Understanding the Impact of Residents' Interpersonal Relationships During Emergency Department Referrals and Consultations

摘要

What was known Communicating with colleagues is an important element of physician practice.;What is new Familiarity and perceived trustworthiness of the referring and consulting residents are critical to the effectiveness of emergency department referrals and consultations.;Limitations The single modality of data collection and single-site setting limit generalizability.;Bottom line Understanding communication dynamics may help junior learners navigate difficulties encountered during the referral process between emergency and consulting physicians.;Editor's Note: The online version of this article contains the focus group questions and a comparison of the study's findings to Giffin's Model of Interpersonal Trust.;Introduction Both the Royal College of Physicians and Surgeons of Canada's CanMEDS framework and the Accreditation Council for Graduate Medical Education (ACGME) in the United States have identified the ability to communicate with colleagues as a key competency for all physicians.1,2 Few studies, however, have attempted to uncover factors that influence the interpersonal dynamics between the referring and consulting physicians,3,4 and these studies mostly focus on primary care referrals to specialists on a routine outpatient basis, not emergent consultations. The referral-consultation process is influenced by the relationships among the participants. Most research on relationships during physician consultations has focused on quantifying and identifying communication problems.3–10 Research has explored nonemergent consultations by family medicine physicians3,4 and the attitudes of consultants during telephone-only consults.5 In the research on urgent or emergent consultations,8–15 most studies sought to define and quantify the emergency department (ED) consultation process.8–13 With the advent of the ACGME core competencies and Milestone Project,16 the teaching and learning of interpersonal and teamwork skills are increasingly highlighted. To our knowledge this is the first study that has explored interpersonal factors that may influence resident communication during the referral-consultation process within the context of the ED. The findings may help to clarify the social dynamics around their interactions with other residents and attending physicians.;Results Our findings are a synthesis of the perceptions of residents from all 3 specialty groups (EM, GS, and IM). We identified 2 dimensions of interpersonal relationships that our participants believe influenced the referral-consultation process: familiarity and trust. table 1 shows example quotes that highlight the themes and subthemes described in this section. View larger version (50K) TABLE 1Exemplar Quotes for Themes and Subthemes;Discussion Interpersonal relationships can affect communication processes in all environments. Our findings reaffirm that interpersonal attributes such as trust affect ED consultations. Multiple researchers have suggested that trust is important during the referral-consultation process.4,6 One important model for understanding trust is Giffin's Model of Interpersonal Trust, which originates from the social science literatures and focuses mainly on business interactions.22 The 6 factors of Giffin's model are listed in table 1, along with analogous themes from our study.22 Notably, Giffin's model serves to theoretically triangulate our findings, as the model aligns very well with our own subthemes of trust. In the 1970s and 1980s , extensive work was done in social science fields around familiarity and trust17,23,24; however, recent work is mainly found in the business literature.25–28 Applications range from increased effectiveness with e-commerce to contractual choices.23,25–27 One of the main findings of our study was the link between familiarity and trust. In many ways, participants spoke of these 2 concepts concurrently. Multiple participants commented that being familiar with a colleague was almost synonymous with increased trust.