Making the Consult Interaction More Than a Transaction: Helping Fellows Be Better Teachers and Residents Be Better Learners

Winn, Ariel S.; Stafford, Diane; Miloslavsky, Eli M.; Grover, Amit S.; Boyer, Debra

doi:10.1016/j.jpeds.2019.04.003

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…This is important because providing education during the consultation process is often put off due to lack of time or understanding of education methods, and is voluntary. Consultation is a valuable opportunity for both fellows and residents [ 11 ]. Several studies have highlighted educational interventions that can improve the quality of resident consultation requests, such as CONSULT by Podolsky et al, [ 12 ] and the delivery of resident education by fellows [ 13 ]; yet, not many institutes have actively adopted these initiatives.…”

Section: Introductionmentioning

confidence: 99%

Essential consultants’ skills and attitudes (Willing CONSULT): a cross-sectional survey

et al. 2021

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Background Despite multi-professional collaboration via consultation being increasingly important given the variety of disease diagnoses and treatment, the key elements as consultants remain unclear. The study aimed to identify the skills and attitudes that are important for consultants from the residents’ perspective so that they can be targeted as priority goals in subsequent educational interventions. Methods We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and a main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke’s International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018 and current residents (2019–2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree). Cronbach’s alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed. Results The survey included 107 individuals (61.1 %, 175 potential participants). The median postgraduate years of education was four (interquartile range: 2–5), and 64.5 % were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters’ needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation’s urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records). Conclusions We propose Willing CONSULT, which are important skills and attitudes for consultants.

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Section: Introductionmentioning

confidence: 99%

Essential consultants’ skills and attitudes (Willing CONSULT): a cross-sectional survey

et al. 2021

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“…A potential reason for perceived pushback may stem from suboptimal communication skills, which impact our ability to clearly relay findings and recommendations to the primary team [ 12 ]. A consultant can prevent miscommunication by explicitly expressing willingness to help and immediately agreeing to the consult request [ 7 , 13 ]. The relationships we build during consults are critical for future collaborations between dermatologists and other fields and help ensure that the patients receive appropriate care.…”

Section: Introductionmentioning

confidence: 99%

Inpatient Dermatology Best Practice Strategies for Educating and Relaying Findings to Colleagues

2020

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Purpose of Review This review examines the role of education and relaying findings to non-dermatologist colleagues when performing inpatient dermatology consults. We highlight best practices for communication and education. Recent Findings Non-dermatologists receive minimal training on the diagnosis and the management of skin conditions. Efforts to teach dermatology in the inpatient setting via traditional didactics have been met with limited success, and hospitalists have indicated a desire to learn from specialists. Incorporating education into standard consultation practices including the note, one-on-one communication, and bedside rounds can efficiently improve teaching and patient care. Summary Our key principles of consultation emphasize communication, use of pre-existing components of a consultation to teach, and close follow-up. Inpatient dermatologists can implement these simple but effective measures to encourage education and communication with primary teams for both in-person and telehealth consults.

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“…The role of fellows as resident supervisors on inpatient subspecialty rotations is an example of a near-peer learning dynamic because fellows are “neither professional educators nor experts in a given field; they teach their peers or junior learners while they themselves continue to learn.” 3,4 Possible advantages of the near-peer learning dynamic include the increased comfort of learners in sharing areas of weakness and the ability of near-peer educators to detect learners who are having difficulty. 3 Although there has been significant focus on the fellow–resident interaction during subspecialty consultations, 5–9 a related but different near-peer learning dynamic, the same attention has not been paid to the role of fellow as resident supervisor on inpatient subspecialty rotations. Although fellows are expected to supervise residents, 2 they receive little training on how to be successful in this role, and unlike faculty 10 and senior residents, 11 for whom there is evidence to inform best supervisory practices, to our knowledge, no such data exist for fellows.…”

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confidence: 99%

Bridge Builders: A Qualitative Study of Fellows’ Successful Supervision of Residents

et al. 2022

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Purpose Clinical fellows, those training to become subspecialists in a program certified by the Accreditation Council for Graduate Medical Education, supervise residents on inpatient subspecialty rotations. Unlike for supervising residents or for faculty, there is a paucity of literature describing fellows’ supervision of residents. The aim of this study was to understand residents’ and fellows’ perception of successful supervision of residents by fellows on inpatient subspecialty rotations to inform the development of curricula to support fellows as supervisors. Method Using grounded theory methodology, the authors held focus groups in May 2020 of pediatric residents and pediatric subspecialty fellows at Boston Children’s Hospital, Boston, Massachusetts. Focus groups were conducted until thematic saturation was achieved. Deidentified transcripts were independently coded by 2 authors. The author team consolidated the codes into themes and developed an interpretive model for fellows’ successful supervision of residents. Key results were confirmed via member checking. Results The authors conducted 4 resident focus groups, composed of 16 pediatric residents, and 4 fellow focus groups, composed of 13 pediatric subspecialty fellows. Participants perceived that fellows who provided successful resident supervision advanced residents’ professional growth and supported residents’ development along 5 “bridges”: (1) generalist to subspecialist, (2) trainee to autonomous practitioner, (3) individual to member of the interprofessional team, (4) emerging physician to patient-facing care provider, and (5) newcomer to engaged clinical learner. Fellows can further residents’ growth in these areas by demonstrating approachability, empathy, appreciation, and kindness. Conclusions As newcomers on inpatient subspecialty rotations, residents engage in legitimate peripheral participation. Fellows who are successful supervisors move residents toward full participation in their profession via the bridge model. The fellow-resident dynamic carries advantages of near-peer learning. Fellows can harness their role, subspecialty knowledge, and familiarity with the training environment to enhance resident supervision.

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Making the Consult Interaction More Than a Transaction: Helping Fellows Be Better Teachers and Residents Be Better Learners

Cited by 4 publications

References 20 publications

Essential consultants’ skills and attitudes (Willing CONSULT): a cross-sectional survey

Essential consultants’ skills and attitudes (Willing CONSULT): a cross-sectional survey

Inpatient Dermatology Best Practice Strategies for Educating and Relaying Findings to Colleagues

Bridge Builders: A Qualitative Study of Fellows’ Successful Supervision of Residents

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