Implementing the iRAPPORT Model to Improve Communication and Teaching in Nephrology Consultations: A Pilot Study

Background: Effective communication during consultations is essential for patient care and trainee education. However, variability in consult delivery can lead to unclear consult questions, missed teaching, and inefficiencies. We aimed to implement a structured model to improve consult clarity, communication and teaching during inpatient consultations. Methods: Participants included Internal Medicine residents and Nephrology fellows at Hospital of the University of Pennsylvania in 2025.Verbal consults (in person or phone) were eligible. iRAPPORT was developed from literature review and informal needs assessment of house staff and faculty (figure 1). It was introduced at noon conference and displayed in housestaff workrooms. Post-intervention survey was distributed. The intervention lasted 1 month. Primary outcome was trainee perception of consult clarity and communication. Secondary outcome was perception of teaching points during consults. Results: Surveys were completed by 80% of fellows (n=4) and 20% of residents (n=7; 2 interns, 5 residents). Most agreed that iRAPPORT improved communication (73%), consult clarity (73%) and professionalism (73%). A majority (81%) planned to continue using it, and 73% found it feasible for daily use. While 75% of fellows reported increased teaching, only 28% of residents perceived increased teaching. Half of fellows and 57% of residents noted improved consult quality and initial workup. Residents valued the structure; fellows noted clearer questions and more complete workups. Barriers included interruptions, limited model awareness, and discomfort stating team roles. Conclusion: iRAPPORT was perceived as a useful tool to enhance consult clarity and communication. Its impact on teaching was mixed, possibly limited by workload. Limitations included short duration, single site, small sample, low survey response rate and no pre-survey or adherence data. Future steps include evaluating patient safety impact, broader implementation, teaching workshops and epic integrating.iRAPPORT model