ABSTRACT
SETTING AND PARTICIPANTS: Three second-year internal medicine residents and primary care-based nurses providing telephone triage at a large, urban academic practice participated in a pilot program in which they were colocated in clinic once weekly for a half-day session over a 6-week period. This setting allowed for direct in-person communication between residents and nurses in real time to address clinical questions and concerns. DESCRIPTION: The ability to triage patient needs is an essential skill in ambulatory medicine. Telephone-based triage has become increasingly important as practices have experienced high volumes of patient calls during the ongoing COVID-19 pandemic and more limited access to care. Though triage is felt to be a critical skill, few internal medicine programs have formalized training in non-face-to-face triage, leading to residents' lack of confidence in their ability to triage outpatient needs and feeling inadequately prepared to engage in triage activities (Flannery et al, 1995). At our institution, primary care residents learn triage skills while participating in off-hour telephone call responsibilities. However, there is little formal training or evaluation of this experience. With aims to strengthen residents' triage skills, as well as foster enhanced interprofessional relationships and bidirectional learning opportunities between residents and other clinical staff, we piloted a program in which primary care residents participated in triage activities alongside experienced triage nurses. Residents offered just-in-time orders and answers to clinical questions, with the ability to engage an attending level physician if needed. EVALUATION: We collected anonymous baseline and post-intervention burnout surveys as well as weekly surveys from nurses and residents about their experiences and the impact of resident involvement in triage. We collected resident feedback on the experience and their confidence in triage skills preand post-experience, as well as triage nurse feedback on the impact of the pilot on interprofessional collaboration and communication with resident physicians. DISCUSSION / REFLECTION / LESSONS LEARNED: We identified the development of ambulatory medicine triage skills as an unmet need in resident medical education, and successfully piloted an intervention to improve resident skill in managing phone-based triage as well as promote interprofessional collaboration and bidirectional learning among residents and triage nurses. The intervention co-located primary care residents with nurses, allowing in-person communication about patient questions and needs as well as just-in-time answers to clinical questions. While further evaluation is ongoing, preliminary data demonstrates positive responses for both triage nurses and residents, who felt the experience was a valuable learning opportunity and benefitted patient care. We hope to gain information that will allow us to modify this pilot program and determine best approaches for teaching and evaluating triage skills in resident education.