The Core Competencies in Hospital Medicine

As part of its commitment to advancing education in hospital medicine, SHM supports and offers hospital medicine-based engagement and training resources.  If you are a residency director, researcher and educator, SHM provides you with a wide range of educational resources providing opportunities for individual and group education through podcasts, webinars, conferences and e-learning modules.

SHM works to assure that hospital medicine-specific core competencies are clearly addressed and reinforced as medical students and residents prepare to enter the profession, and later in practice through continuing medical education.

SHM also identifies subject gaps you may be facing in teaching and reinforcing the core competencies in order to develop new programs, resources and tools. These resources cover a wide range of topics affecting healthcare systems and hospitals, including:

• quality improvement
• transitions of care
• patient education
• palliative care and information management 

Core Competencies in Hospital Medicine: A Framework for Curriculum Development provides a blueprint for the development of standardized curricula for teaching hospital medicine in medical school, post-graduate residency and fellowship, and continuing medical education programs. The core competencies framework was first published in the January/February 2006 supplement of SHM's Journal of Hospital Medicine and continues to evolve in response to advances in medicine and changes in the hospital medicine environment.

SHM encourages you to access the 2006 article in the Journal of Hospital Medicine.

The competencies framework:

• Standardizes expected learning outcomes
• Enables curriculum developers and content experts to select instructional strategies
• Provides relevancy of context
• Selects the most relevant and current medical content.

The special publication is divided up into three sections: Clinical conditions, Procedures and Healthcare systems. Each chapter within these sections is divided into several sections: Knowledge, Skills, Attitudes, and sometimes Systems Organization and Improvement.

Each chapter contains an introduction followed by learning objectives categorized into    traditional knowledge (cognitive domain), skills (affective domain), and attitudes (psychomotor domain) sections. Some chapters include a fourth section, "system improvement", which lists specific activities of a hospitalist to improve the system of care. This section allows for a range of expectations and proficiencies.

The core competencies are designed for use by those of you who need to revise and/or develop curricula and assess your current programs:

• Directors of continuing medical education (CME)
• Hospitalist fellowship directors
• Residency program directors
• Medical school internal medicine clerkship directors
• Hospital administrators and leaders

The hospital medicine core competencies integrate directly with the competency goals   established by the Accreditation Council for Graduate Medical Education (ACGME). Residency program directors utilize the core competencies to help meet the six ACGME competency goals, which are incorporated into each chapter and section of the hospital competencies:

• Interpersonal Skills and Communication
• Medical knowledge
• Systems Based practice
• Practice Based Learning and Improvement
• Patient Care
• Professionalism

By incorporating the core competencies in hospital medicine into residency curricula, you can meet the ACGME requirements and teach resident physicians many of the issues that often fall outside traditional medical curricula.

You can also apply the core competencies to issues that often fall outside traditional medical curricula. For example, a program on community-acquired pneumonia (CAP) should focus on the common etiologic agents of CAP as well as how hospitalists can assist in ensuring hospital-wide adherence to The Joint Commission standards. Similarly, if one is leading a hospitalist program, the core competencies can provide the common language for evaluation of physicians in that program.

The core competencies in hospital medicine are specifically intended to guide you toward developing curricula that incorporate the competencies into the training and evaluation of students, clinicians-in-training and practicing hospitalists, rather than to serve as a compilation of all inpatient clinical topics and recreate and duplicate what many residency training programs already provide.

While the hospital medicine core competencies should not limit and do not define every aspect of hospitalist practice, they do address the common clinical topics and fundamental elements of inpatient care encountered by inpatient physicians.

There is also an emphasis on subject areas that stress the systems-based approach to healthcare, which is central to the practice of hospital medicine. The core competencies additionally address potential areas that could enhance the training of physicians to reflect the current practice of hospitalists.