Enhancing Communication Between Gastroenterology Fellows and Medicine Residents: A Quality Initiative

Abstract

Introduction: Communication between consultant and primary team is essential for inpatient care. For many years at our institution, gastroenterology fellows and medicine residents seem to have problems regarding communication of these consults. Each side appear to have issues with the methods of the other side, leading to unhappy interactions and fractured professional relationships on both sides. Therefore, we performed a quality improvement project with the aim of improving the communication between gastroenterology fellows and medicine residents on inpatient consults. Methods: A quality improvement project was performed between February 2016 and June 2017. All gastroenterology fellows and medicine residents were included in this study. In February 2016, gastroenterology fellows and medicine residents were surveyed regarding key aspects of the other groups performance on inpatient consults using a Likert scale of 1-5 (with 1 being the worst and 5 being the best). Gastroenterology fellows were judged on comfort level, listening, timeliness, courtesy, informing team of results, happiness for consult, and ability to work with the resident. After review, 6 interventions were performed including departmental Professionalism Grand Rounds, consult etiquette posters throughout the department, ghost consults from gastroenterology attendings, dissemination of results to gastroenterology faculty and fellows, counseling of fellows on proper etiquette, and new fellow orientation training on proper etiquette. In June 2017, a repeat identical survey was performed. Results: Initial surveys (n=46 medicine residents) revealed gastroenterology fellows performed poorly on all aspects (overall mean score 2.7 ± 1.2) with poorest performance on happiness to accept consults (2.3 ± 1.2). After interventions, gastroenterology fellows demonstrated statistically significant improvement all outcomes, including comfort level (2.4 vs 3.5, p < 0.001), listening (2.7 vs 3.7, p < 0.001), timeliness (3.1 vs 4, p < 0.001), courtesy (2.4 vs 3.6, p < 0.001), informing team of results (3.3 vs 4.1, p = 0.001), happiness for consult (2.3 vs 3.6, p < 0.001), and ability to work with the resident (2.9 vs 4.1, p < 0.001). Overall score for gastroenterology fellows improved from 2.7 ± 1.2 to 3.8 ± 0.9 (p < 0.001). Conclusion: Communication between gastroenterology fellows and medicine residents significantly improved with counseling of consult etiquette.