A case-based teaching module combined with audit and feedback to improve the quality of consultations

Medical consultation is an integral part of hospitalist physicians' practice, yet there is no uniform training to achieve competency in this area during residency.

To improve the quality of medical consultations performed by hospitalists in an academic medical center.

Single group pre-post study design comparing knowledge and behaviors after exposing physicians to an educational intervention.

Johns Hopkins Bayview Medical Center, 2006-2007.

Seven hospitalist faculty members, and 12 internal medicine house-staff members, who served on the medical consultation service during the study period.

Participants were exposed to an educational intervention consisting of a case-based module teaching the principles of medical consultation, as well as audit and feedback in which they critically reviewed their most recent written consultations.

Pretests and posttests were used to assess knowledge. Performance and physician behaviors were assessed following the intervention; consultations done by hospitalists in the months prior to the educational intervention were scored and compared to their postintervention consultations. Wilcoxon signed rank tests and paired t tests were used for the analyses.

Improvement in the median knowledge score (pretest vs. posttest) was significant only for house-staff and not for faculty (10/14 vs. 12/14, P = 0.03 and 11/14 vs. 12/14, P = 0.08, respectively). The quality of consults written by all hospitalists improved after the educational intervention; the mean scores increased from 2.7 to 3.3 (P = 0.0006).

This curricular intervention including audit and feedback was effective in improving the quality of medical consultations performed by hospitalist physicians.