Comparing the communication habits between residents and consultant fellows: recommendations for curriculum development

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.