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2008 Annual Meeting Abstracts

Professionalism in Consult Practices
Susana C. Wishnia, MD1, Keren Ladin, M.Sc2, Jack Ansell, MD3, James Petros, MD, MPh4, Jennifer Rosen, MD1.
1Section of Surgical Oncology, Department of Surgery, Boston University School of Medicine, Boston, MA, USA, 2Harvard University School of Public Health, Boston, MA, USA, 3Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 4Section of Colorectal Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA.

Objective: Professionalism is one of six core competencies specified by the ACGME and the ABMS. It is an important component of surgical education and may influence patient care. Our goal was to evaluate Boston Medical Center (BMC) surgical and medical residents’ interdepartmental consult experiences, determine whether consults were conducted professionally, and whether professionalism had a perceived impact on patient care.
Design: Survey.
Setting: Academic medical center.
Participants: Population-based sample. BMC general surgery and internal medicine residents were surveyed using our novel, anonymous on-line questionnaire.
Interventions: None.
Main Outcome Measures: Demographic information including gender, PGY year and ethnicity were obtained. Respondents evaluated various aspects of professionalism in consultation practices and assessed seven clinical vignettes for consult appropriateness.
Results: The response rate was 57% (N=84) with comparable demographics between surgical and medical housestaff. Within the two weeks prior to taking the survey, an average of 30% of housestaff reported interacting with a consult, which in their opinion, was conducted unprofessionally; over 30% also reported at least one consult experience perceived as potentially detrimental to patient care. The two most commonly cited factors contributing to negative consult experiences included an incomplete workup by the primary team prior to consultation and inappropriate physician manner.
Conclusions: Our study demonstrates that a significant proportion of residents recently experienced negative consult behaviors and felt these had a negative impact on patient care. While the above findings seem ominous, close to 90% of respondents also reported engaging in positive consult experiences. Future plans already underway are to extend this study to other institutions, and to develop a new professional paradigm based on positive physician-to-physician interactions to improve patient care.


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