Communication is recognized by the LCME and ACGME as an essential competency with significant patient safety implications; the Joint Commission cites communication errors as a major cause of sentinel events. Consultation is a near-universal method of communication between physicians of all disciplines. However, formal education in requesting a consultation is inconsistent in undergraduate medical education (UME).
We aimed to demonstrate the utility of an online training module in presenting a standardized framework for teaching consultation communication to address variability in prior exposure for entering interns, and pilot a novel means for evaluating entering intern performance in requesting a consultation, the consultation OSCE (OSCE).
We trained all incoming interns on a validated, standardized approach to consultation communication: the 5Cs Model (“Contact”, “Communicate”, “Core Question”, “Collaborate”, “Closing the Loop”). Interns completed an online module, beginning with a survey on UME consultation training, satisfaction with training and self-reported preparedness to request consultations. They were then trained on the 5Cs Model and took a knowledge-based quiz. Following module completion, interns participated in a consultation OSCE (COSCE) during institutional GME orientation where they requested a simulated consult via phone to a trained faculty “standardized consultant”. Faculty evaluated intern performance using a 5Cs checklist and Global Rating Scale. Of 123 interns completing the online module, 78% had requested consults in medical school. 66.4% reported prior UME training in consultation, and 44.8% were satisfied with this training. Satisfaction correlated with pre-survey preparedness; interns highly satisfied with training reported mean preparedness of 4.88 on a 5-point Likert scale compared to interns unsatisfied with training (mean 3.33, P<0.01). Although not statistically significant, satisfaction also correlated with quiz performance, measured by attempts to achieve mastery (i.e., 100% of questions correctly answered). Unsatisfied interns required a mean of 3.33 attempts compared to highly satisfied interns (mean 2.19 attempts). For untrained interns, mean preparedness increased following module completion from 2.79 to 4.0 (P<0.01). Notably, after completing the module, both trained and untrained interns reported similar levels of preparedness and had similar COSCE performances as rated by faculty evaluators.
The COSCE is a promising strategy for teaching and evaluating entering intern ability to request a consultation. Despite variability in prior exposure to training in consultation, use of an online training module presenting the 5Cs Model as a standardized teaching framework helped mitigate the lack of standardization in UME training and was effective in preparing even untrained interns to request consults.