Advancement Opportunities

Sunil Kripalani, MD, MSc, chief of hospital medicine at Vanderbilt University in Nashville, Tenn., was working in the emergency department when a woman arrived with an asthma exacerbation. The woman, who spoke only Spanish, had been hospitalized just five days earlier for asthma, and hospital staff had given her discharge instructions through her husband. Speaking to the patient in Spanish, Dr. Kripalani soon learned something had been lost in translation: The patient had not taken any of the prescribed prednisone tablets, and instead was taking a burst of montelukast. She also was taking a long-acting bronchodilator every two hours instead of every 12, and she was incorrectly using her rescue inhaler.

As the principal investigator of a trial aiming to reduce post-discharge adverse events and emergency room visits, Dr. Kripalani knows well the issues that contributed to the patient’s re-hospitalization.1 Through research, he and his colleagues hope to prevent future cases.

“It’s very rewarding to identify problems in the care of hospitalized patients and then develop and evaluate interventions to solve those problems,” says Dr. Kripalani, a 2001 graduate of the Emory Mentored Clinical Research Scholars Program who also leads Vanderbilt University’s hospital medicine fellowship. “Sharing those solutions with colleagues so they can be applied to patient care at my institution and others brings the research full circle.”

As the field of hospital medicine grows, the number of hospitalists moving into research careers is expanding, says Peter Kaboli, MD, MS, associate professor in the Department of Internal Medicine at the University of Iowa and a 2001 graduate of the Veterans Administration Quality Scholars Fellowship program. Research training programs, or fellowships, put hospitalists on the path to new skills and position them for careers in academic medicine and other leadership positions, Dr. Kaboli says. Training programs also put fellows in contact with mentors who provide valuable guidance.

Although there are dozens of general internal medicine (GIM) fellowships available to hospitalists, few programs are specifically designed to train hospitalists in research. “Hospital medicine is still a relatively new field,” Dr. Kaboli explains. “The field still does not have many research training options that are separate from general internal medicine.”

Still, hospitalists have advanced training choices, and, depending on their interests, can pursue field-specific programs or follow a general internal medicine path.

HOSPITAL RESEARCH: WHERE THE HEART IS

Are you considering a research training program? Dr. Brotman recommends physicians consider the following before starting their search.

• If you want to work as a hospitalist in an academic center or you want to be a clinical leader, and you want to participate in research but you don’t anticipate committing the majority of your time to research, then many of the programs listed on SHM’s Web site (www.hospitalmedicine.org) could be useful.
• If you want to spend the bulk of your time performing research, the best programs will be focused on research and allow you to devote at least 50% of your time to research training.

Here are a couple of questions to ask yourself as you narrow your fellowship search:

Q: Will this fellowship lead to an advanced degree?

A: The statistical and methodological training provided by a master’s or PhD degree curriculum will provide the fellow with many of the tools needed to successfully compete for research funding as a faculty member in an academic center.

Q: What kind of research is expected?

A: Most programs encourage fellows to do some research, but if it is a formal expectation rather than an opportunity, it is likely that there will be a greater faculty and program commitment to research. This ensures the fellow leaves the program having completed a research program and, ideally, publishing on it.—GG