Background/Purpose: Analysis of the last five annual program reviews of our fellowship identified repeated concerns raised by both residents and fellows with Rheumatology inpatient rounding and consultation. Thus, one of the specific aims for improvement chosen for our American Council for Graduate Medical Education (ACGME) Self-Study was to obtain feedback regarding our inpatient consult service performance from the Cincinnati Children’s Hospital Medical Center (CCHMC) pediatric residents. We know from the adult rheumatology literature that communication, professionalism, teaching, and pushback have been identified by residents as key measures to evaluate the effectiveness of consultative services. These measures, however, have not been applied to evaluate pediatric rheumatology consultations, and so we modified the existing validated adult survey to 1) determine pediatric resident opinion on the aforementioned areas, and 2) identify areas for improvement.

Methods: Rheumatology consultation patients requiring inpatient admission at CCHMC are primarily admitted to one of the general inpatient teams that is staffed by post graduate year one (PGY-1) through four (PGY-4) residents. Residents on this team from July 2018 through April 2019 were handed and completed a survey during a noon lecture given during the 4-week rotation. Surveys included 6 questions related to the experience and residents’ perception of communication, education, etc. All questions were answered on a 5-point Likert scale (not applicable, poor, fair, good, very good, and excellent). The survey was developed by our pediatric rheumatology program director based on a survey described in the adult literature.

Results: 31/38 (82%) of residents completed the survey (75% PGY-1, 23% PGY-2, and 3% PGY-3 or PGY-4). Overall satisfaction with consulting service was good among residents, with 29/31 (94%) of residents reporting “very good” or “excellent satisfaction”. Resident opinion on the quality of communication was variable, with 5/31 (16%) reporting “poor” to “good” quality of communication and 26/31 (84%) reporting “very good” or “excellent”. The majority of residents reported “very good’ or “excellent” professionalism (30/31, 97%). Teaching was also variable, with 6/31 (19%) reporting “poor” to “good” experience. There was little report of pushback, with 31/31 (100%) of residents reporting receiving pushback “rarely” or “never”.

Conclusion: Overall, experience with the inpatient consulting service seemed favorable among residents. Areas for improvement included communication and teaching. In regards to communication, more first year residents seemed dissatisfied, which some reporting “poor” or “fair” experiences. Prior investigations through end of year reviews in our program have reported that this dissatisfaction in communication revolves around discussion of rounding times and plans, but further investigation is required to fully illuminate ways to improve this. In regards to teaching, though the majority of responders reported favorably, there were still some who did not have a good experience, and next steps include investigations into ways to improve this.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/we-can-do-better-evaluating-inpatient-pediatric-rheumatology-inpatient-consult-service-performance/