Developing Expert Consensus for Specialist e-Consult Response: A Delphi Study to Inform Graduate Medical Education

Background To meet the demands of a growing number of specialty referrals, outpatient electronic consultations (e-consults) have emerged as an access strategy for specialist clinical input, yet no framework currently exists to standardize specialist response to e-consults. With the growing implementation of e-consult platforms throughout North America, it is essential to establish criteria for efficient, high-quality correspondence between specialists and primary care providers (PCP) and develop a formal e-consult curriculum to integrate into Accreditation Council for Graduate Medical Education (ACGME) subspecialty training programs. Methods We used a systematic, consensus-building methodology (modified Delphi) to develop expert recommendations for key elements of specialist response to e-consults. Panelists were purposefully chosen to balance clinical expertise, practice location, and setting. An initial synchronous meeting was held to create a set of items identified through comprehensive literature review using MEDLINE/PubMed, followed by two rounds of anonymous and iterative voting on the importance of each. Consensus was determined a priori as ≥ 80% of panelists agreeing that an item was essential. Results An expert group consisting of 14 clinicians (2 PCPs and 12 specialty providers: 7 hematology/oncology, 1 infectious diseases, 2 endocrinology, 1 gastroenterology, 1 cardiology) from across the U.S. and Canada was selected to form the Delphi panel. After two survey rounds, 8 essential items of specialist e-consult responses were identified and achieved consensus (≥ 80%). All final items that achieved consensus aligned with established ACGME core competencies. Conclusions An expert panel of PCP and medical specialists established consensus on a set of key components of effective specialist e-consult correspondence. These items highlight unique challenges in interprofessional communication and system-based practice that are specific to e-consults and emphasize the importance of formalized medical education curricula to build competence in providing e-consult services.