Perspectives of PHM Fellowship Graduates Working as Community Hospitalists: A Qualitative Study

Although many pediatric hospitalists work in community hospitals, little is known regarding fellowship preparation for community pediatric hospital medicine (CPHM) roles, including nonclinical competencies. This study aims to explore fellowship graduates' perspectives on valuable knowledge, skills, and attitudes (KSA) needed in CPHM and to uncover educational gaps in pediatric hospital medicine (PHM) fellowship training.

We conducted 8 online focus groups between October 2023 and August 2024 with recent PHM fellowship graduates who work in CPHM. Study members conducted focus groups using a semistructured interview guide. Demographics were collected by survey and analyzed through descriptive statistics. Two researchers independently coded transcripts and identified domains through content analysis, reconciling differences with a third researcher and reaching consensus with the full team.

A total of 20 participants were included in the focus groups. We identified 7 domains relevant to CPHM practice and fellow education: (1) business and leadership, (2) practice in a resource-limited setting, (3) systems-based practice and quality care, (4) interpersonal dynamics, (5) perception of CPHM, (6) career development, and (7) high-stakes clinical competencies.

Our findings highlight important KSA necessary for CPHM roles, which are potential educational opportunities during PHM fellowship. For domains already incorporated across fellowship curricula, such as systems-based practice and quality improvement, participants emphasized a need to highlight the CPHM perspective during training. This study suggests an opportunity for PHM fellowship curriculum development to better prepare fellows for careers in CPHM.