Pilot Study Evaluating a Post Hospital Follow-Up Curriculum for Internal Medicine Interns

Abstract

Objective or purpose of innovation Successful hospital follow-up visits can prevent medication errors and mitigate readmissions. Medical education curricula typically focus on how transitions of care are forwarded to providers within an inpatient setting, or from inpatient to outpatient; however, there is little formal training among Internal Medicine (IM) residents in performing ambulatory hospital follow-up visits.

Innovation Design A novel curriculum was created whereby IM interns (PGY1) attended a one hour-long interactive lecture that was offered virtually and in-person. The interns observed patient scenarios that highlighted hospital follow-up tasks, which were then used to create a checklist for the learner to apply to their clinic patients.

Evaluation Plan: methods and measures Before and after attending the interactive lecture, the interns were asked to complete a pre-test (n=14) and post-test (n=12) regarding their knowledge and attitudes about hospital follow-up visits. PGY2&3 IM residents (n=26) were also asked to complete the pre-test, but were not asked to attend the interactive lecture. This was done to establish a baseline of clinical competence that might be expected in more experienced residents.

Outcomes Chi-square analysis revealed no significant differences between the pre-test and post-test results of the PGY1 interns. In comparison to the more senior residents (PGY2&3), the interns remained significantly less likely (p< 0.05) to be confident in their ability to conduct hospital follow-up visits; to identify ways that hospital follow-up visits can help them understand inpatient care and management strategies; to consider social determinants of health as barriers and as possible triggers for readmission; and to be confident identifying next steps in patient care management following hospital discharge.

Innovation’s strengths and limitations Our biggest limitation was the small sample size which may have obscured any impact of the intervention. There are ongoing efforts to replicate this intervention with larger sample size.