Best Practices for Balancing Inquiry and Efficiency on a Gastroenterology Consult Service: Outcomes of a Delphi Survey

Abstract

INTRODUCTION AND BACKGROUND: Gastroenterology fellowship training is a time of development where fellows cultivate new clinical and endoscopic. On busy consultation services, there are unique challenges that put intellectual curiosity, clinical efficiency, and timely delivery of patient care at odds. STUDY OBJECTIVE: We seek to develop a list of best practice advisories (BPAs) aimed at balancing efficiency and inquiry on the GI fellowship consult experiences at Indiana University. METHODS: A literature review of established models for clinical teaching in graduate medical education (GME) was conducted to formulate draft statements. Two rounds of modified Delphi survey cycles were conducted from October to December 2024. For our purposes, the “experts” working to reach consensus were the GI fellows and the faculty members on the clinical competency committee. In round one, experts rated draft statements as essential for, compatible with, or not important for balancing inquiry and efficiency. The minimum threshold of agreement was set at 70% and comments were used to revise or suggest new statements after round one. In round two, respondents were asked to re-rate statements, using the aggregate data from round one, as essential or not essential. RESULTS: 12 fellows and 10 faculty members participated. We identified eight statements that were essential to balancing clinical efficiency and inquiry. Our panels found that because each service had unique pressures, it was difficult to identify practices that could be recommended universally. CONCLUSION: A panel of expert GI fellows and faculty identified best practice statements that can be used to promote clinical efficiency, inquiry for learners on busy GI consult services at IU. The discussions around our proposed BPAs revealed interesting differences in our values and a better understanding of the role of faculty and fellows.