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ABSTRACT
Background
Interprofessional communication, in conjunction with coordination of care between teams, is critical for high-value care in hospital-based units. The consultation process is often the first step in coordinating communication between different groups of physicians.
Objective
We sought to investigate the current practice patterns of internal medicine residents and subspecialty medicine fellow consultants, as well as how perceptions regarding the consultation process differ between groups.
Methods
We used a cross-sectional survey of internal medicine residents and subspecialty medicine fellow consultants at two academic medical centers and one community medical center. Differences between the responses of residents and consultant fellows regarding the consult process were compared. Descriptive and nonparametric comparisons were used.
Results
Of 228 residents from the three sites, 139 responded (61%). Of 192 consultant fellows sent surveys, 118 responded (61%). Both residents and fellows agreed that consult question was the most important aspect of the consultation. Residents considered information including the medical record number, history of present illness and physical exam to be more important than did fellows. The residents’ confidence in their own ability to convey a consult question was statistically different than the consultants’ perceptions about the abilities of these same residents (4.21 vs. 3.14, P < 0.01). Both felt that their interactions during the consultation process were educationally rewarding (3.81 vs. 3.64, P = 0.07).
Conclusions
Our research sheds light on the current communication habits of residents and consultant fellows. Hospital dynamics, workflow and patient length of stay could be negatively affected. Further work, including the development of formal curricula, will lead to improvements in consultation communication.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Amar R. Kohli is Assistant Professor of Internal Medicine and ambulatory medicine clerkship director at the University of Pittsburgh School of Medicine. His areas of research and education work are in doctor to doctor communication, advocating the professional use of social media and promoting the field of general internal medicine.
Neal M. Fitzpatrick is an Internal Medicine Clinician and has more than 5 years of diverse experiences. He affiliates with many hospitals including Milton S Hershey Medical Center and, Lancaster General Hospital.
Jed D. Gonzalo is Assistant Professor of Medicine and Public Health Sciences at the Penn State University College of Medicine. He is a general internist, serving in both inpatient and outpatient settings, medical educator in both undergraduate and graduate medical education and health services researcher with a principal research interest in collaboration and quality.
D. Michael Elnicki is a Professor of Medicine at the University of Pittsburgh School of Medicine. He has published on educational topics that include improving aspects of the internal medicine clerkship, early clinical exposures for medical students, assessment issues, improving the learning environment, teaching evidence-based medicine skills, providing feedback to learners and teaching telephone medicine skills to residents.