When Jeffrey Simmons, MD, MSc, started at Cincinnati Children’s in 2000, hospitalists were just beginning to make their mark in pediatric medicine.

In those years, community pediatricians made twice-daily rounds at the hospital for as many as 75 percent of general pediatric patients. Now, hospitalists manage care for about 80 percent of inpatients at Cincinnati Children’s.

“Today, due to improved technology, changes in reimbursement and other factors, the children admitted to hospitals are significantly sicker than years ago,” Simmons says. “Many patients have complex diagnoses, take multiple medications, or have other special needs that can require frequent oversight. So hospital care evolved into a specialty of its own.”

And the hospital environment became more complex. New quality and safety procedures, electronic medical records systems and demand for greater efficiency require hospitalists who know how to manage the flow of hospital care.

Cincinnati Children’s launched its Pediatric Hospital Medicine fellowship in 2010, just as the medical center was creating its new Division of Pediatric Hospital Medicine.

At least 20 medical centers offer pediatric hospitalist fellowships, Simmons says. However, Cincinnati Children’s program is one of the few that goes beyond clinical training to teach fellows about administrative leadership and how to conduct academic research.

Hospitalist fellows at Cincinnati Children’s follow a three-year program, with the first year immersed in clinical practice and the second and third years devoted to building academic skills and completing a research project. Fellows receive training in biostatistics, clinical epidemiology, quality improvement science, research design and more.

They also work with senior hospital leaders to study the business of quality care.

“These research projects often involve multiple disciplines and can have wide-ranging influences on care,” Simmons says. “It takes a lot of flexibility and collaboration within the institution to support this work. That can be difficult at some institutions. But teamwork is part of the culture here.”

The program helps prepare pediatric hospitalists for leadership roles, whether they wind up working in an academic medical center, a community hospital or a smaller, more rural setting. Years from now, these fellows may find themselves setting standards of care.

“In addition to direct clinical care, hospitalists become experts in how the system works,” Simmons says. “We are training fellows not just to improve the system, but also to conduct the research required to prove that innovations to the system are working.”