Fellow Incentive Program
2010-11
Building on the success of the inaugural resident incentive program in 2009-10, the DOM submitted a proposal for the first fellow-specific incentive program in 2010-11. The goal of the program to engage DOM Clinical Fellows in a peer-reviewed assessment of initial inpatient consultation notes to promote practice-based learning improvement and high-quality consultative skills.
The learning objectives were:
- Describe the elements of a high quality consultation note
- Critically evaluate initial inpatient consult notes for these elements
- Identify specific opportunities to improve your inpatient consultation notes and practices
The program began with focus groups that brought together clinical fellows and residents to have each group describe elements of a "high quality" consultation. A Quality of Consult Assessment Tool (QCAT) was developed by Delphine Tuot, MD, MSc (Nephrology Fellow), working with Niraj Sehgal, MD, MPH and Andy Auerbach, MD, MPH (Division of Hospital Medicine). Given the importance of effective communication between primary teams and sub-specialty consultants, the QCAT measures core elements that all consult notes should contain, regardless of specialty, including:
Delphine Tuot presents the Fellow Incentive Program (PDF) at the Quality & Safety Symposium.
- Reason for Consult + Differential Diagnosis
- Diagnostic Plan
- Rationale for studies
- Thought process
- Therapeutic Plan
- Meds + dose, schedule, route
- Procedures
- Peri-procedural tasks
- Communication
- Documenting discussion
- Eliminating abbreviations
- Education
The tool underwent several rounds of pilot testing and improvements based on feedback from initial users. All clinical fellows participated in the program. The goal of the incentive program this year was improvement of 20% from the baseline QCAT scores.
For additional information on this program, please review the DOM QCAT Primer (PDF) that was developed for participating fellows.
The QCAT project was also presented at the Quality & Safety Symposium in poster format (PDF).
For additional information or questions, please contact:
Delphine Tuot, MDCM
Division of Nephrology
delphine.tuot@ucsf.edu
Niraj L. Sehgal, MD, MPH
Associate Professor of Clinical Medicine
Associate Chair for Quality & Safety
(415) 476-0723
nirajs@medicine.ucsf.edu