Hospital medicine fellowship programs to further the clinical training and foster retention of advanced practice providers (APPs) — including nurse practitioners (NPs) and physician assistants (PAs) — in the hospital system are becoming more prevalent as APPs continue to become an increasingly larger part of the healthcare workforce, according to research published in the Journal of Hospital Medicine. However, little is known about how these programs are structured.

To describe the characteristics of the existing APP fellowships, researchers distributed an online survey to program directors of all adult and pediatric fellowship programs in hospital medicine. The survey tool was influenced by prior validated surveys of postgraduate medical fellowships and consisted of 25 multiple choice questions on fellowship and learner characteristics, program rationales, curricula, and methods of fellow assessment.

A total of 11 fellowships comprised of 10 adult programs and 1 pediatric program were identified, and a 91% response rate from program directors was obtained. The majority of programs had been in existence for ≤5 years, with 80% of programs in existence for 1 year. A total of 60% of fellowships enroll 2 to 4 fellows per year, while 40% enroll ≥5 fellows. The salaries range between $55,000 to >$70,000, with half of the programs paying >$65,000. A total of 80% of fellows are age 26 to 30 years, and 90% have been out of NP or PA school for ˂1 year.

All programs reported that training and retaining applicants is the main driver for developing the fellowship, and 50% offer financial incentives for retention on successful completion of the program. In the last 5 years, 89% of graduates were asked to remain for a full-time position after program completion. Other rationales for program development included building an interprofessional team (50%), managing patient volume (30%), and reducing overhead (20%).

Of the 9 adult programs, 67% teach to the Society of Hospital Medicine (SHM) core competencies, and 33% send the fellows to SHM NP/PA Boot Camp. Six of the 9 programs with active physician residencies offer shared educational experiences for the medical residents and APPs. However, differences in clinical rotations between the programs were identified. General hospital medicine is required in all adult fellowships, but no other clinical rotation is universally required. The majority (80%) of programs offer at least 1 elective. Six rotations reported mandatory rotations outside of general medicine; the most common were neurology or the stroke service. Differences were also found in educational experiences and learning formats; 90% of programs offer or require fellow presentations, journal clubs, reading assignments, or scholarly projects. Presentations and journal club attendance are required in more than half of programs, but reading assignments and scholarly projects are rarely required.

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Each program has a unique method of fellow assessment, with 90% of the programs using more than one method. Faculty reviews are the most commonly used form of assessment and are conducted in all rotations in 80% of fellowships. Both self-assessment exercises and written examinations are used in some rotations by the majority of programs, and capstone projects are required in 30% of programs. 

“Despite their similarities, fellowships have striking variability in their methods of teaching and assessing their learners,” the authors concluded. “Best practices have yet to be identified, and further study is required to determine how to standardize curricula across the board.”


Klimpl D, Franco T, Tackett S, et al. The current state of advanced practice provider fellowships in hospital medicine: a survey of program directors. J Hosp Med. 2019;14:E1-E6.