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

BACKGROUND: Medical consultation is an integral part of hospitalist physicians' practice, yet there is no uniform training to achieve competency in this area during residency. OBJECTIVE: To improve the quality of medical consultations performed by hospitalists in an academic medical center. DESIGN: Single group pre-post study design comparing knowledge and behaviors after exposing physicians to an educational intervention. SETTING: Johns Hopkins Bayview Medical Center, 2006-2007. PARTICIPANTS: Seven hospitalist faculty members, and 12 internal medicine house-staff members, who served on the medical consultation service during the study period. INTERVENTION: 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. MEASUREMENTS: 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. RESULTS: 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). CONCLUSIONS: This curricular intervention including audit and feedback was effective in improving the quality of medical consultations performed by hospitalist physicians.