Defining Supervision Preferences and Roles Within a New Subspecialty: Pediatric Hospital Medicine

Published:March 19, 2022DOI:



      To describe supervision preferences among pediatric hospitalists, Pediatric Hospital Medicine (PHM) fellows, and senior residents (SRs), and to better define the ideal role of a PHM fellow.


      We conducted a cross-sectional survey study at 6 institutions nationwide. We developed 3 complementary surveys, one for each population (hospitalists, fellows, SRs). We calculated univariate descriptive and bivariate statistics for categorical variables using Chi-square tests with the Rao-Scott correction to account for clustering by institution.


      Survey respondents included 106 of 200 hospitalists (53%), all 20 fellows (100%), and 149 of 380 SRs (39%). Most hospitalists and all fellows preferred the supervising hospitalist to have 3+ years of experience or be fellowship-trained. Nearly all fellows preferred the attending round in-person providing progressive independence; while hospitalists and SRs desired greater attending presence on rounds. Hospitalists and fellows wanted more frequent communication when the attending does not round with the team, and more hospitalists desired at least 2 points of contact regardless of attending presence on rounds. Fifty-five percent of SRs reported experiencing much less/less autonomy when on with a fellow than when supervised by a hospitalist only. Regarding the fellow's role, most participants agreed SRs should lead rounds and contact the fellow first with questions. The majority agreed teaching should be a shared responsibility but lacked consensus about how to provide feedback.


      Study results reveal preferences about supervising fellows in this new subspecialty. Hospitalists, fellows, and SRs may have differing opinions regarding workflow, communication, and teaching, impacting team leadership and autonomy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kilminster S
        • Jolly B
        • van der Vleuten CPM
        A framework for effective training for supervisors.
        Med Teach. 2002; 24: 385-389
        • Crockett C
        • Joshi C
        • Rosenbaum M
        • et al.
        Learning to drive: resident physicians’ perceptions of how attending physicians promote and undermine autonomy.
        BMC Med Educ. 2019; 19: 293
      1. American Board of Medical Specialties. ABMS officially recognizes pediatric hospital medicine subspecialty. Available at: Accessed April 20, 2020.

        • ACGME Task Force on Quality Care and Professionalism
        The ACGME 2011 Duty Hour Standards: Enhancing Quality of Care, Supervision, and Resident Professional Development.
        Accreditation Council for Graduate Medical Education, Chicago, Ill2011 (Available at) (Accessed December 17, 2019)
      2. ACGME program requirements for graduate medical education in pediatric hospital medicine. Available at: Accessed July 20, 2020.

        • Shah NH
        • Rhim HJH
        • Maniscalco J
        • et al.
        The current state of PHM fellowships.
        J Hosp Med. 2016; 5: 324-328
        • Ryan RM
        • Deci EL
        Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.
        Am Psychol. 2000; 55: 68
        • Kumar NL
        • Perencevich ML
        • Trier JS
        Perceptions of the inpatient training experience: a nationwide survey of gastroenterology program directors and fellows.
        Dig Dis Sci. 2017; 62 (Epub 2017 Aug 16. PMID: 28815353): 2631-2647
        • Palinkas LA
        • Horwitz SM
        • Green CA
        • et al.
        Purposeful sampling for qualitative data collection and analysis in mixed method implementation research.
        Adm Policy Ment Health. 2015; 42 (PMID: 24193818; PMCID: PMC4012002): 533-544
        • Messick S
        Foundations of Validity: Meaning and Consequences in Psychological Assessment.
        Educational Testing Service, Princeton, NJ1993
        • Cook DA
        • Beckman TJ
        Current concepts in validity and reliability for psychometric instruments: theory and application.
        Am J Med. 2006; 119
        • Farnan JM
        • Johnson JK
        • Meltzer DO
        • et al.
        On-call supervision and resident autonomy: from micromanager to absentee attending.
        Am J Med. 2019; 122: 784-788
        • Artino Jr., AR
        • La Rochelle JS
        • Dezee KJ
        • et al.
        Developing questionnaires for educational research: AMEE Guide No. 87.
        Med Teach. 2014; 36: 463-474
        • Cook DA
        • Artino Jr., AR
        Motivation to learn: an overview of contemporary theories.
        Med Educ. 2016; 50 (PMID: 27628718; PMCID: PMC5113774): 997-1014
        • Harris PA
        • Taylor R
        • Thielke R
        • et al.
        Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • The American Association for Public Opinion Research
        Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
        9th ed. AAPOR, 2016 (Available at) (Accessed November 15, 2020)
        • Falco C
        • Balmer D
        Teamwork on an inpatient ward team: an ethnographic study.
        Hosp Pediatri. 2018; 8: 353
        • Maniscalco J
        • Gage S
        • Teferi S
        • Stucky Fisher E
        The pediatric hospital medicine core competencies: 2020 revision. Introduction and methodology.
        J. Hosp. Med. 2020; 7: 389-394
        • Maniscalco J
        • Davis E
        • Gay AC
        • et al.
        Factors and behaviors related to the promotion of pediatric hospital medicine fellow autonomy: a qualitative study of faculty.
        Acad Pediatr. 2019; 19 (Epub 2019 May 9): 703-711
      3. The American Board of Pediatrics. Entrustable professional activities for subspecialties: hospital medicine. Available at: Accessed December 1, 2020.

        • Weisgerber MC
        • Toth H
        • Aylor M
        Rounding like a ninja: preparing faculty and team to empower senior residents during family-centered rounds.
        in: Presented at: Association of Pediatric Program Directors Annual Meeting, San Antonio, TexasSeptember 2012 (Available at)
        • Weisgerber MC
        • Toth H
        • Brewer C
        • et al.
        The instructor's guide for the SOS-REACH (suspected observable senior resident empowerment action checklist) and SREA-21: tools for evaluating senior resident empowerment during family-centered rounds.
        MedEdPORTAL. 2011;
        • Beck J
        • Kind T
        • Meyer R
        • et al.
        Promoting resident autonomy during family-centered rounds: a qualitative study of resident, hospitalist, and subspecialty physicians.
        J Grad Med Educ. 2016; 8: 731-738
        • Seltz LB
        • Preloger E
        • Hanson JL
        • et al.
        Ward rounds with or without an attending physician: how interns learn most successfully.
        Acad Pediatr. 2016; 16 (Epub 2016 Jun 6. PMID: 27283038): 638-644
        • Moriarty JA
        • Vellanki S
        • Trope LA
        • et al.
        Righting the autonomy-supervision pendulum: understanding the impact of independent rounds on medical students, residents, and faculty.
        Acad Med. 2020; 95 (11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 59th Annual Research in Medical Education Presentations): S28-S36
        • Franzone JM
        • Kennedy BC
        • Merritt H
        • et al.
        Progressive independence in clinical training: perspectives of a national, multispecialty panel of residents and fellows.
        J Grad Med Educ. 2015; 7: 700-704
        • Sargeant J
        • Armson H
        • Driessen E
        • et al.
        Evidence-informed facilitated feedback: the R2C2 feedback model.
        MedEdPORTAL. 2016; 12: 10387
        • Fainstad T
        • McClintock AA
        • Van der Ridder MJ
        • et al.
        Feedback can be less stressful: medical trainee perceptions of using the prepare to ADAPT (ask-discuss-ask-plan together) framework.
        Cureus. 2018; 10 (Published 2018 Dec 11): e3718
        • Owens ST
        • Owens GE
        • Rajput SH
        • et al.
        Perceptions of 24/7 in-house attending coverage on fellow education and autonomy in a Pediatric Cardiothoracic Intensive Care Unit.
        Congenit Heart Dis. 2015; 10: E107-E112
        • Wiley 2nd, JF
        • Hegenbarth MA
        • Krug S
        • et al.
        Pediatric emergency medicine fellow clinical work requirements.
        Pediatr Emerg Care. 1995; 11: 381-388
        • Gangat M
        • Klein GW
        • Cohen HW
        • et al.
        National study of continuity clinic satisfaction in pediatric fellowship training.
        Adv Med Educ Pract. 2013; 4 (Published 2013 Sep 16): 165-169
        • Hipp DM
        • Rialon KL
        • Nevel K
        • et al.
        “Back to Bedside”: residents' and fellows' perspectives on finding meaning in work.
        J Grad Med Educ. 2017; 9: 269-273
        • Ziniel SI
        • McDaniel CE
        • Beck J
        Bringing scientific rigor to survey design in health care research.
        Hosp Pediatri. 2019; 9: 743
        • Groves RM
        • Fowler FJ
        • Couper MP
        • et al.
        Survey Methodology.
        2nd ed. John Wiley & Sons, New York, NY2009