Background/Purpose: The role of subspecialty consultation in inpatient medicine is increasing.  Effective consultation services have an important impact on the quality and efficiency of patient care as well as care transitions.  Within academic medical centers, successful resident-fellow interactions during consultation positively affect resident and student education and may influence their career choice.  Therefore, enhancing the performance of subspecialty inpatient consultation services may have a broad reaching impact.  To our knowledge, an instrument designed to measure consult service performance has not been described.  We developed a consult service evaluation tool and evaluated its psychometric properties at a large academic center.

Methods: The instrument was developed by the investigators and Internal Medicine (IM) subspecialty fellowship program directors at a single academic center.  It asked IM residents to evaluate ten IM subspecialty consult services (rheumatology, cardiology, etc.) on the following items (5-point scale): overall satisfaction, communication, professionalism, teaching and pushback (reluctance or resistance to perform the consult).  The instrument was administered in May 2015 and May 2016 to all IM residents.  Pearson correlation coefficients were used to summarize the relationship between measured items and overall satisfaction.  To take into account the repeated measures data structure, linear regression models with Generalized Estimating Equations were used to compare across post graduate year (PGY), year of survey administration or consult service.

Results: One hundred and thirteen residents responded (47 in 2015 and 66 in 2016 [45 PGY-I, 35 PGY-II and 33 PGY-III or IV], combined response rate 35%).  Each of the four items measured (communication, professionalism, teaching, pushback) significantly correlated to the overall satisfaction rating in univariate analyses (all with p<0.01), suggesting internal validity.  Multivariate analyses demonstrated that each item independently contributed to the overall satisfaction score (communication [r=0.68], professionalism [r=0.64], teaching [r=0.42] and pushback [r=0.47], all with p<0.01).  There were no differences in ratings across PGY year or year of survey administration demonstrating reliability of the instrument (Table).  There was considerable variation in ratings among the 10 services evaluated (all with p<0.01, Table) signifying that consult services are perceived differently, even within a single academic center.

Conclusion: We describe the development and evaluation of an instrument designed to evaluate subspecialty consult service performance.  Our results suggest that perception of consult services varies considerably among residents.  This tool can be utilized to assess consult services and measure the effect of interventions designed to improve consult service performance.     Table – Ratings of Internal Medicine Subspecialty Consult Services and Comparisons by PGY Year and Year of Survey Administration