Abstract
Background and Objectives As resident physicians specialize, they lose familiarity with knowledge central to other fields. This can yield what we term the dual fallacies: (1) the sense that their own expertise is common knowledge, and (2) unfamiliar clinical situations seem beyond their scope. In graduate medical education, these dual fallacies may engender the perception of inappropriate consults among specialties. This project evaluated biases in residents' perceptions of expected knowledge and inappropriate consults to improve interdisciplinary education among neurology residents (neurologists) and internal medicine residents (internists). Secondarily, we evaluated whether these biases were mitigated after implementing an educational intervention.
Methods Resident neurologists and internists at a large, urban, academic medical center answered board-style questions reflecting neurology and medicine consultation scenarios. They then rated the extent to which each scenario reflected common knowledge to both specialties and whether a consult was warranted. After revising the internal medicine residency curriculum to include a neurology rotation, another cohort of residents was surveyed and participated in semistructured interviews. Paired sample t tests and qualitative data analysis were performed.
Results Neurologists and internists participated in phase 1 (n = 23) and phase 2 (n = 42) of the study. Residents from both fields answered more questions correctly from their own specialty than the other in phase 1 (p < 0.05) and phase 2 (p < 0.001). Neurologists and internists in both cohorts thought that each other should know more neurology answers than they actually did (p < 0.05). Neurologists were less likely to agree than internists that medicine questions deserved a consult (p = 0.014). Interviews revealed themes regarding perceived consult appropriateness, affected by educational, communication, clinical, and administrative factors. In addition, residents agreed that appropriate consults must pose a specific question and occur only after an initial investigation was performed, but that this rarely happens.
Discussion Our findings support that discordant expectations of expertise contribute to a perception of inappropriate consults among neurologists. Nonclinical factors, from cognitive biases to contextual considerations, inform clinical consultation and interdisciplinary patient care. Implementing rotations on other services alone is insufficient to eradicate discordant expectations; however, we propose additional interventions that may prove valuable in medical education.
Glossary
- EMR=
- electronic medical record;
- PGY=
- postgraduate year
Footnotes
Go to Neurology.org/NE for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Roy Strowd III, MD, MEd, MS.
- Received July 10, 2022.
- Accepted in final form November 29, 2022.
- © 2023 American Academy of Neurology
This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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