High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations

Nandiwada, Deepa Rani; Kohli, Amar; McNamara, Megan; Smith, Kenneth J.; Zimmer, Shanta M.; McNeil, Melissa; Spagnoletti, Carla; Rubio, Doris McGartland; Berlacher, Kathryn

doi:10.4300/jgme-d-17-00177.1

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…The number of participants ranged from 17 to 86 across studies. Doctors in training were working in discipline-specific training programmes including neonatal-perinatal medicine,23 paediatrics,24 25 family medicine,26 27 emergency medicine,28 otolaryngology,29 cardiology,30 psychiatry31 and geriatric-palliative care 32. The length of EBM courses ranged from 1 day27 29 to 4 years 31.…”

Section: Resultsmentioning

confidence: 99%

“…The predominant study designs were before–after studies. A variety of learning activities were undertaken, including some didactic teaching/learning course components,24 26–28 32 33 online or blended learning25 26 30 34 and EBM learning integrated with clinical activities 22 26 30 32 33 35. EBM learning was integrated with clinical activities that included outpatient clinics, inpatient hospital rounds and morning reports.…”

Section: Resultsmentioning

confidence: 99%

“…One study used a survey of attitudes and behaviour (Practice-Based Learning and Improvement competency rating 34. Author-devised surveys were also implemented 26 30 31 33. Three studies used qualitative methods (focus group, feedback, debriefing) in addition to quantitative methods to evaluate the EBM curriculum 30 34 35…”

Section: Resultsmentioning

confidence: 99%

“…Author-devised surveys were also implemented 26 30 31 33. Three studies used qualitative methods (focus group, feedback, debriefing) in addition to quantitative methods to evaluate the EBM curriculum 30 34 35…”

Section: Resultsmentioning

confidence: 99%

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Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

et al. 2022

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ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.DesignScoping review of literature from January 2017 to June 2021.SettingAny setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).ParticipantsDoctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.MethodsSearches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews.ResultsOf the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM.ConclusionsSDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors’ skills and patient care.ProtocolA protocol for this review has been published and contains further details of the methodology.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

et al. 2022

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“…One of the pillars of safe and effective patient care is comprehensive and efficient communication between medical teams ( 1 – 6 ). The common program requirements published by the Accreditation Council for Graduate Medical Education list physician communication as a core component of residency training ( 1 ); however, few institutions incorporate a formal curriculum on calling consults ( 2 , 7 ). Education about calling consults is largely left to observational learning as opposed to formal teaching ( 3 ), which can lead to perpetuation of inconsistent and ineffective communication methods between care providers.…”

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confidence: 99%

Calling Consults: A Workshop to Teach Trainees Using Both Didactic and Small Group–based Learning

et al. 2020

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Background: Safe patient care includes effective communication. The Accreditation Council for Graduate Medical Education common program requirements include core requirements for trainees to act in a consultative manner and communicate effectively. However, trainees do not commonly receive formal education on this topic. Objective: We created a 1-hour workshop to teach residents and fellows how to effectively call consults, including how to formulate a cogent and comprehensive consult question. Methods: The workshop, delivered over a 1-hour noon conference, included a didactic portion and interactive small-group case-based learning. We used pre- and postworkshop surveys to assess learners’ prior training, knowledge, and comfort levels in calling consults. Subspecialists answered a separate survey about the quality of consults received from trainees before and 30 days after the workshop. Results: Seventy-three trainees attended the workshop (41.2% of total trainees invited). After the workshop, the percentage of learners who identified as very or somewhat comfortable with calling consults increased from 82% to 91%. Before the workshop, 87% of trainees could identify key elements in a consult, which increased to 100% after the workshop. There was not a statistically significant improvement in subspecialists’ ratings of the overall quality of consults they received 30 days after the workshop. Conclusion: Training learners on the key components and etiquette of calling consults is crucial for the development of effective communication among providers. This training is generally lacking from undergraduate medical education; thus, it is important to provide education in calling consults during residency and fellowship.

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Factors Associated With Inpatient Subspecialty Consultation Patterns Among Pediatric Hospitalists

et al. 2023

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ImportanceSubspecialty consultation is a frequent, consequential practice in the pediatric inpatient setting. Little is known about factors affecting consultation practices.ObjectivesTo identify patient, physician, admission, and systems characteristics that are independently associated with subspecialty consultation among pediatric hospitalists at the patient-day level and to describe variation in consultation utilization among pediatric hospitalist physicians.Design, Setting, and ParticipantsThis retrospective cohort study of hospitalized children used electronic health record data from October 1, 2015, through December 31, 2020, combined with a cross-sectional physician survey completed between March 3 and April 11, 2021. The study was conducted at a freestanding quaternary children’s hospital. Physician survey participants were active pediatric hospitalists. The patient cohort included children hospitalized with 1 of 15 common conditions, excluding patients with complex chronic conditions, intensive care unit stay, or 30-day readmission for the same condition. Data were analyzed from June 2021 to January 2023.ExposuresPatient (sex, age, race and ethnicity), admission (condition, insurance, year), physician (experience, anxiety due to uncertainty, gender), and systems (hospitalization day, day of week, inpatient team, and prior consultation) characteristics.Main Outcomes and MeasuresThe primary outcome was receipt of inpatient consultation on each patient-day. Risk-adjusted consultation rates, expressed as number of patient-days consulting per 100, were compared between physicians.ResultsWe evaluated 15 922 patient-days attributed to 92 surveyed physicians (68 [74%] women; 74 [80%] with ≥3 years’ attending experience) caring for 7283 unique patients (3955 [54%] male patients; 3450 [47%] non-Hispanic Black and 2174 [30%] non-Hispanic White patients; median [IQR] age, 2.5 ([0.9-6.5] years). Odds of consultation were higher among patients with private insurance compared with those with Medicaid (adjusted odds ratio [aOR], 1.19 [95% CI, 1.01-1.42]; P = .04) and physicians with 0 to 2 years of experience vs those with 3 to 10 years of experience (aOR, 1.42 [95% CI, 1.08-1.88]; P = .01). Hospitalist anxiety due to uncertainty was not associated with consultation. Among patient-days with at least 1 consultation, non-Hispanic White race and ethnicity was associated with higher odds of multiple consultations vs non-Hispanic Black race and ethnicity (aOR, 2.23 [95% CI, 1.20-4.13]; P = .01). Risk-adjusted physician consultation rates were 2.1 times higher in the top quartile of consultation use (mean [SD], 9.8 [2.0] patient-days consulting per 100) compared with the bottom quartile (mean [SD], 4.7 [0.8] patient-days consulting per 100; P &lt; .001).Conclusions and RelevanceIn this cohort study, consultation use varied widely and was associated with patient, physician, and systems factors. These findings offer specific targets for improving value and equity in pediatric inpatient consultation.

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High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations

Abstract: The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

Cited by 6 publications

References 7 publications

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

Calling Consults: A Workshop to Teach Trainees Using Both Didactic and Small Group–based Learning

Factors Associated With Inpatient Subspecialty Consultation Patterns Among Pediatric Hospitalists

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