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Initially, the hospitalist movement arose to reduce length of stay by having dedicated physicians in the hospital most of the time. Over time, the role evolved, and it became clear that hospitalists could improve the quality of inpatient care, promote patient safety, and educate the next generation of physicians. Although the term hospitalist was coined in 1996, over the subsequent decade there remained considerable variability in the definition of hospitalist and the scope of work attributed to that role from one practice setting to the next. At the same time that Hospital Medicine leaders embraced the importance of evidence-based care and systems improvement—especially around transitions of care and the well-publicized safety and quality issues facing hospitalized patients—they were recruiting physicians from traditional residency programs that had not adequately prepared them for their new roles. In fact, the Accreditation Council for Graduate Medical Education (ACGME) acknowledged training gaps in six main competency areas for evaluation of medical trainees: patient care, medical knowledge, practice-based learning improvement, interpersonal and communication skills, professionalism, and systems based learning.
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The Society of Hospital Medicine (SHM) recognized the need to define specific competencies of a hospitalist to establish performance standards, differentiate Hospital Medicine as a unique subspecialty, and create a framework for training programs. SHM hoped that the creation of a document detailing core competencies would further serve to standardize training programs, highlight training gaps within internal medicine residency programs, and identify the professional development needs of practicing hospitalists. In 2006, SHM developed and published The Core Competencies in Hospital Medicine: A Framework for Curriculum Development. This document is a compendium of competencies for the practice of Hospital Medicine and was developed by SHM in conjunction with more than 100 hospitalists and physician leaders from university and community hospitals, teaching and nonteaching programs, and for- and not-for-profit programs throughout the United States (Figure 5-1).
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Table 5-1 illustrates how the SHM core competencies align with ACGME outcome requirements.
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