Jennifer Maniscalco
1. As one of the first official PHM fellows, it must be fascinating to reflect on how much PHM fellowship has grown. How do you advise current residents considering a fellowship in pediatric hospital medicine versus starting their career as a hospitalist immediately out of residency?
When I decided to pursue fellowship training, PHM was in its infancy and fellowship training was practically unheard of. Not only did I need to explain why I was choosing fellowship training, but I also had to explain what a pediatric hospitalist was! But, I was in the right place at the right time, with a program director and mentor who made it so easy for me to take that leap of faith. Now, when I look out at the sea of faces at the AAP SOHM Fellows Conference, I am humbled by the growth of the field and motivated to give back in support today’s fellows and the fellowship community.
When advising current residents, I think it is important to have a balanced discussion about their personal and professional goals and national movements in the field (particularly the recent subspecialty certification). However, I always seem to come back to the topics of mentorship and community. PHM fellows receive an invaluable amount of formal and informal mentorship in all domains of the field, and opportunities for fellows within local, regional, and national organizations abound. This reality is difficult to match in other early career positions.
2. What are the best resources and conferences for younger pediatric hospitalists looking to get involved in medical education? How would you suggest getting involved when first starting out?
Enthusiasm, volunteerism, and collaboration will serve you well! Sign up for opportunities that support the educational enterprise at your institution and will also help you grow professionally. Start thinking about which level of learner (students, residents, fellows, faculty) or which section of medical education (undergraduate, graduate, or continuing) you are most interested in and slowly narrow your involvement towards that group. Alternatively, choose an area of focus within medical education, such as the balance of supervision and autonomy, and explore that topic among all levels of learners.
Engage in national organizations. Sign up for committees and initiatives that provide an opportunity for you to make both a local/institutional and a regional/national impact. In addition to the education committees in the three societies supporting PHM (AAP, APA, SHM), there are several national organizations dedicated to medical education and pediatric medical education – three are listed here:
3. After being in D.C. for college, medical school, residency, and fellowship and earning an MPH there, you uprooted yourself and ventured across the country to work in L.A, which must have been difficult. What advice do you have for fellow pediatric hospitalists considering a location or job change and what factors do you think are most important in the job search?
Moving across the country and to a new institution was certainly difficult, but it was also a profound personal and professional development experience. My best advice for those embarking on a new position is to stay true to yourself, but be mindful and respectful of the history and culture at your new institution. As my dad advised me at the time, combine the best things about your new institution and the best things about you, and good things will come of it.
With regard to the job search, I think it is important to identify what your “must-haves” or “non-negotiables” are, within reason of course. This makes your search more efficient and helps guide your negotiation. Keep in mind that factors like location, weather, and proximity to friends and family may supersede factors like number of clinical hours and patient population – and that’s ok. It’s all about what will make you personally and professionally content.
4. You were the co-author of the Pediatric Medicine Core Competencies as well as a JAMA Pediatrics article entitled, “Pediatric Hospital Medicine and Education: Why We Can't Stand Still,” along with many other articles about the role of pediatrics hospitalists in education. The articles emphasize training learners in quality improvement, patient safety, and cost-effective care. For hospitalists in programs where they spend only a few days at a time with learners or those pulled in other directions by committees and administrative duties, how best can these subjects be passed on to learners?
What a great question! First, never underestimate the power of both explicit and implicit role-modeling. Hospitalists who role model attention to operational, safety, or cost issues are powerful educators in these domains. There is also an opportunity to role model professional, collaborative, and respectful behavior among all team members, particularly when working on interdisciplinary teams. Second, adopt a systematic approach to incorporating these domains into your patient care or your team’s family-centered bedside rounds. One idea is to choose a theme of the day, and then take a minute or two to discuss that theme for every patient that your team rounds on. For example, review the medication orders or medical administration record (MAR) for every patient, ensuring that the indication for every medication ordered is clear and deleting those that are no longer needed. You can discuss potential medication interactions and side effects or medication errors. This is especially fun if you have a pharmacist on your team. Another idea is to have your team conduct its own PDSA cycles on the efficiency of rounds, nursing involvement on rounds, or another systems topic. In just a few days, you can cover quite a few of the essential tenets of quality improvement. Third, consider mentoring a trainee who wants to lead projects or conduct research in these domains. This allows for a longitudinal relationship that is not tied to clinical supervision. Finally, get involved on a program or institutional level. Participate in committees and initiatives related to conducting work or teaching in these areas. Is there a residency curriculum that you can participate in? Is there a clinical practice guideline that you can help develop? Direct contact with individual trainees may be limited, but the broader impact on trainee education may be significant.
5. Your husband is also a physician. How do you two step away from medicine when you’re at home? How do you juggle everything in your work and personal life?
Yes, and with three active children, we always have a lot going on! I like to refer to it as “managed chaos.” I don’t have the perfect answer, but in recent years we’ve made a greater commitment to prioritizing individual and family time, making sure that each of us has an opportunity to rest and replenish. We’ve tried to let go of a lot of artificial pressures and say no to social events that feel more like obligations. I try to connect daily with each child, even if it is just for a moment, to make sure they know that I value them. From a practical perspective, we outsource what we are able to – grocery delivery, house cleaning, etc. – which saves us time and energy that can be redirected to other, more enjoyable activities. And the family organization app Cozi has helped a lot!
6. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Do what makes you feel alive!
When I decided to pursue fellowship training, PHM was in its infancy and fellowship training was practically unheard of. Not only did I need to explain why I was choosing fellowship training, but I also had to explain what a pediatric hospitalist was! But, I was in the right place at the right time, with a program director and mentor who made it so easy for me to take that leap of faith. Now, when I look out at the sea of faces at the AAP SOHM Fellows Conference, I am humbled by the growth of the field and motivated to give back in support today’s fellows and the fellowship community.
When advising current residents, I think it is important to have a balanced discussion about their personal and professional goals and national movements in the field (particularly the recent subspecialty certification). However, I always seem to come back to the topics of mentorship and community. PHM fellows receive an invaluable amount of formal and informal mentorship in all domains of the field, and opportunities for fellows within local, regional, and national organizations abound. This reality is difficult to match in other early career positions.
2. What are the best resources and conferences for younger pediatric hospitalists looking to get involved in medical education? How would you suggest getting involved when first starting out?
Enthusiasm, volunteerism, and collaboration will serve you well! Sign up for opportunities that support the educational enterprise at your institution and will also help you grow professionally. Start thinking about which level of learner (students, residents, fellows, faculty) or which section of medical education (undergraduate, graduate, or continuing) you are most interested in and slowly narrow your involvement towards that group. Alternatively, choose an area of focus within medical education, such as the balance of supervision and autonomy, and explore that topic among all levels of learners.
Engage in national organizations. Sign up for committees and initiatives that provide an opportunity for you to make both a local/institutional and a regional/national impact. In addition to the education committees in the three societies supporting PHM (AAP, APA, SHM), there are several national organizations dedicated to medical education and pediatric medical education – three are listed here:
- American Association of Medical Colleges (AAMC)
- Council on Medical Student Education in Pediatrics (COMSEP)
- Association of Pediatric Program Directors (APPD)
3. After being in D.C. for college, medical school, residency, and fellowship and earning an MPH there, you uprooted yourself and ventured across the country to work in L.A, which must have been difficult. What advice do you have for fellow pediatric hospitalists considering a location or job change and what factors do you think are most important in the job search?
Moving across the country and to a new institution was certainly difficult, but it was also a profound personal and professional development experience. My best advice for those embarking on a new position is to stay true to yourself, but be mindful and respectful of the history and culture at your new institution. As my dad advised me at the time, combine the best things about your new institution and the best things about you, and good things will come of it.
With regard to the job search, I think it is important to identify what your “must-haves” or “non-negotiables” are, within reason of course. This makes your search more efficient and helps guide your negotiation. Keep in mind that factors like location, weather, and proximity to friends and family may supersede factors like number of clinical hours and patient population – and that’s ok. It’s all about what will make you personally and professionally content.
4. You were the co-author of the Pediatric Medicine Core Competencies as well as a JAMA Pediatrics article entitled, “Pediatric Hospital Medicine and Education: Why We Can't Stand Still,” along with many other articles about the role of pediatrics hospitalists in education. The articles emphasize training learners in quality improvement, patient safety, and cost-effective care. For hospitalists in programs where they spend only a few days at a time with learners or those pulled in other directions by committees and administrative duties, how best can these subjects be passed on to learners?
What a great question! First, never underestimate the power of both explicit and implicit role-modeling. Hospitalists who role model attention to operational, safety, or cost issues are powerful educators in these domains. There is also an opportunity to role model professional, collaborative, and respectful behavior among all team members, particularly when working on interdisciplinary teams. Second, adopt a systematic approach to incorporating these domains into your patient care or your team’s family-centered bedside rounds. One idea is to choose a theme of the day, and then take a minute or two to discuss that theme for every patient that your team rounds on. For example, review the medication orders or medical administration record (MAR) for every patient, ensuring that the indication for every medication ordered is clear and deleting those that are no longer needed. You can discuss potential medication interactions and side effects or medication errors. This is especially fun if you have a pharmacist on your team. Another idea is to have your team conduct its own PDSA cycles on the efficiency of rounds, nursing involvement on rounds, or another systems topic. In just a few days, you can cover quite a few of the essential tenets of quality improvement. Third, consider mentoring a trainee who wants to lead projects or conduct research in these domains. This allows for a longitudinal relationship that is not tied to clinical supervision. Finally, get involved on a program or institutional level. Participate in committees and initiatives related to conducting work or teaching in these areas. Is there a residency curriculum that you can participate in? Is there a clinical practice guideline that you can help develop? Direct contact with individual trainees may be limited, but the broader impact on trainee education may be significant.
5. Your husband is also a physician. How do you two step away from medicine when you’re at home? How do you juggle everything in your work and personal life?
Yes, and with three active children, we always have a lot going on! I like to refer to it as “managed chaos.” I don’t have the perfect answer, but in recent years we’ve made a greater commitment to prioritizing individual and family time, making sure that each of us has an opportunity to rest and replenish. We’ve tried to let go of a lot of artificial pressures and say no to social events that feel more like obligations. I try to connect daily with each child, even if it is just for a moment, to make sure they know that I value them. From a practical perspective, we outsource what we are able to – grocery delivery, house cleaning, etc. – which saves us time and energy that can be redirected to other, more enjoyable activities. And the family organization app Cozi has helped a lot!
6. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Do what makes you feel alive!