.g., call-in consults, fax prescriptions, have the resident phone constantly interrupting you, etc.) one has to do early in their residency training. Sorry, interns! The longitudinal plan and ability to enter the track in second year of training is beneficial for those who may or may not know which pediatric subspecialty they want to pursue. The choice to decide during the end of intern year is enticing and helpful at the same time. Going into pediatric residency, I believed I would do pediatric emergency medicine or general pediatrics. By some divine intervention, I was placed on the wards in my first month, and never considered anything else besides hospital medicine. I was lucky to know what specialty I wanted early in my training. It is more than likely trainees won’t have that same experience and early decision, which is where these specialized tracks could help with choosing a specialty.
Just to avoid any confusion, these tracks are not designed to replace fellowship training. This should be seen as an adjunct to future fellowship training or strengthening your abilities when entering a community hospital setting where you don’t have the subspeciality support, as well as incorporating non-clinical skills such as QI, research, and medical education. This article is interesting and informative, while highlighting the possibility of where the field is going, why these tracks are helpful, and a solid blueprint for other programs to follow and build upon. Pediatric residency program directors should take these suggestions into consideration when thinking of ways to expand their program.
