Clinical Shift Distribution in Academic Hospital Medicine Fellowship across 10 Years

Objectives: As hospital medicine (HM) has grown as a specialty, it has been paralleled by an increase in HM fellowship training programs. Limited data are available surrounding clinical exposure for HM fellows. Using data from a large academic medical center with a long-standing HM fellowship program, we reviewed the types of clinical shifts and distribution of shift data completed by HM fellows from 2013 to 2023. Methods: We performed a retrospective analysis of clinical shifts available from an internal Web-based scheduling program. Shifts performed by HM fellows were downloaded from May 2013 through February 2023. We characterized clinical service shifts as day coverage, off-hour coverage, teaching services, or jeopardy. We calculated summary statistics of the number of shifts worked by HM fellows per year. Results: During a period of 10 years, 22 HM fellows completed 4430 shifts, with a mean total of 197.3 shifts during fellowship (standard deviation 56.7 shifts). Most of the shifts completed by HM fellows were off-hours shifts (51.0%, n = 2214), with less exposure to daytime shifts (n = 1285, 29.6%) and the least exposure to teaching shifts (n = 390, 9.0%). Conclusions: HM fellows spend the majority of their clinical time on off-hours shifts, which does not reflect the clinical practice of an academic hospitalist. The least amount of time was spent attending on traditional teaching services. Because HM fellowships are designed to prepare HM fellows for careers as academic hospitalists, more work is necessary to determine how best to optimize and standardize clinical exposure while maintaining adequate time for opportunities to engage in academic development.