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The Core Competencies in Hospital Medicine


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The Core Competencies in Hospital Medicine: A Framework for Curriculum Development published in the January/February 2006 Supplement of the Journal of Hospital Medicine, is a blueprint to develop standardized curricula for teaching Hospital Medicine in medical school, post-graduate (i.e., residency, fellowship), and continuing medical education programs. The competencies standardize expected learning outcomes, but leave it to the curriculum developers and content experts to select instructional strategies, provide relevancy of context, and select the most relevant and up to date medical content.

The publication contains 51 chapters, divided into three sections: Clinical Conditions, Healthcare Systems, and Procedures. Each chapter has an introduction followed by learning objectives categorized into knowledge, skills or attitudes. Some chapters have a fourth section, "system improvement" that lists specific activities of a Hospitalist to improve the system of care. Statements in this fourth section allow for a range of expectations and proficiencies.

SHM will use the core competencies to drive education programs. SHM is currently engaged in an analysis to identify gaps in our educational efforts relative to the core competencies, with a focus on healthcare system topics such as quality improvement, transitions of care, patient education, palliative care, and information management. Educational modalities are being explored including POD Casts, webinars, conferences, and CME modules and physician preferences for the modalities are being analyzed.

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Frequently Asked Questions

How can I get more information about the core competencies, or provide feedback?

For more information about the core competencies, or provide feedback E-mail us at

Who should use the Core Competencies?

We hope educators will utilize these competencies to revise and/or develop curricula; and assess their current programs. Further, we hope review of these competencies by the larger medical community will lead to educational reform that better prepares physicians to become Hospitalists. The Core Competencies were developed with the following audiences in mind:

  • Directors of Continuing Medical Education
  • Hospitalist fellowship directors
  • Residency program directors
  • Medical School Internal Medicine Clerkship directors
  • Hospital administrators/leaders

The Core Competencies offer residency Program Directors an opportunity to help meet the goals outlined by the ACGME Outcomes Project. The Core Competencies addresses all six of the ACGME competencies, especially communication skills, medical knowledge, systems-based practice, and practice-based learning and improvement. By incorporating the Core Competencies in Hospital Medicine into residency curricula, a Program Director can meet the ACGME requirements and teach resident physicians many of the issues that often fall outside traditional medical curricula.

The Core Competencies should provide the framework of professional development for and evaluation of hospitalists. Any hospitalist-specific CME should be developed around the Core Competencies. For example, a program on community-acquired pneumonia (CAP) should not only focus on the common etiologic agents of CAP, but also on 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.

What methodology was used to develop the core competencies?

A Task Force representing academic and community Hospitalists from varying U.S. regions was formed following SHM's Education Summit in 2002. The Task Force developed an initial table of contents and structure for the Core Competencies which was vetted through SHM's various regional chapters and councils, as well as the Education Committee and Executive Committee. Contributors were selected based on a nomination and panel review process. When appropriate, authors were paired with non-hospitalist experts. Once submitted, chapters underwent an extensive editing process for accuracy, level of detail, formatting and adherence to established educational principles. The final document underwent internal and external review. Once all review comments were received, the TF editorial board reviewed each comment and made changes to the Competencies when necessary.

The complete project methodology is detailed in the article, The Core Competencies in Hospital Medicine: Development and Methodology (Dressler, et. al. Journal of Hospital Medicine 2006;1:48-56).

Who contributed to the development of the core competencies?

The Core Competencies are a result of the contributions of over 100 hospitalists and other content experts, under the guidance and leadership of the SHM Core Curriculum Task Force and Editorial Board. Task Force members were chosen from university and community hospitals, teaching and non-teaching programs, for- and not-for-profit programs, and from all geographic regions of the United States to ensure broad representation of practicing Hospitalists and SHM membership. The editors are Michael Pistoria, DO; Alpesh Amin, MD, MBA; Daniel Dressler, MD, MSc; Sylvia McKean, MD; and Tina Budnitz, MPH.

How are the core competencies different from other competency guidelines?

The Core Competencies integrates the six competencies of ACGME into the four sections of each chapter. Besides the traditional knowledge (cognitive domain), skills (affective domain), attitudes (psychomotor domain) sections, a fourth section on systems-based practice was included to highlight the role of Hospitalists in improving the systems (hospital) in which they work.

Other published competencies often use vague terms like "understand" that give little or no insight into the level of proficiency that is expected. The Core Competencies are carefully crafted to place the concept at the correct level of proficiency.

Why aren't all clinical conditions addressed?

The Core Competencies in Hospital Medicine is meant to guide educators to develop curricula that incorporates the competencies into the training and evaluation of students, clinicians-in-training, and practicing hospitalists. It is not meant to contain a complete compilation of all inpatient clinical topics or recreate what many residency training programs in adult inpatient care already provide. It should not limit and does not define every aspect of hospitalist practice. It includes the most common and fundamental elements of inpatient care without an exhaustive listing of every clinical entity that may be encountered by a hospitalist. Some of the more common clinical topics encountered by inpatient physicians are included, with 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 also focuses on potential areas that could enhance the training of physicians to reflect the current practice of hospitalists.

What changes can be expected in future editions?

The Society of Hospital will analyze feedback from residency directors, curriculum developers and other medical educators and practicing Hospitalists to determine how future editions of the Core Competencies can best meet the needs of its audience. Already underway are the development of chapters for additional clinical topics and a pediatric hospital medicine supplement.

Table of Contents

Section 1: Clinical Conditions

Acute Coronary Syndrome1.1
Acute Renal Failure1.2
Alcohol and Drug Withdrawal1.3
Cardiac Arrhythmia1.5
Chronic Obstructive Pulmonary Disease1.7
Community Acquired Pneumonia1.8
Congestive Heart Failure1.9
Delirium and Dementia1.10
Diabetes Mellitus1.11
Gastrointestinal Bleed1.12
Hospital-Acquired Pneumonia1.13
Pain Management1.14
Perioperative Medicine1.15
Sepsis Syndrome1.16
Urinary Tract Infection1.18
Venous Thromboembolism1.19

Section 2: Procedures

Chest Radiograph Interpretation2.2
Electrocardiogram Interpretation2.3
Emergency Procedures2.4
Lumbar Puncture2.5
Vascular Access2.8

Section 3: Healthcare Systems

Care of the Elderly Patient3.1
Care of Vulnerable Populations3.2
Diagnostic Decision Making3.4
Drug Safety, Pharmacoeconomics and Pharmacoepidemiology3.5
Equitable Allocation of Resources3.6
Evidence Based Medicine3.7
Hospitalist as Consultant3.8
Hospitalist as Teacher3.9
Information Management3.10
Management Practices3.12
Nutrition and the Hospitalized Patient3.13
Palliative Care3.14
Patient Education3.15
Patient Handoff3.16
Patient Safety3.17
Practice Based Learning and Improvement3.18
Prevention of Healthcare Associated Infections and Antimicrobial Resistance3.19
Professionalism and Medical Ethics3.20
Quality Improvement3.21
Risk Management3.22
Team Approach and Multidisciplinary Care3.23
Transitions of Care3.24

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For more information about the core competencies, or provide feedback email us at

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