Background: Much of medical education relies on effective consultation between primary teams and consultants. Previous work has shown that trainees have difficulty with placing and receiving consults. Resident-driven interventions have been shown to increase the number of teaching interactions during consults.
Purpose: Our objective was to evaluate the effect of an educational workshop and the use of memory aids on residents’ satisfaction with inpatient consults.
Description: We hosted a 90-minute, Zoom-based workshop for Internal Medicine residents. consisting of a review of consult etiquette; the introduction of memory-aids (one to place, and another to respond to a consult) via small groups practice; and a panel discussion with faculty about the consultative process.Forty-eight hours later, we provided all 9 Internal Medicine teams, and the Infectious Diseases consult service at our Veterans Affairs Medical Center, with printed copies of the memory-aids: “placing consults” for Medicine teams, and “responding consults”, for the ID consult team. Medicine teams and the ID consult service at our non-VA teaching hospital did not receive these.Three weeks later, we sent a survey to all 69 IM residents who were finishing their rotation on a primary IM service at either VA or another non-VA teaching hospital. Surveys focused on assessing residents’ satisfaction with ID consultant interactions. A 5-point Likert scale was used to grade satisfaction with various aspects of consult interactions. Residents who responded to the survey were included in the analysis, those who either attended the workshop, used the “placing consults” aid or rotated at our VA (exposed to “responding consults” tool via ID consult service) were the intervention group. Residents who did not fulfill any of the above were our control. We compared the percentage of satisfied residents between intervention and control groups using Fisher’s exact test.Thirty-six residents from IM teams responded to the survey (52.2% response rate). We organized residents into 4 groups to analyze combined interventions: 7 residents were exposed to both memory-aid tools and attended the workshop (Group 1), 8 residents were only exposed to the “responding consults” tool (via the ID consult team at the VA [Group 2]), 10 residents only used the “placing consults” tool or attended the workshop, no rotation through the VA (Group 3), and 11 residents were not exposed to any intervention (Group 4, control).Residents in Group 4 had a significantly lower satisfaction with the overall consult experience (36.4% residents satisfied vs. 100%, 100% and 90.0%, in Groups 1, 2 and 3 respectively with a p value of 0.0004. They also had a significantly lower satisfaction with the consultant’s professionalism, communication and teaching received from the consultant, compared to groups 1, 2 and 3.
Conclusions: We found that our workshop or the use of memory-aids improved the satisfaction of residents with inpatient consults. Our intervention aimed to encourage peer-teaching with minimal workflow disruption. By using previously published aids, we combined both into one intervention and assessed it in a real-world setting. Future directions include incorporating randomization, a larger sample size and controlling for inherent consulting resident teaching skills. Care should be taken to minimize non-response bias given the nature of the study.
