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The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on
Shannon K Martin1, Keme Carter, Noah Hellermann
1S.K. Martin is assistant professor of medicine and associate program director, Internal Medicine Residency Program, University of Chicago Pritzker School of Medicine, Chicago, Illinois. K. Carter is associate professor of medicine and assistant dean for admissions, University of Chicago Pritzker School of Medicine, Chicago, Illinois. N. Hellermann was a student, College of the University of Chicago, Chicago, Illinois, at the time of writing. The author is now a research assistant, Veterans Affairs Medical Center New York-Manhattan Campus, New York, New York. L.R. Glick is a third-year student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. S. Ngooi is research coordinator, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. M. Kachman is a second-year student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. J.M. Farnan is associate professor of medicine and associate dean for evaluation and continuous quality improvement, University of Chicago Pritzker School of Medicine, Chicago, Illinois. V.M. Arora is professor of medicine, assistant dean for scholarship and discovery, and director of clinical learning environment innovation, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Problem:
Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues' 5Cs of Consultation model to teach and assess consultation communication skills.
Approach:
In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The COSCE featured an online training module on the 5Cs and an in-person simulated consultation. Using specialty-specific patient cases, interns requested telephone consultations from faculty, who evaluated their performance using validated checklists. Interns were surveyed on their preparedness to request consultations before and after the module and after the simulation. Subspecialty fellows serving as consultants were surveyed regarding consultation quality before and after the COSCE.
Outcomes:
After completing the online module, 84% of interns (103/122) were prepared to request consultations compared with 52% (63/122) at baseline (P < .01). After the COSCE, 96% (122/127) were prepared to request consultations (P < .01). Neither preparedness nor simulation performance differed by prior experience or training. Over 90% (115/127) indicated they would recommend the COSCE for future interns. More consultants described residents as prepared to request consultations after the COSCE (54%; 21/39) than before (27%; 11/41, P = .01).
Next Steps:
The COSCE was well received and effective for preparing entering interns with varying experience and training to request consultations. Future work will emphasize consultation communication specific to training environments and evaluate skills via direct observation of clinical performance.
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