A prospective, randomized, controlled study demonstrating a novel, effective model of transfer of care between physicians: the 5 Cs of consultation

Acad Emerg Med. 2012 Aug;19(8):968-74. doi: 10.1111/j.1553-2712.2012.01412.x.


Objectives: The objective was to evaluate whether a standardized consultation model in the emergency department (ED), the 5 Cs of Consultation (Contact, Communicate, Core Question, Collaboration, and Closing the Loop), would improve physicians' ability to relay appropriate information and communicate successfully during a consultation.

Methods: This was a prospective, randomized study at a large, academic, urban, tertiary care medical center in Chicago. Forty-three emergency medicine (EM) and EM/internal medicine (EM/IM) residents were randomized into two groups, an intervention group and an unstructured group, stratified by postgraduate year (PGY). Intervention group participants received an interactive educational session on the 5 Cs of Consultation, a standardized consultation model. Intervention and unstructured groups placed two simulated consultation phone calls, based on pretested simulated patient cases, to a standardized consultant. Three raters, naive to the consultation model and blinded to group assignments, individually assessed recordings of each call using a seven-item, five-point global rating scale (GRS). Finally, an attending surgeon and an attending psychiatrist each rated respective cases using a single global rating to provide validity evidence for the scale.

Results: Residents trained with the 5 Cs model communicated significantly better, regardless of PGY and clinical case. The intervention group had significantly higher mean GRS scores than the unstructured group (4.1 vs. 3.5, F(1,39) = 33.5, p < 0.0001). Secondary analysis of the recordings suggested that encounters with more 5 Cs behaviors tended to receive higher GRS scores.

Conclusions: A standardized educational model increased the effectiveness of consultation communication from the ED. Residents trained with the 5 Cs of Consultation scored better on consultation assessments compared with untrained residents. Training programs should consider adopting standardized consultation models.

Trial registration: ClinicalTrials.gov NCT01316172.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Academic Medical Centers
  • Clinical Competence*
  • Continuity of Patient Care*
  • Emergency Medicine / education*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Internship and Residency
  • Male
  • Models, Educational
  • Patient Transfer
  • Prospective Studies
  • Referral and Consultation

Associated data

  • ClinicalTrials.gov/NCT01316172