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Table 1 The 4 steps of an intervention designed to improve communication between residents and fellows

From: A randomized trial of an intervention to improve resident-fellow teaching interactions on the wards

Action Rationale
1. The supervising resident assists the intern in coming up with a specific consult question using a task-list software (Apprentice, Boston MA) used for patient care. “Pushback” or reluctance to see the consult on the part of fellows has been cited as a major barrier to resident-fellow teaching interactions [7]. One of the most common reasons for fellow “pushback” is the lack of a clear consult question. Interns, due to their limited experience, can find it challenging to effectively determine the consult question [7]. This step of the intervention was designed to enhance the quality of the consult question posed to the consult team by the interns.
2. When requesting the consultation from a fellow (initial interaction, which typically occurred by telephone), interns should ask the fellow to discuss the case in-person after they have seen the patient (follow-up interaction). The supervising resident encourages interns to have an in-person interaction with the fellow at least once during the consult. Teaching interactions most commonly occur during in-person communication (as compared to by telephone or consult note) [7]. Fellows are typically responsible for initiating in-person communication when relating their recommendations. This step of the intervention sought to incentivize interns to have in-person communication with fellows and incentivize fellows to locate the interns in order to have an in-person interaction.
3. During the follow-up interaction, interns encouraged to ask the fellow at least one question about the case in order to initiate the teaching interaction. Fellows are more likely to teach residents that express an interest in learning [7]. This is in part due to the perception, on the part of fellows, that interns may be too busy to learn or not interested in learning [7]. Therefore, interns may be responsible for initiating the teaching interaction. This step of the intervention was designed to encourage interns to initiate the teaching interaction, thereby incentivizing fellows to teach.
4. Interns share a teaching point they learned from the fellow on rounds. In the team-based care model employed in the general medicine service, this step of the intervention both incentivized the interns to initiate the teaching interaction and disseminated the teaching to the rest of the team.