Using an Entrustable Professional Activity to Assess Consultation Requests Called on an Internal Medicine Teaching Service

INTRODUCTION: The Accreditation Council for Graduate Medical Education's milestones require internal medicine residents to have competency in calling consults. Based on a literature review, we developed an Entrustable Professional Activity (EPA) to delineate the knowledge, skills, and attitudes required for a consultation request and, building on the EPA, implemented an assessment instrument to provide feedback to interns calling consultation requests and assess the quality of their consult questions and the level of supervision required in performing this milestone. METHODS: Assessments were done on internal medicine inpatient teaching services. Consultation requests were performed by interns and observed by residents using the assessment instrument. Feedback was provided to the interns. Interns then completed a self-reflection instrument based on the feedback. RESULTS: Twenty-six paired observations were collected over three 1-month rotations. There was a moderate positive correlation (r = .43) comparing resident and intern responses to how they felt about the intern's ability to make a consultation request. There was a strong positive correlation (r = .65) comparing resident opinion of how strong the intern's ability in calling a consult to how well the consult question used the PICO (patient, intervention, comparators, outcomes of interest) framework. Twenty-five out of 28 interns (89%) said they would make a change during their next consultation request due to feedback from their resident. DISCUSSION: Our EPA-based assessment instrument provided an opportunity to give interns feedback and to assess the quality of the consultation requests they made.