Original Article

Teaching during Consults: Effects of Multiple Educational Interventions on Satisfaction with Consultant Interactions among Internal Medicine Residents

Authors: Christian A. Inchaustegui, MD, Suchi Agrawal, MD, Prathit A. Kulkarni, MD

Abstract

Objective: To evaluate the effect of an educational intervention on Internal Medicine residents’ satisfaction with the inpatient consultation process.

Methods: We hosted an optional workshop for Internal Medicine residents on placing and responding to consults using two memory aid tools. We then provided copies of these memory aids to residents on inpatient Medicine and Infectious Diseases teams, and later surveyed all of the residents who were finishing their inpatient Medicine rotation. Surveys assessed residents’ participation in the workshop, receipt of the memory-aid tools, and satisfaction with Infectious Diseases consultation using a 5-point Likert scale. Residents were organized into the following groups: group 1 residents were exposed to the workshop and both memory aid tools; group 2 residents were exposed only to the “responding to consults” memory aid tool; group 3 residents were exposed to the workshop and the “placing consults” memory aid tool; and group 4 residents were not exposed to any interventions. We compared the percentage of satisfied residents among groups.

Results: A total of 36 out of 69 residents answered our survey (response rate of 52%). Among survey respondents, 7 (19.4%) were in group 1, 8 (22.2%) in group 2, 10 (27.8%) in group 3, and 11 (30.6%) in group 4. Group 4 residents had lower satisfaction with the overall consultation process (36.4% residents satisfied vs 90%–100% in the intervention groups, P < 0.001), the consultant’s professionalism (54.5% vs 100%, P = 0.002), communication between the primary team and the consultant (54.5% vs 90%–100%, P = 0.01), and teaching received from the consultant (18.2% vs 57.1%–80.0%, P = 0.02).

Conclusions: An educational workshop and use of structured memory aids can lead to improved resident satisfaction with the consultation process.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Myers R, Goldstein J, Ponitz, K, et al. Calling the consultant! The educational opportunity of the subspecialty consultation. http://appd.s3.amazonaws.com/docs/meetings/2018SpringPresentations/ELS31Slides.pdf. Published 2018. Accessed February 23, 2023.
 
2. Roy A, Heckman MG, Roy V. Associations between the hospitalist model of care and quality-of-care-related outcomes in patients undergoing hip fracture surgery. Mayo Clin Proc 2006;81:28–31.
 
3. Forsblom E, Ruotsalainen E, Ollgren J, et al. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2012;56:527–535.
 
4. Smetana GW. Principles of medical consultation. In: Goldman L and Schafer AI, eds., Goldman-Cecil Medicine, 26th ed. New York: Elsevier; 2019, chap. 402.
 
5. Goldman L. Ten commandments for effective consultations. Arch Intern Med 1983;143:1753–1755.
 
6. Cohn SL. The role of the medical consultant. Med Clin North Am 2003;87:1–6.
 
7. Salerno SM. Principles of effective consultation: an update for the 21st-century consultant. Arch Intern Med 2007;167:271–275.
 
8. Adams TN, Bonsall J, Hunt D, et al. Hospitalist perspective of interactions with medicine subspecialty consult services. J Hosp Med 2018;13:318–323.
 
9. Hale AJ, Freed JA, Alston WK, Ricotta DN. What are we really talking about? An organizing framework for types of consultation and their implications for physician communication. Acad Med 2019;94:809–812.
 
10. Podolsky A, Stern DT, Peccoralo L. The courteous consult: A CONSULT card and training to improve resident consults. J Grad Med Educ 2015;7: 113–117.
 
11. Gupta S, Alladina J, Heaton K, et al. A randomized trial of an intervention to improve resident-fellow teaching interactions on the wards. BMC Med Educ 2016;16:276.
 
12. Chen DC, Miloslavsky EM, Winn AS, et al. Fellow as Clinical Teacher (FACT) curriculum: improving fellows’ teaching skills during inpatient consultation. MedEdPORTAL 2018;14:10728.
 
13. Ishak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ 2009;1:236–242.
 
14. Miloslavsky EM, Chang Y. Development and evaluation of a novel survey tool assessing inpatient consult service performance. J Grad Med Educ 2017;9:759–762.
 
15. Miloslavsky EM, Degnan K, Mcneill J, et al. Use of Fellow as Clinical Teacher (FACT) curriculum for teaching during consultation: effect on subspecialty fellow teaching skills. J Grad Med Educ 2017;9:345–350.
 
16. ACGME Internal Medicine Milestones Work Group. Internal medicine milestones. https://www.acgme.org/globalassets/PDFs/Milestones/InternalMedicineMilestones2.0.pdf?ver=2020-12-02-124816-380&ver=2020-12-02-124816-380 Published November 2020. Accessed February 20, 2021.
 
17. Snell L. The resident-as-teacher: it’s more than just about student learning. J Grad Med Educ 2011;3:440–441.